Alexander Bischoff

Health and ill health of asylum seekers in Switzerland : an epidemiological study

BACKGROUND Although the focus of health care for people seeking asylum in Western European countries is usually on communicable diseases, there is little data about the general health care need of this population. In this study, we investigated the actual burden of disease among asylum seekers. METHODS Data were collected from a Swiss Health Maintenance Organisation (HMO; a type of managed care organization in which physicians act as gate keepers) that was set up specifically to provide health care for asylum seekers. The data included socio-demographic characteristics, international classification of diseases (ICD-10) diagnoses and number of clinic visits. Descriptive statistics were used to assess the types of health problems and the number of clinic visits. Logistic regression analysis was used to determine whether age, gender or country or region of origin was predictive in terms of incidence of disease as diagnosed by using ICD classifications. RESULTS The total number of asylum seekers (mean age 22 years; 38% women) enrolled in the HMO from 2000 through 2003 was 979. Half of this group came from the former country of Yugoslavia. The remainder came primarily from sub-Saharan Africa, Turkey, Iraq and Sri Lanka. The most common health problems encountered in the population included musculoskeletal diseases, respiratory diseases, depression and post-traumatic stress disorder. The prevalence of all disease clusters was significantly associated with age. One-fifth of the population did not request health care at all during the time they were enrolled in the HMO. It is not known whether those who did not visit the medical clinic did not require health care or just chose not to request clinic services. CONCLUSIONS The most frequent health problems encountered in the study population were chronic medical conditions, not communicable acute diseases. Although health care services provided to asylum seekers usually focus on episodic acute care, what this group actually needs is continuity of care.

Chronic Disease Management in Sub-Saharan Africa: Whose Business Is It?

Public health specialists and clinicians alike agree that Humanity faces a global pandemic of chronic diseases in the 21st century. In this article we discuss the implications of this pandemic on another global issue, the health workforce. Because both issues are particularly acute in Sub-Saharan Africa (SSA), we will focus on this region and use Cameroon as a case in point. We first gauge the epidemic of chronic conditions in SSA. We then discuss the implications of chronic conditions for the reshaping of health systems and the health workforce. We conclude by making a strong case for the building up and strengthening the health workforce, insisting on the crucial role of nurses, their training, and involvement in chronic disease management.

The self-reported health of immigrant groups in Switzerland.

Background: More than 20% of people living in Switzerland are immigrants, defined as people with foreign nationality. This study examines health disparities between the main immigrant groups in Switzerland and the majority Swiss population. Methods: Epidemiological analysis of the 2002 Swiss Health Survey (SHS): the SHS contains health-related information about 19,706 people who were randomly sampled from among people living in Switzerland. Bi-variate and multivariate analyses of six variables on self-reported health were performed. Findings: The data from the 2002 Swiss Health Survey provide some evidence of health disparities between Swiss people and immigrants. Although the self-reported health of “Northern immigrants” (people from Germany and France) does not differ significantly from that of the majority Swiss population, “Southern immigrants” (people from Italy, Former Yugoslavia, Portugal, Spain and Turkey) report lower levels of health in several areas. Lower levels of health are particularly likely to be reported by Italian men and women. Conclusion: The self-reported health of immigrants is currently inferior to that of the Swiss. If it is the position of the Swiss health care system to ensure equal health provision for all Swiss residents, including immigrant groups, and to strive for equal health outcomes for all, self-reported ill health among immigrants is a useful basis for health policy and planning.

Self-reported cardiovascular risk factors in immigrants and Swiss nationals

OBJECTIVE The purpose of this study was to investigate whether the prevalence of self-reported cardiovascular risk factors differs between immigrants and Swiss nationals. DESIGN AND SAMPLE This study is a secondary data analysis of the Swiss Health Survey 2002, a cross-sectional survey. In total, 19,249 individuals living in Switzerland were included. MEASURES The prevalence of hypertension, high cholesterol level, smoking, diabetes, overweight, low fruit and vegetable intake, and physical inactivity were calculated for major immigrant groups and Swiss nationals. Demographic data were used to control for age and socioeconomic status. RESULTS Major immigrant groups were people from Italy, Germany, former Yugoslavia, Spain, Portugal, France, and Turkey. Compared with Swiss women, women from former Yugoslavia were more likely to have hypertension, and women from Germany were more likely to have high cholesterol levels. Women from Italy, former Yugoslavia, Spain, Portugal, and Turkey were more likely to show physical inactivity and (except Turkish women) to be overweight. Men from these countries (except Spanish men) were more likely to be overweight than Swiss men. CONCLUSIONS Differences exist in the prevalence of modifiable cardiovascular risk factors between Swiss nationals and many of the immigrant groups. Age and socioeconomic status could only partly explain the differences.