Signe Smith Jervelund

Morbidity, Self-Perceived Health and Mortality Among non-Western Immigrants and Their Descendants in Denmark in a Life Phase Perspective

To enable preventive policies to address health inequity across ethnic groups, this review overviews the current knowledge on morbidity, self-perceived health and mortality among non-Western immigrants and their descendants in Denmark. A systematic search in PUBMED, SCOPUS, Embase and Cochrane as well as in national databases was undertaken. The final number of publications included was 45. Adult immigrants had higher morbidity, but lower mortality compared to ethnic Danes. Immigrant children had higher mortality and morbidity compared to ethnic Danes. Immigrants’ health is critical to reach the political goals of integration. Despite non-Western immigrants’ higher morbidity than ethnic Danes, no national strategy targeting immigrants’ health has been implemented. Future research should include elderly immigrants and children, preferably employing a life-course perspective to enhance understanding of parallel processes of societal adaptation and health.

Loneliness, immigration background and self-identified ethnicity: a nationally representative study of adolescents in Denmark

ABSTRACT Migration is an increasing worldwide phenomenon that creates multicultural societies with a growing number of adolescents who have experienced a process of migration or who have an ethnic background other than that of the majority. Migration may lead to loss of social relations and create challenges related to acculturation in the new country. These experiences may induce feelings of loneliness. Research on ethnic and migrant disparities in loneliness among adolescents is limited and inconsistent. The purpose of this study was to examine how adolescents’ immigration background and self-identified ethnicity are associated, independently and combined, with loneliness. We used data from the Danish 2010 Health Behaviour in School-aged Children survey which included a representative sample of 3083 13- and 15-year-olds. The results suggest that immigrants but not descendants of immigrants have an increased risk of loneliness compared to adolescents with a Danish origin. The results also suggest that adolescents’ self-identified ethnicity plays an essential role but differently for immigrants and descendants: identifying with the Danish majority was protective against loneliness among immigrants, whereas identifying with an ethnic minority group was protective against loneliness among descendants.

Ignorance is not bliss: The effect of systematic information on immigrants’ knowledge of and satisfaction with the Danish healthcare system:

Aims: Suboptimal healthcare utilisation and lower satisfaction with the patient–doctor encounter among immigrants has been documented. Immigrants’ lack of familiarity with the healthcare system has been proposed as an explanation for this. This study investigated whether a systematic delivery of information affected immigrants’ knowledge of and satisfaction with the Danish healthcare system. Methods: A prospective, randomised intervention study of 1158 adult immigrants attending two language schools in Copenhagen was conducted. Two intervention groups received written information or a 12-hour course on the Danish healthcare system, while a control group received nothing. Survey data included self-assessed knowledge, true/false questions on access and questions relating to satisfaction with the healthcare system. Data were linked to socioeconomic registry data. Logistic regression analyses were performed. Results: The course improved knowledge of who to contact in the event of an accident (odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.56–4.59) but not in the event of illness. Further, it positively affected correct answers for nine out of 11 questions on the healthcare system (varying from OR = 1.87, 95% CI = 1.08–3.24 to OR = 3.11, 95% CI = 1.58–6.11). Written information positively affected correct answers for three out of 11 questions, but negatively affected one out of 11 compared with the control group. Neither intervention affected immigrants’ satisfaction with the healthcare system. Conclusions : Knowledge of the healthcare system is necessary for optimal healthcare-seeking behaviour. The results may form the basis of national and international changes in immigrant reception and optimise immigrants’ contact with the healthcare system.

Healthcare system information at language schools for newly arrived immigrants: A pertinent setting in times of austerity

Objective: In most European countries, immigrants do not systematically learn about the host countries’ healthcare system when arriving. This study investigated how newly arrived immigrants perceived the information they received about the Danish healthcare system. Methods: Immigrants attending a language school in Copenhagen in 2012 received either a course or written information on the Danish healthcare system and subsequently evaluated this quantitatively. Results: The evaluation revealed a positive appraisal of the course/information provided. Conclusion: In times of austerity, incorporating healthcare information into an already existing language programme may be pertinent for providing immigrants with knowledge on the healthcare system.

Recruitment of ethnic minorities for public health research: An interpretive synthesis of experiences from six interlinked Danish studies:

Aims: This paper examines the importance of recruitment site in relation to the recruitment of ethnic minorities into health research. It presents a synthesis of experiences drawn from six interlinked Danish studies which applied different methods and used healthcare facilities and educational settings as sites for recruitment. Methods: Inspired by interpretive reviewing, data on recruitment methods from the different studies were synthesized with a focus on the various levels of recruitment success achieved. This involved an iterative process of comparison, analysis and discussion of experiences among the researchers involved. Results: Success in recruitment seemed to depend partly on recruitment site. Using healthcare facilities as the recruitment site and healthcare professionals as gatekeepers was less efficient than using schools and employees from educational institutions. Successful study designs also depended on the possibility of singling out specific locations with a high proportion of the relevant ethnic minority target population. Conclusions: The findings, though based on a small number of cases, indicate that health professionals and healthcare institutions, despite their interest in high-quality health research into all population groups, fail to facilitate research access to some of the most disadvantaged groups, who need to be included in order to understand the mechanisms behind health disparities. This happens despite the genuine wish of many healthcare professionals to help facilitate such research. In this way, the findings indirectly emphasize the specific challenge of accessing more vulnerable and sick groups in research studies.

Cultural competence in medical education: A questionnaire study of Danish medical teachers’ perceptions of and preparedness to teach cultural competence

Aims: The cultural competence training of healthcare professionals is a key element in ensuring the quality of both the access and delivery of healthcare to increasingly ethnically diverse populations. The aim of this study is to investigate Danish medical teachers’ opinions about cultural competence, their willingness to receive training and preparedness to teach cultural competence topics. Methods: The survey was sent to medical teachers, clinical teachers and external lecturers who teach in the medical programme at the University of Copenhagen. A total of 1400 medical teachers received the survey, and 199 responded. The response rate is 14%. Data were analysed through descriptive calculations, and answers to open-ended questions were coded using content analysis. Results: Results showed that 82.4% of the informants agreed or strongly agreed that the medical education programme should include training on cultural issues, and 60.3% agreed or strongly agreed that students should be assessed on their cultural competence skills. Regarding preparedness to teach a diverse classroom, 88.4% felt somewhat or very prepared to engage and motivate all students. About 70% were interested in receiving training on cultural competence. Conclusions: Generally, there is interest in and acknowledgement of the importance of cultural competence in Danish medical education among teachers at the University of Copenhagen. This creates an opportunity to implement cultural competence in the medical curriculum, training of teachers and strengthening the diversity sensitivity of the organisation. However, support for this programme by management and the allocation of an appropriate level of resources is a prerequisite to the success of the programme.

): Challenged assumptions and invisible effects: an explorative case study of a health education intervention addressing immigrants.

Purpose The purpose of this paper is to examine any unanticipated effects of an educational intervention among newly arrived adult immigrants attending a language school in Denmark. Design/methodology/approach A qualitative case study was conducted including interviews with nine informants, observations of two complete intervention courses and an analysis of the official intervention documents. Findings This case study exemplifies how the basic normative assumptions behind an immigrant-oriented intervention and the intrinsic power relations therein may be challenged and negotiated by the participants. In particular, the assumed (power) relations inherent in immigrant-oriented educational health interventions, in which immigrants are in a novice position, are challenged, as the immigrants are experienced adults (and parents) in regard to healthcare. The paper proposes that such unexpected conditions for the implementation – different from the assumed conditions – not only challenge the implementation of the intervention but also potentially produce unanticipated yet valuable effects. Research limitations/implications Newly arrived immigrants represent a hugely diverse and heterogeneous group of people with differing values and belief systems regarding health and healthcare. A more detailed study is necessary to fully understand their health seeking behaviours in the Danish context. Originality/value Offering newly arrived immigrants a course on health and the healthcare system as part of the mandatory language courses is a new and underexplored means of providing and improving newly arrived immigrants knowledge and use of the Danish healthcare system.

How social media is transforming the spreading of knowledge: Implications for our perceptions concerning vaccinations and migrant health:

With the exception of clean water, nothing else, not even antibiotics, has had such a significant effect on reduced mortality as vaccines [1]. Therefore, childhood vaccination programmes have been established in the vast majority of countries; their aim is to protect children against various potentially life-threatening diseases [1]. If the national coverage of the childhood vaccination programme is sufficiently high, the programme also indirectly covers individuals in the population who are at risk of the infections, but who themselves were not able to be immunised (for instance due to medical reasons), the so-called herd immunity [2]. Currently, immunisation averts an estimated 2–3 million deaths every year [3]. Despite this successful public health story, during the last decade, Europe and the USA have experienced a rapid increase in some reoccurring communicable diseases, such as measles and rubella, due to a declining vaccine uptake [4,5]. The (in-)famous fraudulent research article from 1998 by Andrew Wakefield who claimed an association between the reception of the measles, mumps and rubella (MMR) vaccine and autism and bowel disease fuelled the Western decline in MMR vaccine uptake [6]. Likewise, Denmark experienced an epidemic increase in reported adverse events of the Human Papilloma Virus (HPV) vaccine in 2015. This was followed by extensive media coverage and negative debates that led to a subsequent drastic decline in the uptake of the HPV vaccination programme [7,8]. These adverse events related to the HPV vaccine were were rejected by scientific evidence from international studies [7,9], yet, the knowledge, attitudes and behaviours relating to the uptake of the HPV vaccine programme in Denmark still suffer from the past controversy, [8] while the uptake in the other Nordic countries remains stable and high [10,11]. In this issue of the Scandinavian Journal of Public Health, Francia Fausto and her colleagues’ study demonstrates that excess mortality among the elderly in Bologna, Italy, in 2015 appeared to be caused by decreased influenza immunisation coverage rates, among other factors. Likewise, albeit in Singapore, Li Wei Ang and colleagues showed that adults aged ≥ 50 years had a very low uptake of seasonal influenza and pneumococcal vaccination, despite national recommendations for such uptake among the elderly (≥ 65 years) and persons with chronic medical conditions. It was shown that among this population group, higher levels of education, higher household incomes, better self-rated health and having a general practitioner were associated with vaccine uptake. Therefore, these studies show that the lack of immunisation is not only a concern for children, but for other vulnerable groups in society, such as the elderly and adults in poorer health and socioeconomic conditions. While such examples of deceitful health messages and low uptake of vaccines among population groups complicates the tasks of the international and national health authorities, it also creates new ethical considerations, which Jessica Nihlèn Fahlquist’s study sheds light on in this issue. In this paper, ethical aspects of policy and risk communication in the context of the H1N1 vaccine Pandemrix in Sweden is discussed. Fahlquist argues that health authorities should communicate health messages respectfully; this includes meeting the concerns of the vaccine sceptics with due respect. Further, Fahlquist addresses the How social media is transforming the spreading of knowledge: Implications for our perceptions concerning vaccinations and migrant health

Ethnic inequalities in child and adolescent health in the Scandinavian welfare states: The role of parental socioeconomic status – a systematic review:

Aims: Adult non-Western immigrants in Scandinavia tend to be worse off in terms of health than native-born populations, which cannot be fully ascribed to their often lower socioeconomic status (SES). This review examines if differences in health status are also present between non-Western immigrant and majority children in Denmark, Norway and Sweden, and if SES explains the differences. Methods: Following PRISMA guidelines, relevant Scandinavian peer-reviewed quantitative publications since 1990 were identified through a systematic search of PubMed, EMBASE, Scopus, Web of Science and SveMed. Of 1197 identified publications, 27 remained relevant after applying inclusion criteria: 3 Danish, 6 Norwegian and 18 Swedish studies. Results: Non-western immigrant children had overall poorer outcomes compared with ethnic majority children in Denmark, Norway and Sweden in health issues covered by the included studies: diabetes, obesity, oral and mental health, and well-being. However, in diabetes, obesity and mental health, non-Western immigrant children from certain countries and regions, and descendants of non-Western immigrants had similar/more favourable outcomes than majority children. In mental health and well-being, ethnic inequalities were strongly associated with SES, while for diabetes, obesity and oral health, differences remained significant after adjusting for SES. Conclusions: Overall poorer health outcomes in non-Western immigrant compared with majority children in Scandinavia cannot be fully explained by SES. Evidence points to additional mechanisms at individual, household, societal or policy levels, including reasons for migration, culture and societal discrimination. Finally, methodological issues may influence study outcomes, e.g. heterogeneity of populations studied and socioeconomic variables included.

Diminishing social inequality between refugee children and their peers growing up in Denmark

ABSTRACT Not being in employment, education or training (NEET) as a youth consistently predicts adverse educational, labour market and health outcomes. School-aged refugee children are known to be particularly vulnerable within each of these domains. Yet little is known about how these outcomes have evolved over time. This study explores trends in the risk of youth NEET status during the early twenties for refugees and their non-refugee peers in Denmark from 1995 to 2014 by utilising national registry data on demographics, income, education and diagnoses covering the full population. The analysis shows that the inequality in the probability of youth NEET status has diminished considerably from up to 20 percentage points among the oldest cohorts to less than 5 percentage points among the youngest. This development was robust to compositional differences, although much more so for girls than boys. For refugee girls, the change in the probability of youth NEET status coincided with changes in timing of family formation, but was not explained by it. In addition, the correlation between family formation and youth NEET status became considerably weaker over time. The findings suggest that some circumstances surrounding the incorporation of refugee school children into their new social contexts have improved.