Beatriz Padilla

Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal

Although Portugal has been deeply affected by the global financial crisis, the impact of the recession and subsequent austerity on health and to health care has attracted relatively little attention. We used several sources of data including the European Union Statistics for Income and Living Conditions (EU-SILC) which tracks unmet medical need during the recession and before and after the Troikas austerity package. Our results show that the odds of respondents reporting having an unmet medical need more than doubled between 2010 and 2012 (OR=2.41, 95% CI 2.01-2.89), with the greatest impact on those in employment, followed by the unemployed, retired, and other economically inactive groups. The reasons for not seeking care involved a combination of factors, with a 68% higher odds of citing financial barriers (OR=1.68, 95% CI 1.32-2.12), more than twice the odds of citing waiting times and inability to take time off work or family responsibilities (OR 2.18, 95% CI 1.20-3.98), and a large increase of reporting delaying care in the hope that the problem would resolve on its own (OR=13.98, 95% CI 6.51-30.02). Individual-level studies from Portugal also suggest that co-payments at primary and hospital level are having a negative effect on the most vulnerable living in disadvantaged areas, and that health care professionals have concerns about the impact of recession and subsequent austerity measures on the quality of care provided. The Portuguese government no longer needs external assistance, but these findings suggest that measures are now needed to mitigate the damage incurred by the crisis and austerity.

Fluxos migratórios em Portugal: do boom migratório à desaceleração no contexto de crise. Balanços e desafios

Migration has been an increasingly present phenomenon in the Portuguese society, both with regard to immigration and to emigration. This article presents a brief overview of this recent history, describing not only the flows and their main features but also the European and national context, with a special connection to legislative changes, in which the migration flows are developed. The article highlights how Portugal has suffered an unprecedented migration boom, which is influenced by the current crisis, leading not only to a decline in immigration, but also to a revival of the emigration phenomenon.

Understanding healthcare practices in superdiverse neighbourhoods and developing the concept of welfare bricolage: Protocol of a cross-national mixed-methods study

BackgroundDiversity in Europe has both increased and become more complex posing challenges to both national and local welfare state regimes. Evidence indicates specific barriers for migrant, faith and minority ethnic groups when accessing healthcare. However, previous studies of health in diverse cities in European countries have mainly adopted an ethno-national focus. Taking into account the new complexity of diversity within cities, a deeper and multi-faceted understanding of everyday health practices in superdiverse contexts is needed to support appropriate healthcare provision.Methods/DesignThis protocol describes a mixed method study investigating how residents in superdiverse neighbourhoods access healthcare. The study will include participant observation and qualitative interviewing as well as a standardised health survey and will be carried out in eight superdiverse neighbourhoods – with varying deprivations levels and trajectories of change – in four European countries (Germany, Portugal, Sweden and UK). In each neighbourhood, trained polylingual community researchers together with university researchers will map formal and informal provision and infrastructures supportive to health and healthcare. In-depth interviews with residents and healthcare providers in each country will investigate local health-supportive practices. Thematic analysis will be used to identify different types of help-seeking behaviours and support structures across neighbourhoods and countries. Using categories identified from analyses of interview material, a health survey will be set up investigating determinants of access to healthcare. Complex models, such as structural equation modelling, will be applied to analyse commonalities and differences between population groups, neighbourhoods and countries.DiscussionThis study offers the potential to contribute to a deeper understanding of how residents in superdiverse neighbourhoods deal with health and healthcare in everyday practices. The findings will inform governmental authorities, formal and informal healthcare providers how to further refine health services and how to achieve equitable access in diverse population groups.

Cidadania e diversidade em saúde: necessidades e estratégias de promoção de equidade nos cuidados

Since 2004, formaldehyde (FA) has been classified by the International Agency for Cancer Research as a carcinogen. The FA ranks 25th in the overall United States chemical production, with more than 5 million tons produced each year. Due to its economic importance and varied use, many individuals are exposed to FA at their occupational settings. This study aimed to assess the exposure to FA in two occupational settings – FA production factory and pathology anatomy (PA) laboratories – and relate it to possible health effects by comparing frequency of micronuclei (MN) in peripheral bloodIntroducao: As desigualdades em saude sao reconhecidamente um problema de saude publica. A relacao entre determinantes sociais e as desigualdades em saude sao um achado robusto. Enquanto nos adultos e claro que estas desigualdades socioeconomicas se manifestam no seu estado de saude, a situacao e menos clara nas criancas e adolescentes. Foi entao efetuada uma revisao da literatura sobre a influencia dos determinantes sociais na saude na idade pediatrica. De forma a contribuir para um melhor conhecimento sobre a materia. Metodologia: A pesquisa foi efetuada segundo as normas PRISMA, com base nos termos MeSH: Social Class, Pediatric, Hospital, Emergency Treatment, Socioeconomic factor e Healthcare Disparities, na PubMed, Scielo e nas bases de dados da Cochrane. Foram excluidos artigos de revisao, opiniao bem como artigos que tratavam de questoes de acesso aos cuidados. Foi efetuada uma descricao quantitativa e qualitativa dos resultados. Resultados: Foram selecionadas 17 publicacoes, exceto uma do tipo descritiva, todas referentes a estudos observacionais analiticos, a maioria usando dados retrospetivos. Encontrou-se forte evidencia na relacao entre desigualdades em saude e os fatores socio economicos na idade pediatrica. Conclusao: Apesar de nenhuma das publicacoes selecionadas apresentar dados colhidos em Portugal, e seguro afirmar que e possivel encontrar a mesma relacao na idade pediatrica. E importante estudar mais esta area, identificar os determinantes sociais mais importantes bem como as populacoes mais vulneraveis, para melhor poder planear os cuidados de saude e combater as desigualdades. Palavras-Chave: Desigualdades em Saude, Determinantes Sociais da Saude, Fatores Socio-economicos, Pediatria

Portuguese policies fostering international student mobility: a colonial legacy or a new strategy?

ABSTRACT This paper explores policies on international student mobility to Portugal from within the Lusophone space, analyzing the cases of Angola, Cape Verde and Brazil. We argue that Portuguese strategies to attract international students respond to different demands and interests embedded in its geopolitical memberships. One the one hand, they respond to pressure from the European Commission to increase the internationalisation level within the European Higher Education Area. On the other hand, they are embedded within Portugal’s desire to continue its influence over the former colonies. We analyze available statistical data and policy documents on Angolan, Cape Verdean and Brazilian students in Portugal, using insights from postcolonial theoretical frameworks. Our results suggest that Portuguese policies on international student mobility, even if discontinuous over time, still aim at maintaining a leading role among the Portuguese-speaking countries, through practices rooted in neocolonial logics. However, Portugal’s membership of the European Union propels the need to adapt to wider political forces through contextual and opportunistic strategies as well.

Migraciones y cambios : trayectorias, identidades y transformaciones de inmigrantes brasileños en Portugal

Este trabajo aborda la tematica de la migracion y sus efectos transformadores en las esferas individual, social e identitaria, segun es sufrida por los/las inmigrantes, mostrando como modelan los procesos de adaptacion e integracion en el pais de destino. Estos cambios y transformaciones son ejemplificados recurriendo a narrativas de inmigrantes brasilenos residentes en Portugal. Diferenciamos los cambios que experimentan en tres grandes categorias: a) los que ocurren a nivel personal, en las formas de socializar y de sentir, b) los que se relacionan con el tipo de empleo y experiencia laboral, y c) los que suceden en las identidades. Dentro de los cambios identitarios se destacan la identidad nacional, que adquiere gran relevancia, asi como la identidad de genero que en Portugal deriva en estigmatizacion. Palabras clave: Brasilenos; Brasilenas; Cambios; Percepcion del inmigrante; Identidades; Portugal.

Universalism, diversity and norms: gratitude, healthcare and welfare chauvinism

ABSTRACT Access to universal healthcare is a normative expectation of citizens in European welfare states. As part of a comparative study of healthcare in diverse European neighbourhoods, we met women who described failures of the public healthcare system, together with gratitude for that system. Challenges to European welfare states of ageing populations, the retraction of resources available for healthcare, and globalised migration streams have been linked to xenophobic ‘welfarist’ attempts to restrict access to services for new arrivals and those seen as failing to contribute sufficiently. Stories of healthcare systems’ failure to treat symptoms, pain, and suffering in a timely and caring fashion came from eight women of non-European migrant backgrounds as part of a wider interview study in four European cities (Birmingham, Uppsala, Lisbon, Bremen). These accounts suggest that a normative aspect of welfare provision has been reproduced – that is, the expression of gratitude – despite inadequate services. Where welfarist attitudes to migration meet normative aspects of healthcare, suffering may be compounded by an expectation of gratitude. The regrettable unmet healthcare need of the eight women whose cases are presented suggests that other marginalised healthcare users may also be under-served in apparently universal healthcare systems.

Reflecting on international academic mobility through feminist lenses: moving beyond the obvious

Academic mobility has always been a reality in academia, however nowadays it has gained new meanings and features. On the one hand, it brings benefits such as knowledge circulation, international network promotion, and reduction in experimental costs. On the other hand however, it reproduces old social hierarchies and power asymmetries. Gender is on important marker of difference that shape academic mobility experiences unevenly, therefore women face more obstacles than men to develop their academic career. This paper analyses academic mobility through a feminist perspective aiming to reinforce the importance of taking gender differences in account in this dynamics.

Construção das identidades de jovens de origem imigrante em Europa: resultados dum projeto europeu

Este artigo descreve e analisa alguns dos elementos que influenciam a construcao das identidades dos jovens de origem imigrante na Europa. Os resultados derivam dum projeto de investigacao europeu intitulado “Rumo a construcao social duma juventude europeia: a experiencia de inclusao e exclusao na esfera publica dos jovens migrantes de segunda geracao” 1 , desenvolvido entre 2006 e 2009 em nove cidades localizadas em cinco paises: Espanha (Madrid e Barcelona), Italia (Genova e Roma), Portugal (Lisboa e Porto), Franca (Metz), Alemanha (Berlim) e Holanda (Utrecht). A primeira parte analisa os dados quantitativos recolhidos nos contextos de estudo, comparando os jovens descendentes de imigrantes com os jovens autoctones, focando a questao da identidade como um assunto central no processo de inclusao dos jovens imigrantes. A segunda parte aborda alguns dos marcadores identitarios presentes nos jovens descendentes de imigrantes em Portugal, a luz de dados etnograficos recolhidos especificamente para o caso dos jovens na Area Metropolitana de Lisboa focando as questoes de identidade, genero e discriminacao. Palavras chave: origem imigrante, descendentes de imigrantes, jovens, identidades, Portugal, Europa.