Estratificación del estatus legal precario y desigualdades en el acceso a la atención en salud: una revisión narrativa de la literatura
Data
2021-09-30
Autores
Abarca Brown, Cristóbal Emilio [UNIFESP]
Orientadores
Coviello, Denise Martin [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
As políticas nacionais de imigração e os discursos políticos contra a migração em nível global estão diretamente relacionados com as possibilidades de acesso e uso efetivo dos serviços de saúde pelas populações migrantes. Os efeitos da pandemia de Sars-Cov-2 exacerbaram os problemas de saúde das populações mais vulneráveis, e as organizações internacionais de Saúde Global insistem em sua preocupação com a necessidade de melhorar o acesso aos cuidados formais de saúde para os grupos migrantes e suas famílias. Entretanto, o acesso à saúde é limitado por uma série de fatores estruturais, socioculturais e subjetivos que antecedem a crise sanitária da Covid-19. No caso dos migrantes, o status legal desempenha um papel fundamental, além das diferenças linguísticas e culturais ou falta de informação, o medo de ser detido e deportado tem um impacto sobre a confiança nas instituições de saúde pública. Com base em uma perspectiva transnacional e uma abordagem de "redimensionamento dos estudos da migração", foi realizada uma revisão narrativa da literatura qualitativa sobre migração internacional e atenção primária em saúde, a fim de analisar os desafios enfrentados pelos sistemas de saúde no cuidado dos migrantes internacionais. Especificamente, são descritas as principais barreiras ao acesso enfrentadas pelos usuários migrantes. É examinada a importância do status legal precário para o uso efetivo dos serviços de saúde na população migrante e, finalmente, são identificadas as dificuldades enfrentadas por profissionais de saúde, como médicos e enfermeiros, no cuidado de migrantes. Como principais resultados, em primeiro lugar, destaca-se a importância dos determinantes sociais da saúde e a perspectiva interseccional como foco de análise das desigualdades em saúde dos usuários migrantes. Em segundo lugar, entre os temas mais recorrentes, surgem os seguintes: a relevância do status legal como categoria central para pensar sobre as dificuldades no uso efetivo dos serviços de saúde; a complexidade progressiva dos estudos sobre a saúde mental das migrantes; e, finalmente, a estabilidade dos estudos de gênero no caso das mulheres migrantes durante a última década. Em particular, o estudo propõe uma análise baseada em três eixos problemáticos a fim de pensar no acesso à saúde da população migrante a partir da perspectiva de seus principais atores. Primeiro, é apresentado o conflito de "navegação" nos sistemas de saúde em geral; depois é analisada a "falta de confiança" nos usuários migrantes; e, finalmente, é considerado a "potencialidade" que os profissionais de saúde têm para atender aos migrantes além do espaço clínico. A título de análise, ela destaca a importância de pensar conjuntamente sobre os diversos fatores que dificultam o acesso à saúde, considerando a vulnerabilidade estrutural dos sujeitos migrantes e suas interseções. Em conclusão, a ênfase da literatura sobre a "adaptação cultural" dos serviços de saúde é adotada de uma perspectiva institucional que supera a responsabilidade individual pelos estilos de vida dos migrantes e a falta de competências específicas dos profissionais de saúde.
National immigration policies and political discourses against migration at the global level are directly related to the possibilities of access and effective use of health care services by the migrant population. The effects of the Sars¬Cov-2 pandemic exacerbated the health problems of the most vulnerable populations and international Global Health organizations insist on their concern about the need to improve access to health care for migrant groups and their families. However, access to health is limited by various structural, socio¬cultural, and subjective factors that preceded the Covid-19 health crisis. In the case of migrants, legal status plays a fundamental role, in addition to linguistic and cultural differences or lack of information, the fear of being detained and deported has an impact on trust in public health institutions. Based on a transnational perspective and a "rescaling migration studies" approach, a narrative review of the qualitative literature on international migration and primary health care was carried out with the aim of analyzing the challenges faced by health systems in the care of international migrants. Specifically, the main barriers to access faced by migrant users are described. The importance of precarious legal status for the effective use of health services in the migrant population is examined and, finally, the difficulties faced by health professionals such as medical doctors (gps) and nurses in the care of migrants are identified. As main results, in the first place, the importance of the social determinants of health and the intersectional perspective as focal points of analysis for health inequities in migrant users is highlighted. Secondly, among the most recurrent themes, the following emerge: the relevance of legal status as a central category to think about the difficulties in the effective use of health services; the progressive complexity of studies on mental health in migrants; and finally, the stability of gender studies in the case of migrant women during the last decade. In particular, the study proposes to go beyond the analysis based on three problematic axes in order to think about access to health care in the migrant population from the perspective of its main actors. First, the conflict of "navigation" in health systems is presented; then the "lack of trust" in migrant users is analyzed, and finally, the "potentiality" that health professionals maintain to attend migrants beyond the clinical space is considered. By way of analysis, the importance of thinking jointly about the various factors that hinder access to health care is highlighted, considering the structural vulnerability of migrant subjects and their intersections. In conclusion, the emphasis of the literature on the "cultural adaptation" of health services is adopted from an institutional perspective that overcomes the individual responsibility for migrants' lifestyles and the lack of specific competencies of health professionals.
National immigration policies and political discourses against migration at the global level are directly related to the possibilities of access and effective use of health care services by the migrant population. The effects of the Sars¬Cov-2 pandemic exacerbated the health problems of the most vulnerable populations and international Global Health organizations insist on their concern about the need to improve access to health care for migrant groups and their families. However, access to health is limited by various structural, socio¬cultural, and subjective factors that preceded the Covid-19 health crisis. In the case of migrants, legal status plays a fundamental role, in addition to linguistic and cultural differences or lack of information, the fear of being detained and deported has an impact on trust in public health institutions. Based on a transnational perspective and a "rescaling migration studies" approach, a narrative review of the qualitative literature on international migration and primary health care was carried out with the aim of analyzing the challenges faced by health systems in the care of international migrants. Specifically, the main barriers to access faced by migrant users are described. The importance of precarious legal status for the effective use of health services in the migrant population is examined and, finally, the difficulties faced by health professionals such as medical doctors (gps) and nurses in the care of migrants are identified. As main results, in the first place, the importance of the social determinants of health and the intersectional perspective as focal points of analysis for health inequities in migrant users is highlighted. Secondly, among the most recurrent themes, the following emerge: the relevance of legal status as a central category to think about the difficulties in the effective use of health services; the progressive complexity of studies on mental health in migrants; and finally, the stability of gender studies in the case of migrant women during the last decade. In particular, the study proposes to go beyond the analysis based on three problematic axes in order to think about access to health care in the migrant population from the perspective of its main actors. First, the conflict of "navigation" in health systems is presented; then the "lack of trust" in migrant users is analyzed, and finally, the "potentiality" that health professionals maintain to attend migrants beyond the clinical space is considered. By way of analysis, the importance of thinking jointly about the various factors that hinder access to health care is highlighted, considering the structural vulnerability of migrant subjects and their intersections. In conclusion, the emphasis of the literature on the "cultural adaptation" of health services is adopted from an institutional perspective that overcomes the individual responsibility for migrants' lifestyles and the lack of specific competencies of health professionals.
Descrição
Citação
ABARCA BROWN, C. E. Estratificación del estatus legal precario y desigualdades en el acceso a la atención en salud: una revisión narrativa de la literatura. São Paulo, 2021. 71 f. Dissertação (Mestrado em Saúde Coletiva) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2021.