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Highlighting Inequalities and Insufficient Awareness of Global Health Issues 

What are the barriers in people realising their right to health?

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Why is health an important topic for development?

Table of Content

• Tessa & Dessy : Refugees & the Right to Health
• Eline & Anna : Inequalities & Vulnerabilities
• Gráinne, Francesca & Miyabi : Mental Health
• Conclusion and Discussion

What are the barriers in people realising their right to health?

General Comment No. 14 (ICESCR)

• The right to health: “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” 
• Health facilities, goods and services should be:

Available, Accessible (to all, within safe physical reach, affordable & information), Acceptable and of Quality. 

What barriers do refugees face in realising the right to health?

Dessy and Tessa

Case Study: Large-scale Right to Health violations in Moria refugee camp on Lesbos Island, Greece

Can you think of problems these refugees are facing regarding the right to health?

Can you think of problems these refugees are facing regarding the right to health?

Identifying refugees' barriers to realising their right to health

• Substandard quality and quantity of food
• Overcrowded cabins and tents
• Need to walk far for water
• Overcrowding creates unhealthy conditions which stimulate viral and bacterial infections (COVID-19)

Identifying refugees' barriers on realising the right to health care

• Limited public health available by the Greek authorities; no referral possibilities for emergency care providing NGOs
• Limited access on grounds of discrimination (refugees vs. European citizens)
• The NGO's health facilities are affordable, but not for specialist care
• Healthcare not of quality due to the limitations of referral 

COVID-19

• Many affected people
  
• Inability of following WHO's public health recommendations
  
• Not enough place in the health facilities
  
• Lack of health professionals
  

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What are the barriers to people realising their right to health?

A vulnerability perspective: Eline and Anna 

In which way can inequalities have an impact on individuals' health or healthcare?

Vulnerable groups

• Poverty
  
• Religion, tribe, caste
  
• Women and children
  

• And many others....
  

Possible effects

• Changes in livelihoods, agriculture and food
  
• Water availability
• Combination of global warming and floods: mosquitos
  

Climate Change

• Changing weather patterns : water
  
• Droughts and floods
  

I

Just a few barriers...

• Gender
  
• Ethnicity
  
• Rural area
  
• Income
  

 

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Can you think of other barriers in realizing her access to health?

How can these barriers be removed?

• Creating awareness
  
• Fighting discrimination
  
• Climate change issues should be included in health policies
  

Also affect mental health

Mental Health

The lesser talked-about side of Global Health

What percentage of all developmental assistance for health is spent on mental healthcare?

1. 5%
2. 1%
3. 10%
4. 20%

A completely inadequate mental healthcare system- in "normal" times

• Less than one mental health professional per 10,000 people worldwide
  
• In LICs and MICs, between 76% and 85% of people with mental health concerns receive no treatment for their conditions
• "Taboos" or stigma still exist across the world
  

And then came the coronavirus... 

What percentage of healthcare workers in China were suffering from depression in the early months of this year?

1. 80%
2. 40%
3. 50%
4. 20%

What percentage of Spanish and Italian parents reported their children had difficulty concentrating while being homeschooled?

1. 77%
2. 45%
3. 60%
4. 38%

What percentage of the Irani people reported feeling distress during the early months of the COVID-19 pandemic?

1. 30%
2. 80%
3. 60%
4. 45%

Evidence from previous pandemics, epidemics and societal trauma

• Ebola, Sierra Leone: 76% of population with symptoms of PTSD
  
• SARS, China, one year after the outbreak: 90% of healthcare workers scored above the GHQ threshold
  
• Similar results in the aftermath of tsunamis, hurricanes, financial crises, and so on


• WHO: More than 1 in 5 people living in conflict-affected settings have a mental health condition

The Silver Lining

Using the increased awareness of mental health in these unprecedented times as the impetus to re-structure the entire mental health system

Cultural Awareness  

• Right to health  for all 
• Inadequate provision of mental health service for ethnic minorities 
• Lack of cultural awareness
• Solutions have been provided in the form of cross cultural trainings 

1. Right to health includes mental healthcare

2. This right has been particularly inadequately addressed for certain minority groups

3. While this has been recognised by some cultural awareness trainings, they have proven inadequate- dominated by Western thinking

4. Restructuring of trainings including feedback from those with first-hand experience essential

What is lacking in the implementation of such trainings?

• Western ideas of Medicine are still dominant and alternative treatments are hardly considered 
• Cultural competence is often too superficial and might end up reinforcing cultural stereotypes 
• Lack of evaluation and users' experience evaluations

Explanatory models - Rohingya

• Body-mind division 
  
• Language 
• Religion 
• Medicalization of mental health

Mental Health

The lesser talked about side of health

Questions?

Do you agree that mental health is just as important as physical health? Why?

Who do you think should be responsible for the health care in refugee camps?

Do you have examples of barriers you experienced while seeking healthcare yourself?

The right to health

“The right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” 

This is a universal human right, which should be realized by all, and therefore any barriers to it must be removed.

References

• Downing R, Kowal E. A postcolonial analysis of indigenous cultural awareness training for health workers. Health Sociol Rev. 2011;20:5–15

• Es, A. V. (2020, February 13). Large-scale right to health violations in Moria refugee camp on Lesbos island, Greece. 
• Lee et al (2007). Stress and Psychological Distress Among SARS Survivors 1 Year After the Outbreak. The Canadian Journal of Psychiatry 52(4): 233-240. 
• Kakuma et al. (2011). Human Resources for Mental Healthcare: Current Situation and Strategies for Action. Lancet 378: 1654-63. doi:10.1016/S0140- 6736(11)61093-3
• Kuch, U. (2017). Health-sector responses to address the impacts of climate change in Nepal. WHO South-East Journal of Public Health, 9-14. doi:10.4103/2224-3151.213795
• Pandey, B., & Costello, A. (2019). The dengue epidemic and climate change in Nepal. The Lancet, 2150-2151. doi:10.1016/S0140-6736(19)32689-3
• Shultz et al. (2015). The 2014 Ebola Outbreak and Mental Health: Current Status and Recommended Response. JAMA 313 (6). doi:10.1001/jama.2014.17934.Tay, A. K., Riley, A., Islam, R., Welton-Mitchell, C., Duchesne, B., Waters, V., ... & Silove, D. (2019). The culture, mental health and psychosocial wellbeing of Rohingya refugees: a systematic review. Epidemiology and psychiatric sciences, 28(5), 489-494.Dhimal, M., Lamichhane Dhimal, M., Pote-Shrestha, R., Groneberg, D., & Tarannum, S., Elshazly, M., Harlass, S., & Ventevogel, P. (2019). Integrating mental health into primary health care in Rohingya refugee settings in Bangladesh: experiences of UNHCR. Intervention, 17(2), 130.
• Xu, J., Grumbine, R., Shrestha, A., Eriksson, M., Yang, X., Wang, Y., & Wilkes, A. (2009). he Melting Himalayas: Cascading Effects of ClimateChange on Water, Biodiversity, and Livelihoods. Conservation Biology, 520-530. doi:10.1111/j.1523-1739.2009.01237.x

References

• Balarajan, Y., Selvaraj, S., & Subramanian, S. (2011). Health care and equity in India. The Lancet, 377(9764), 505-515.
• Borooah, V. (2010). Inequality in health outcomes in India: the role of caste and religion. MPRA, 179-207.
• Mehrotra, M. A., & Chand, S. (2012). An Evaluation of Major Determinants of Health Care Facilities for Women in India. Journal of Humanities and Social Science, 2(5), 1-9.
• Jungari, S., & Chauhan, B. G. (2017). Caste, Wealth and Regional Inequalities in Health Status of Women and Children in India. Contemporary Voice of Dalit, 9(1), 87-100.
  
• Kamalapur, S. M., & Reddy, S. (2013). Women Health in India: An Analysis. International Research Journal of Social Science, 2(10), 11-15.
  
• Shaikh, M., Miraldo, M., & Renner, A.-T. (2018). Waiting time at health facilities and social class: Evidence from the Indian caste system. PLoS ONE, 13(10)