Access to health services of undocumented migrants and xenophobic attitudes in EU countries

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1 health services of undocumented migrants and xenophobic attitudes in EU countries Aldo Rosano & Amedeo Spagnolo Contact person Aldo Rosano: Background No one would dream of calling minority people with red hair or left-handed, because a minority is only thought as a minority when it constitutes some kind of a threat to the majority (Isherwood, 1964). Fear of minority and ethnic groups is expressed at political level by more or less explicit xenophobic and racist political parties. Immigration issues are indeed strongly connected to party identification (Demker, 2007). In Europe, in recent years the rise of consensus in these kinds of political parties has been growing. The most recent cases concern the elections held in 2010 in Austria and Sweden, where the openly xenophobic parties, the Austrian Freiheitliche Partei Österreichs and Swedish Sverigedemokraterna obtained respectively 27% of votes in municipal elections in Austria and 5.7% in the political general elections. The slogans of these parties were in favor of "national values against Islamization and multicultural society", the latter considered serious threats to national culture. The economic crisis has increased the popularity of the nationalist organizations that breed resentment against minorities (MRGI, 2011). This trend is clearly visible looking at the results of 2009 European elections, when parties with more or less openly xenophobic programs obtained over 10% of votes in Italy, the Netherlands, Belgium, Denmark, Hungary, Austria, and Bulgaria, while in Finland, Romania, Greece, France, United Kingdom, and Slovakia the percentages are still growing and show a range between 5 and 10%. Ideological orientation is often stronger than education in explaining attitudes toward receiving refugees. Political xenophobic attitudes may strongly influence debated issues such as full access to of undocumented migrants (UM). The right to life and the prohibition of inhuman treatment stated under the European Convention on Human Rights (ECHR), and previously already stated by the Article 12 of the 1966 United Nations (UN) International Covenant on Economic, Social and Cultural Rights (ICESCR), which has been ratified by all 27 EU Member States, imply the need to provide assistance in

2 emergencies. Accordingly, emergency care is guaranteed to UM in every EU Member States. Even if the ICESCR highlighted that States are under the obligation to respect the right to health by, inter alia, refraining from denying or limiting equal access for all persons, including illegal immigrants, to preventive, curative and palliative health services, the European human rights provisions allow some differentiation in the provision of between documented and undocumented migrants. The provision on the right to social and medical assistance of the European Social Chart is limited to lawfully resident foreigners. As a result, the only safeguard on access to which is enforceable for migrants with irregular status that is binding for all EU Member States remains the State obligation to provide emergency health assistance. The access to free of charge for infants, to medicines, to mental or primary care is hence differently regulated among EU countries. The Institute for Social Affairs (IAS), within the activity of the national observatory on migration, supported the present study aiming at analyzing the correlation between the cultural and political attitudes toward immigration issues and the level of access to by UM in EU countries. Data source Information on access of UM to health services were drawn from the European Union Agency for Fundamental Rights Report (2011) and from the OECD report (2007). Information was available for 11 EU countries. Votes and figures of xenophobic parties obtained at national elections were drawn through a Wikipedia search and then checked through institutional sites. Methods We built an indicator of access of UM to health services using information on different aspects, with level of access classified with a score from 1 (low access) to 3 (high access): access to by law (1=only access to emergency care, with payment components, 2=access beyond emergency care, free of charge ); access to medicine for adults (1=cost of medicines generally borne by the migrant, 2=costs of medicines partially or fully covered); cost-free entitlements for migrant children (1=emergency care only, 2=access beyond emergency care for specific categories, 3=same access as nationals); access to mental (1=no, 2=yes) and access to free of charge antenatal and postnatal care (1=no, 2=partial, 3=yes). A combined indicator was obtained by summing up from each component. The cultural and political attitudes concerning immigration issues was measured through the weight of xenophobic parties by considering the percentage of votes at the last general elections. The list of xenophobic parties in EU countries was drawn from a publication specialized in the field of immigration issues (Quaderni dell Ufficio Pastorale Migranti, n.10, 2010); they were: Freiheitliche Partei Österreichs (Austria), Vlaams Belang (Belgium), Front National (France), Nationaldemokratische Partei/Republikaner (Germany), Popular Orthodox Rally LAOS (Greece), Jobbik (Hungary), Lega Nord (Italy), Liga Polskich Rodzin (Poland), Democracia Nacional (Spain), and Sverigedemokraterna (Sweden).

3 We classified the weight of the xenophobic parties into 3 levels, according to the percentage of votes at the most recent general elections: 1 (less than 5%); 2 (between 5 and 10%); 3 (over 10%). We performed a non-parametric correlation analysis comparing the indicator evaluating the access to of undocumented migrants and the indicator of the weight of xenophobic parties in the countries. Results Table 1. Indicators of the access to of undocumented migrants and vote at general elections of xenophobic parties. Country by law medicine for adults Cost free for children mental ante/post natal care Composite health access indicator Vote % at general elections Weight of the parties Austria Belgium France Germany Greece Hungary Italy Poland Spain Sweden Hungary and Austria have the lowest level of access to by UM. In these countries the access is restricted in all the items considered. The situation is similar in Sweden, where only free of charge is allowed for migrant children, but only for failed asylum seekers. Spain has the highest level of access to for UM, while Italy, France, and Belgium have only some formal restrictions for children. Consensus of xenophobic parties is high in Austria, Belgium and Hungary, while in Spain and Greece the xenophobia is practically not present in the political agenda. Only in Italy and Hungary xenophobic parties have had responsibility of government, thus they could directly influence the legislation on the issue. The correlation between the composite indicator of access to of UM and the weight of xenophobic parties is negative (-0.62, p value < 0.05). Conclusions There is increasing concern about health problems of UM, their limited rights to accessing care in certain countries, and the special problem of the undocumented migrants of not accessing services due to the fear to be detected. The study showed as cultural and political attitudes are correlated with the entitlement of UM to access services, with low access in countries with higher weight of xenophobic parties compared to those with lower weight.

4 The situation is critical in Austria, Hungary, and Sweden where UM have no public social or support. In these countries, children of UM do not have more chance to access services than adults, and they are required to pay for all care received. In Sweden and Austria UM are even obliged to pay the entire costs for emergency care they receive. (Chavin, 2008; OECD, 2007) Only in Hungary and Italy xenophobic parties have responsibility of government, but this seems not to be a decisive factor. The cultural attitudes, expressed by the political consensus, seems to have a more relevant influence on debated migration issues, such as access to health care of UM. Anyway, to have xenophobic parties with responsibility of government may play a dangerous role. In Italy, in September 2008, the xenophobic party Lega Nord sponsored the adoption by the government of a security plan to contrast crime rate. With the new act, the criminal offence of illegal immigration has been introduced in Italy; this caused concern for of immigrant populations, especially among UM. After the plan, a 16% reduction of hospital accesses of infants aged less than 3 years and born from undocumented immigrants was observed (Spagnolo, 2010), suggesting a negative impact of the security plan also in neonatal care where the disadvantage of the children of immigrants was already existed. (De Curtis, 2008) A limit of the study derives from the difficulty to define a political party as xenophobic. To find explicit elements of xenophobia in the statutes or in the parties' programs is difficult; however the source we used to identify xenophobic parties is highly competent in the field and not politically minded. Limitations of the study may derive also from the choice of the election votes percentage of xenophobic parties as a cultural and political attitudes indicator of a country concerning migration issues. However, this approach produced a clear and easily interpretable indicator: political choice, expressed through the vote, an indubitable sign of social and cultural orientation. In addition, the fallacy due to the ecological design of this analysis may not be discarded. On the other hand, attitudes of groups and laws are phenomena observable and measurable only at ecological level. Finally, we considered the health care access of UM according to laws. The effective access could be impeded by other factors, such as inefficiency, misinterpretation of law, lack of adequate health services, migrants discrimination, which we have not considered in our study. From public health and ethical perspectives, free of charge access to services should be guaranteed also to migrants with an irregular juridical status Such provisions should not be limited to emergency care only, but should also include other forms of essential, such as the possibility to see a doctor or to receive necessary medicines. EU countries should promote initiatives demonstrating practical and innovative attempts at resolving problems of racism and xenophobia and at preventing the growth of such sentiments, also by developing European co-operation on migration issues. This work was supported by the Institute for Social Affair (research project Observatory on migrant health decision n. 10, 2/25/2009)

5 References Chauvin, Parizot, Simmonot, for undocumented migrants in 11 european countries, Médecins du monde European. Observatory on access to Survey Report. September De Curtis M Moscarini M. Concerns in Italy over mother child health care after security plan. Lancet Aug 9; 372:448 Demker M. Attitudes toward immigrants and refugees. Swedish trends with some comparisons. International Studies Association 48th Annual Convention, February 28 March , Chicago, Illinois, USA. Directorate of Social and Economic Affairs. Tackling racism and xenophobia: practical action at the local level: practical action at the local level. Council of Europe Press, 1994, Strasbourg (France) European Union Agency for Fundamental Rights. Migrants in an irregular situation: access to in 10 European Union Member States. Office of the EU. Luxembourg Isherwood C. A single man. New York, NY: Simon and Schuster, Inc., 1964 Minority Rights Group International (MRGI). State of the World s Minorities and Indigenous Peoples Edited by Ishbel Matheson. 2011, UK. Organization for Economic Co-operation and Development (OECD). Report by the Global Commission on International Migration in " for undocumented migrants in Europe", PICUM, Brussels, 2007 Quaderni dell Ufficio Pastorale Migranti. Discriminazione e razzismo. n.10, 2010, Torino. Spagnolo A, Rosano A. The health care for undocumented migrants in Italy after the security plan. 3rd Conference on Migrant and Ethnic Minority Health in Europe, May 2010, Pécs