verona hetical and public health concerns
TRANSCRIPT
Ethical and public health concerns
based on the retrospective analysis of
referrals for diagnostic parasitology
of immigrants and autochtonous population
in Lampedusa island (Italy)
Livia Bellina - ASL 6 - Sicily Region
Marcella Maugeri - ASL 6 - Sicily Region
Eduardo Missoni - CERGAS, Bocconi University, Milano
How we started our collaboration
• the need to confirm a diagnosis of malaria; the firstdetected on Lampedusa Island, ever.
• Why not going for the easy solution? It is the best!
• Bellina L., Missoni E., Mobile cell-phones (M-phones) intelemicroscopy: increasing connectivity of isolated laboratories,Diagnostic Pathology 2009, 4:19 (19 June 2009)
The Method
• Analysis of the legal and procedural framework
for immigrants’ care and right to health
• A retrospective review (January 2008- May 2009)
of referral to Policlinic and to the clinical
laboratory (only one in Lampedusa), with focus on
parasitological diagnosis (blood, urine and stools)
• Comparison of data related to regular resident
population (permanent and seasonal) and irregular
immigrant (“boat-people”) population
WHO on immigrants health
WHA Resolution 61.17 “Health of migrants”
World Health Assembly CALLS UPON Member States:
(1) to promote migrant-sensitive health policies;
(2) to promote equitable access to health promotion, diseaseprevention and care for migrants, subject to national lawsand practice, without discrimination on the basis of gender,age, religion, nationality or race;
(3) to establish health information systems in order to assess andanalyse trends in migrantsí health, disaggregating healthinformation by relevant categories;
(4) to devise mechanisms for improving the health of allpopulations, including migrants, in particular throughidentifying and filling gaps in health service delivery;
The Right to Health in Italy
• According to Italian Constitution, health is a
“fundamental right of the individual and (an)
interest of the community” (art. 32)
• “political, economic and social solidarity”
are identified as “intransgressible duties”
(art. 2).
Immigrants health care in the
Italian Law
• Legislative Decree n.286/98 - the access to health services
is granted to foreign citizens without permit and they
cannot be reported to authority, but in the cases where this
is foreseen also for Italian citizens
• Law n. 94 15.7.2009 criminalizes illegal immigration -
debate about interpretation of its effect of LD n.286/98,
obligation of Medical officers to report illegal immigrants
• Following Agreement with Lybia, Italy introduced a policy
of returning boatloads of migrants to Libya before they can
claim asylum. This policy was actively implemented
starting in May 2009
Health care provision for
irregular immigrants• Medical personnel of the “Malta Cross” on board of
military boats for immediate assistance to people rescuedin open sea
• On arrival at the dock, first care managed by INMP andMSF (triage) in collaboration with the Management ofthe “First aid and reception centers” (CSPA):
– Identification and management of emergencies and nonemergency conditions (subjective emergencies)
– Screening for cutaneous communicable disease
– Color codes assignment according to urgency and follow-up atthe local Emergency and Policlinic, worst cases may betransferred by helicopter to Palermo
The resident population
The immigrant population“boat-people”
Medical care
Laboratory services
Referrals to laboratory services
Parasitological findings
Conclusions (1/2)
• The high disproportion between cases referred tohealth services between the resident population andirregular immigrants, as well as differences in thenumber of diagnostic services per attended patienthighlights the scarce attention given to the latter.
• The high proportion of confirmed cases of parasiticinfection shows the relevance of these diseasesamong the immigrant population and elicits concernsabout the potential risk of the emergence or theincreased incidence of communicable diseases in theisland (oral-faecal route of transmission).
Conclusions (1/2)
Ethical concerns
• The right to health of immigrant populationis highly restricted
• Need for more attentive, comprehensivescreening and health care provision toimmigrant population
• Need to reconsider current immigrationpolicies and official attitude which are incontrast with the right to health, not tomention feelings of human compassion.