Lecture series: Public Health and Migration

Immigrants to European countries experience health risks and develop health needs that may differ from the risks and needs of the majority population of country receiving the immigrants. Additionally, immigrants may face specific barriers to accessing health care. These barriers apply both to refugees and ‘regular’ migrants. I will show that a life course perspective can help to better understand the resulting health-related diversity, or heterogeneity, of today’s societies in Europe. Further, I will illustrate how health services address this heterogeneity, with a particular emphasis on entitlement restrictions and access barriers to health care In Germany. These insights demonstrate that public health research and practice are not ‘neutral’, i.e., not free of underlying normative agendas. A life course approach can serve as a tool to expose such hidden normative agendas in immigrant health.

Es ist weithin bekannt, dass strukturelle Ungleichheiten sich auch im Gesundheitswesen fortschreiben. So zeigen Studien etwa, dass postmigrantische Minderheiten – v.a. aufgrund ihres Beschäftigungsprofils – ein disproportional höheres Risiko haben, an Covid-19 zu erkranken und zu sterben. Wir wissen zudem, dass für postmigrantische Minderheiten und Geflüchtete Zugangsbarrieren zum Gesundheitswesen bestehen, dass sie negative Erfahrungen im Umgang mit Gesundheitspersonal machen, und dass Abläufe der gesundheitlichen Versorgung selten auf ihre Bedürfnisse zugeschnitten sind. Obgleich diese Trends gut dokumentiert sind, hat sich die Forschungsliteratur bisher unzureichend mit dem Konzept des institutionellen Rassismus beschäftigt. Auf der Grundlage dreier Forschungsprojekte, die zwischen 2016 und 2020 durchgeführt wurden, werde ich nachzeichnen, wie sich Rassismus institutionell im Gesundheitswesen fortschreibt. Zunächst lege ich dar, welche Formen der Ungleichbehandlung belegt sind, und welche Mechanismen ihnen zu Grunde gelegt werden können. Im zweiten Teil illustriere ich am Beispiel zweier Wohlfahrtsverbände, wie rassistische Differenz im Gesundheitswesen immer wieder neu erzeugt wird.

Aleksandra Lewicki is a political sociologist who teaches at the University of Sussex. She is a Senior Lecturer in Sociology and directs the Sussex European Institute. Lewicki is one of the editors of the Journal of Ethnic and Migration Studies and an editorial board member of the research journal Social Movements. Her research focuses on structural inequality in immigration societies, particularly Germany and the United Kingdom. Empirically, she researches political mobilization and institutional discrimination. In particular, she is interested in how, by whom, and for what motivations collective attributions such as "race" or "nation" are generated and used for argumentation - and how they are then perpetuated in public institutions and political initiatives.

The ideal of a human right to health has been rhetorically significant, but its effectiveness as a means for forced, undocumented and former migrants to gain access to healthcare is far from proven. Formal rights to healthcare do not necessarily mean that those rights can be claimed and healthcare that is formally accessible does not necessarily meet people’s self-defined needs. Migrants themselves, as well as healthcare professionals express reluctance regarding the clinical encounter. Taking various types of evidence into account this presentation will imagine an ideal of accessible care in an age of migration.

Hannah Bradby has been Professor at the Sociology Department, Uppsala University, Sweden since 2013, having previously held a senior lectureship at the University of Warwick, UK. Her research interrogates the links between identity, structure and health with particular reference to racism, ethnicity and religion. She is Field Chief Editor for Frontiers in Sociology, her latest co-authored book is Exploring Welfare Bricolage in Europe’s Superdiverse Neighbourhoods and has recent papers in the Scandinavian Journal of Public Health and the Sociology of Health and Illness.