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This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

The psychosocial well-being of migrant children has become an urgent issue facing many Western countries as the number of migrant children in the population is rapidly increasing and health care systems struggle to support them. Often, these children arrive with extensive exposure to trauma and loss. They also face additional stressors in their host country, yet these children don't always access mental health support even when it is available. Barriers to mental health care access include cultural and linguistic barriers, the primacy of resettlement needs, and the stigma attached to mental health illness. There is a need to move away from a focus on trauma and mental health symptoms and instead look at migrant children’s well-being across multiple domains, including activities that may promote or diminish psychological well-being. Trauma Systems Therapy for Refugees (TST-R) is an example of an approach that has succeeded in overcoming barriers to mental health care access by adopting a culturally relevant and comprehensive approach to mental health care. A case study illustrates the ways in which this approach is able to overcome barriers by targeting four specific refugee core stressors and providing support across multiple domains to facilitate the meeting of existing mental health needs, as well as prevent further psychological distress.

Nearly 80% of the world’s population lives in low- and middle-income countries (LMICs) and these regions bear the greatest burden of maternal, neonatal, and child mortality, with most of the deaths occurring at home. Much of global maternal and child mortality is attributable to easily preventable and treatable conditions. However, the challenge lies in reaching the most vulnerable communities, especially the rural populations, making it imperative that maternal, newborn, and child health (MNCH) interventions focus on communities in tandem with facility-based strategies. There is widespread consensus that delivering effective primary health care (PHC) interventions through the continuum of care, starting from pregnancy to delivery and then to the newborn, infant, and the young child, is an integral component of health strategies in high-, middle- and low-income settings.

Despite gaps in research, several effective community-based PHC approaches have been proven to impact MNCH positively. Implementation of these strategies is needed at scale in LMICs and in partnership with all stakeholders including the public and private sector. Community-based PHC, operating on the principles of community engagement and community mobilization, is now more critical than ever. Further robust studies are needed to evaluate certain strategies of community-based PHC and their impact on maternal and child health outcomes, such as the use of mobile technology and social franchises. Recognition of community health workers (CHWs) as a formal cadre and the integration of community-based health services within PHC are vital in strengthening efforts to impact maternal, neonatal, and child health outcomes positively. However, despite the importance of community-based PHC for MNCH in LMICs, the existence of a strong health system and skilled workforce is central to achieving positive health outcomes in these regions.

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

For decades, researchers have been puzzled by the finding that despite low socioeconomic status, fewer social mobility opportunities, and access barriers to health care, migrants appear to experience lower mortality than the majority population of the respective host country, and possibly also of the country of origin. This phenomenon has been acknowledged as a paradox and, in turn, researchers have attempted to explain this paradox through theoretical interpretations, innovative research designs, and methodological speculations.

Specific focus on the salmon effect/bias and the convergence theory may help characterize the past and current tendencies in migrant health research to explain the paradox of healthy migrants. The first examines whether the paradox reveals a real effect or is a reflection of methodological error; and the second suggests that even if migrants indeed have a mortality advantage, it may soon disappear due to acculturation. These discussions should encompass mental health in addition to physical health.

It is impossible to forecast the future trajectories of present migration patterns and equally impossible to predict, with full accuracy, the physical and mental health outcomes of migrants/refugees who cannot return to their country of origin due to the current climate. However, the ability to follow individuals on their path to becoming acculturated in new societies can both enrich our understanding of the relationship between migration and health, and contribute to the acculturation process by generating advocacy for inclusive health care.

Migration is a reality of today’s world, with over one billion migrants worldwide. While many choose to move voluntarily, others are forced to migrate due to economic reasons or to flee war, conflict, or persecution. Such migrants often find themselves in precarious and marginalized situations—particularly asylum seekers, refugees, and undocumented or irregular migrants. While often viewed as a single group, the legal status and entitlements of these three groups are different. This has implications for their ability to access health care; in addition, rights and entitlements vary across the 28 countries of the European Union and across different parts of national health systems. The lack of entitlement to receive care, including primary and secondary care, is a significant barrier for many asylum seekers and refugees and an even greater barrier for undocumented migrants. Other barriers include different health profiles and awareness of chronic disease risk amongst migrants; awareness of the organization of health systems in host countries; and language and communication. The use of professional interpreters can help to overcome communication barriers, but entitlement to free interpreting services is highly variable. Host countries need to consider how to ensure their health systems are “migrant-friendly”: solutions include provision of professional interpreters; ensuring that health care staff are aware of migrants’ rights to access health care; and increasing knowledge of migrants in relation to the organization of the health care system in their host country and how to access care, for example through the use of patient navigators. However, perhaps one of the greatest facilitators for migrants will be a more favorable political situation, which stops demonizing people who are forced to migrate due to situations out of their control.

The construction of the concepts of diplomacy and health diplomacy must consider their conceptions and practices, at both the global and regional levels. Health diplomacy is vitally important in a global context, where health problems cross national borders and more new stakeholders appear every day, both within and outside the health sector. On the other hand, regional integration processes provide excellent opportunities for collective actions and solutions to many of the health challenges at the global level. In the current global context, the best conditions for dealing with many health challenges are found at the global level, but the regional and subregional spheres also play essential roles.

The region of Latin America and the Caribbean (LAC) consists of 26 countries or territories that occupy a territory of 7,412,000 square miles—almost 13% of the Earth’s land surface area; it extends from Mexico to Patagonia, where about 621 million people live (as of 2015), distributed among different ethnic groups. Geographically, it is divided into Mexico and Central America, the Caribbean, and South America, but it presents subregions with populations and cultures that are a little more homogenous, like the subregions of the Andes and the English Caribbean. By its characteristics, LAC has acquired increasing global political and economic importance.

In the 1960s, integration processes began in the region, including the creation of the Union of South American Nations (UNASUR), Mercosur, the Andean Community, the Caribbean Community (CARICOM), the Central American System, the Bolivarian Alliance for the Peoples of Our America (ALBA), the Amazon Cooperation Treaty Organization (ACTO), the Sistema Económico Latinoamericano y del Caribe (SELA), the Asociación Latinoamericana de Integración (ALADI), and finally, since 2010, the Community of Latin American and Caribbean States (Comunidad de Estados Latinoamericanos y Caribeños, or CELAC), which is the most comprehensive integrative organization.

While originally a mechanism for political and economic integration, health is now an important component of all the abovementioned integration processes, with growing social, political, and economic importance in each country and in the region, currently integrating the most important regional and global negotiations.

Joint protection against endemic diseases and epidemics, as well as noncommunicable diseases, coordination of border health care, joint action on the international scene (particularly in multilateral organizations such as the United Nations and its main agencies), and the sectoral economic importance of health are among the main situations and initiatives related to health diplomacy in these integration processes.

The effectiveness of integration actions—and health within those actions—varies according to the political orientations of the national governments in each conjuncture, amplifying or reducing the spectrum of activities performed. The complexity of both the present and future of this rich political process of regional health diplomacy is also very important for global health governance (GHG).

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

There is one common health objective by all nations, as stated in the constitution of the World Health Organization of 1947: the progress toward the best feasible level of health for all people. This goal captures the concept of health equity: fair distribution of unequal health. However, 70 years later, this common global objective has never been measured. Most of the available literature focuses on measuring health inequalities, not inequities, and tends to concentrate on comparisons among population subgroups, specific health risks, diseases, or health services, thereby indirectly contributing to the high fragmentation of health policies, actions, and even constituencies and resulting in competition for funds and/or priority.

A method to identify standards for the best feasible levels of health through criteria of healthy, replicable, and sustainable (HRS) models is needed. The avoidable death toll has not improved significantly since the 1970s. Younger age groups (though gradually shifting toward older age groups) and women are most affected. Data analysis of smaller sample units (such as provinces, states, counties, or municipalities) increases the sensitivity of measurement and detects higher levels of health inequity.

Most of the burden of health inequity takes place in countries with levels of income per capita below the average of the HRS countries, which is called the “dignity threshold” (the economic condition threshold necessary to enjoy the best feasible levels of health). Based on this threshold, it is possible to estimate the necessary distribution of the world’s resources compatible with the universal right to health—“the equity curve.” Income above the upper thresholds, and hence wealth accumulation, prevents others from living in conditions of dignity compatible with the universal right to health, is correlated with a carbon footprint above the ethical sustainable threshold, and does not translate into better health nor well-being. The international redistribution of wealth required to enable all nations to have at least an average per capita income above the dignity threshold would be around 8%, much higher than the present, nonbinding, and volatile levels of international cooperation, which currently lack an equity approach.

At subnational levels, the burden of health inequity can be the most sensitive barometer of socioeconomic justice among territories and the population, informing and directing fiscal and territorial equity schemes to enable all people within and between nations to enjoy the universal right to health. HRS models can also inspire lifestyles, political, and economic frameworks that increase efficiency, replicability, and sustainability of ethical well-being without undermining the rights of others in present and future generations.

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

In 1978, at an international conference in Kazakhstan, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) put forward a policy proposal entitled Primary Health Care (PHC). Adopted by all the member states of the WHO, this proposal was the seed by which governments and people began to change their views about how good health was obtained and sustained. The Alma-Ata Declaration (as it is known after the city in which the meeting was held) committed WHO member states to take action to achieve the WHO definition of health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Arguing that good health was not merely the result of biomedical advances, provision of health services, and professional care, the Declaration stated that health was a human right, that the inequality of health status among the world’s populations was unacceptable, and that people had a right and duty to become involved in the planning and implementation of their own health care. It proposed that this policy be supported through collaboration with other government sectors to ensure health was recognized as a key to development planning.

Under the banner call of “Health for All by the Year 2000,” WHO and UNICEF set out to translate into practice their vision of how health could be improved. The task confronted a number of critical challenges to implementation. These challenges included defining PHC and translating PHC into practice, developing frameworks to translate equity into action, experiencing the potentials and limitations of community participation, and seeking finances to support the transformation of health systems. Global, national, and non-governmental organization (NGO) programs attempted to balance the PHC vision and the reality of health service delivery success by monitoring and evaluating health impact and cost effectiveness. After 40 years, PHC policy has retained its commitment to social justice but has reduced its broad advocacy of health in overall development to focus on universal health coverage encompassing commitment to equity and community participation through support of community health workers.

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

There is a broad consensus that the health of an individual or population is not influenced solely by the efforts of the formal health sector. Rather, it is also defined by the conditions of daily life as well as the inputs, intentional or not, of various stakeholders and policies. The recognition that health outcomes and inequity in health extend beyond the health sector across many social and governmental sectors has led to the emergence of a comprehensive policy perspective known as Health in All Policies (HiAP). Building on the key principles outlined in the Alma Ata Declaration (1978), the Ottawa Charter for Health (1986), the Final Report of the Commission on the Social Determinants of Health (2008), and the Rio Political Declaration on the Social Determinants of Health (2011), Health in All Policies is a collaborative approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. Given the breadth and ambition of the Health in All Policies approach, it has great potential to serve as a powerful mechanism for linking the goals, means, and priorities associated with health in numerous global agendas such as Universal Health, the Social Determinants of Health, and the Sustainable Development Goals (SDGs) of the 2030 Agenda.

The health status of refugees and asylum seekers varies significantly across the European region. Differences are attributed to the political nature of the legal categories of “asylum seeker” and “refugee”; the wide disparities in national health services; and the diversity in individual characteristics of this population including age, gender, socioeconomic background, country of origin, ethnicity, language proficiency, migration trajectory, and legal status. Refugees are considered to be at risk of being or becoming relatively “unhealthy migrants” compared to those migrating on the basis of economic motives, who are characterized by the “healthy migrant effect.” Refugees and asylum seekers are at risk to the drivers of declining health associated with settlement such as poor diet and housing. Restricted access to health care whether from legal, economic, cultural, or language barriers is another likely cause of declining health status. There is also evidence to suggest that the “embodiment” of the experience of exclusion and marginalization that refugee and asylum seekers face in countries of resettlement significantly drives decrements in the health status of this population.

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article.

As a result of climate change, workers are at increased risk to their health and safety. Workers, especially those who work outdoors or in already-hot indoor environments, are at increased risk of heat stress and other heat-related disorders, occupational injuries, and reduced productivity at work. Increased ambient temperatures may contribute to chronic kidney disease of unknown etiology among workers. A variety of approaches have been developed to measure and assess workers’ occupational heat exposure and their risk of heat-related disorders. In addition, increased ambient temperature may increase worker exposure to hazardous chemicals and the adverse effects of chemicals on workers’ health. Global warming will influence the distribution of weeds, insect pests, and pathogens, changing the types and amounts of pesticides used and thereby affecting the health of agricultural workers and others. Global warming is increasing ground-level ozone concentrations, with adverse effects on outdoor workers and others, as well. Extreme weather events related to climate change pose injury risks to rescue and recovery workers. Reducing the risks of work-related illnesses and injuries from climate change requires a three-pronged approach: (1) mitigating the production of greenhouse gases, the primary cause of climate change; (2) implementing adaptation measures to address the overall consequences of climate change; and (3) implementing improved measures for occupational health and safety.