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    Challenges for the prevention of hypertension among international migrants in Latin America: prioritizing the health of migrants in healthcare systems
    (2024)
    Isabel Rada
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    <jats:p>Among the health priorities of international migrants, non-communicable diseases such as hypertension are of major interest due to their increasing prevalence, mainly in low- and middle-income countries. Previous evidence has reported a significant risk of hypertension in international migrants derived from multiple exposures during the migration process and at the destination, such as living conditions, health literacy and access to preventive services. Also, poorer disease control has been found compared to the local population. Considering existing deficiencies in access and use of healthcare services related to hypertension prevention and continuity of care of migrants globally, we aimed to offer a Latin American perspective of the challenges faced by international migrants residing in Latin America in accessing hypertension preventive care from a human rights, equity, and universal primary healthcare approaches. From a health systems perspective, we conducted a scoping review of scientific literature on hypertension prevention and control among international migrants in Latin America and the Caribbean. Based on the findings, we discuss the potential influence of migration and health policies on healthcare systems and individual and structural barriers to healthcare access, including lack of insurance, linguistic barriers, limited intercultural competence, and geographical and financial barriers. From existing evidence related to hypertension, we highlight the particular healthcare needs of migrants and their implications for regional public health goals. This aligns with promoting culturally tailored interventions considering the migration process, lifestyle patterns, structural vulnerabilities, and gender particularities in hypertension prevention, diagnosis, and treatment. We advocate for developing universal, voluntary, and systemic regional screening and disease control initiatives in Latin America for hypertension and other chronic conditions.</jats:p>
      8Scopus© Citations 4
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      1
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    Health access to immigrants: identifying gaps for social protection in health
    (2020-01-01)
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    Oyarte, Marcela  
    OBJECTIVE: To compare the access to and effective use of health services available among international migrants and Chileans. METHODS: Secondary analysis of the National Socioeconomic Characterization Survey (CASEN - Caracterización Socioeconómica Nacional ), version 2017. Indicators of access to the health system (having health insurance) and effective use of health services (perceived need, appointment or coverage, barriers and need satisfaction) were described in immigrants and local population, self-reported. Gaps by immigrant status were estimated using logistic regressions, with complex samples. RESULTS: Immigrants were 7.5 times more likely to have no health insurance than local residents. Immigrants presented less perceived need than local residents, together with a greater lack of appointments (OR: 1.7 95%CI: 1.2-2.5), coverage (OR: 2.7 95%CI: 2.0-3.7) and unsatisfied need. The difference between immigrants and locals was not statistically significant in barriers to health care access (α = 0.005). CONCLUSIONS: Disadvantages persist regarding the access to and use of health services by immigrants as opposed to Chileans compared with information from previous years. It is necessary to reduce the gaps between immigrants and people born in Chile, especially in terms of health system access. This is the first barrier to effective use of services. The generation of concrete strategies and health policies that consider an approach of social participation of the immigrant community is suggested to bring the health system closer to this population.
    Scopus© Citations 38  1
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    Access to health services for international migrants during the COVID-19 pandemic: a qualitative study
    (2023)
    Alice Blukacz
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    OBACH KING, ALEXANDRA ALICE  
    ;
    CARREÑO CALDERON, ALEJANDRA ANGELICA  
    ;
    Carolina Stefoni
    <jats:p>ABSTRACT Objective: To explore the experience and perception of international migrants in Chile regarding access to health services during the pandemic. Method: Collective case study following the qualitative paradigm. Forty semi-structured interviews were carried out with 30 migrants from different countries in Latin America and the Caribbean and 10 key actors from the health or social sector in November and December 2020. The interviews were analyzed thematically. Results: Perceived facilitators for general access to health services are related to formal work, support networks, and good treatment, while barriers are linked to immigration status, information gaps, discrimination, lack of cross-cultural skills, and personal limits of the system. In the context of access to COVID-19 diagnosis and treatment, the main barriers identified are: cultural approach to the disease, communication gaps, experiences of discrimination, costs, and lack of support networks. Conclusion: Access to health services is related to social vulnerability and violation of international migrants rights.</jats:p>
    Scopus© Citations 1  2
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    The social and health protection of migrants in Chile: qualitative analysis of civil society proposals for constitutional change
    (2023-12-01)
    Esnouf, Sophie
    ;
    Blukacz, Alice
    ;
    OBACH KING, ALEXANDRA ALICE  
    ;
    Mezones-Holguin, Edward
    ;
    Espinoza, Manuel
    Background: A sustained period of social, economic, and political unrest took place during October of 2019 in Chile. As an institutional solution, the “Agreement for Social Peace and the New Constitution” was signed. In this document, most political parties committed to reestablishing peace and public order in Chile, agreeing on the initiation of a constitutional process. To promote participation of civil society actors, the “Popular Initiative for Norms” was enabled. This was a platform where civilians could submit proposals for constitutional norms to be discussed by the Constitutional Convention. We aimed to analyze proposals related to migrants and migrant health. Methods: We conducted a qualitative thematic analysis of the proposals. Sixteen of them were related to migrants, and we analyzed their association to health. We also evaluated their link to the Health Goals 2030 set out by the Chilean Ministry of Health and the Global Action Plan 2019–2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. Results: Four main thematic categories were identified: 1) Humans rights of migrants, refugees, and asylum seekers; 2) Nationality and regularization of migrants and refugees; 3) Political participation and cultural integration of migrants and refugees; and 4) Specific regulations on slavery and human trafficking. These resonated with broader frameworks established in the Health Goals 2030 (Chile) and the Global Action Plan 2019–2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. Conclusions: The ‘Popular Initiative for Norms’ was a non-binding participatory mechanism. Although the proposals sent through were not guaranteed to be included in the constitutional draft—and despite the final draft being rejected last September 2022—the platform allowed to gain insights into civilian opinions. Our findings showed that there is an incipient yet weak recognition of the rights and situation of migrants in Chile. There was no direct mention of health nor an explicit contemplation of social determinants of health. Despite there being an urgent need to define strategies for migrants’ health in Chile, this study demonstrated that civil awareness and interest are still insufficient.
    Scopus© Citations 3  6
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    Immigration, perceived discrimination and mental health: evidence from Venezuelan population living in Peru
    (2021)
    Benoît Mougenot
    ;
    Elard Amaya
    ;
    Edward Mezones-Holguin
    ;
    Alfonso J. Rodriguez-Morales
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>The association between international migration and mental health is conditioned to several factors, and discrimination may play a significant role. Currently, Peru is one of the principal Venezuelan migrant-receiving countries in Latin America. There are around one million Venezuelan refugees and migrants in the country. This study evaluates the association between self-perceived discrimination and mental health problems in Venezuelan population living in Peru.</jats:p> </jats:sec><jats:sec> <jats:title>Method</jats:title> <jats:p>We analyzed data from the Venezuelan Population Residing in Peru Survey 2018, a nationally representative urban sample aimed at collecting information on several dimensions of Venezuelan population wellbeing. We applied logistic regression models to assess the association between self-perceived discrimination and mental health problems. Moreover, we applied the propensity score matching method as a robustness check of our results.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Of 9487 Venezuelans surveyed, 6806 included complete information. From this sample, 6.3% reported mental health problems related to fear, anger, anxiety, or stress. Logistic regression models showed that Venezuelans who perceived being discriminated against had 2.4 higher odds of presenting mental health problems than their non-discriminated counterparts. Moreover, propensity score matching models showed that Venezuelans who perceived being discriminated against increased by 3.5 percentage points their probability of presenting mental health problems compared to their non-discriminated counterparts.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>There is evidence that self-perceived discrimination is associated with mental health deterioration in Venezuelan migrants living in Peru. Our findings are relevant in the current geopolitical context and could be useful in the decision making processes in international health.</jats:p> </jats:sec>
    Scopus© Citations 41  1
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    Feeling prepared to face COVID-19 pandemic among Venezuelans in Chile: findings from an opinion poll
    (2021)
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    Florencia Darrigrandi
    ;
    Alice Blukacz
    ;
    OBACH KING, ALEXANDRA ALICE  
    ;
    Claudia Silva
    <jats:p>Introduction International migration is a social determinant of health. The past decade has seen a large exodus of Venezuelans within Latin America, including Chile. In the past months, the world has been facing the SARS-CoV-2 coronavirus pandemic and its respiratory disease COVID-19. Objective To explore what factors are associated with feeling prepared to face the COVID-19 pandemic among the Venezuelan population residing in Chile. Methods Cross-sectional quantitative study with an opinion poll design. An online self-reported survey in Spanish and Creole was designed and piloted with experts and international migrants. It was disseminated to various international migrant groups through networks of migrant and pro-migrant organizations and the Chilean public health care network across the national territory. An effective sample size for analysis of 1690 participants was reached, of which 1008 (60%) were from Venezuela and included in this analysis. Feeling prepared to face the COVID-19 pandemic (yes/no) among Venezuelan migrants was described, as well as relevant variables like sex, level of education, length of stay, healthcare provision, anxiety or depression due to COVID-19, confinement, and evaluation of the quality of the information provided by the COVID-19 government. Results 65% of the Venezuelan participants reported not feeling prepared for the pandemic. Compared to Venezuelan migrants who feel prepared to face the COVID-19 pandemic, migrants who reported not feeling prepared were in a higher proportion female, with secondary education level, had arrived in Chile in the past year, do not have a job but want to work, and belong to the public healthcare provision. Discussion Receiving good quality information on the pandemic and mental health symptoms are important factors associated with feeling prepared to face COVID-19 in Venezuelan migrants in Chile, suggesting that increased attention towards the physical and mental health of Venezuelan migrants in Chile and the region is needed.</jats:p>
    Scopus© Citations 6  2
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    Promoting the Participation of “Hard-to-Reach” Migrant Populations in Qualitative Public Health Research during the COVID-19 Pandemic in Chile
    (2023)
    Alice Blukacz
    ;
    CABIESES VALDES, BALTICA BEATRIZ  
    ;
    OBACH KING, ALEXANDRA ALICE  
    ;
    María Inés Álvarez
    ;
    Paula Madrid
    <jats:p>The COVID-19 pandemic has further deepened socioeconomic and health inequities worldwide, especially among populations experiencing social vulnerability, such as international migrants. Sustained lockdowns and social distancing have raised challenges to conducting public health research with hard-to-reach populations. This study aims at exploring strategies to recruit “hard-to-reach” international migrants for qualitative public health research during the pandemic in Chile, based on the authors’ experience. A retrospective qualitative evaluation process was carried out on the recruitment processes of three qualitative research projects focused on international migrants in Chile. All projects were implemented during the COVID-19 pandemic, demanding complementary and flexible strategies: (i) social media; (ii) snowball sampling; (iii) referrals from social workers and pro-migrant and migrant-led organizations; (iv) vaccination centers and healthcare centers; and (v) community-based recruitment. The strategies are qualitatively evaluated around seven emerging qualitative categories: (i) feasibility during lockdown periods; (ii) speed of recruitment; (iii) geographical coverage; (iv) sample diversity; (v) proportion of successful interviews; (vi) ethical considerations; and (vii) cost. Engaging hard-to-reach international migrants in public health research during the pandemic required constantly adapting recruitment strategies. Furthermore, relying on strategies that were not only Internet-based promoted the participation of populations with limited access to the Internet and low-digital literacy.</jats:p>
    Scopus© Citations 10  1
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    The Work, Economic, and Remittance Stress and Distress of the COVID-19 Pandemic Containment Policies: The Case of Venezuelan Migrants in Argentina and Chile
    (2023)
    Deisy Del Real
    ;
    Felipe Crowhurst-Pons
    ;
    Lizeth Olave
    <jats:p>According to the social stress process model, global crises are macro-level stressors that generate physiological stress and psychological distress. However, existing research has not identified immigrants’ COVID-19 containment policy stressors or examined the social stress of sending remittances amid crises. Drawing on in-depth longitudinal interviews with 46 Venezuelan immigrants—half before and half during the pandemic—in Chile and Argentina, we identified the COVID-19 containment policies’ stressors. We focused on Venezuelan immigrants because they constitute one of the largest internationally displaced populations, with most migrating within South America. We found that the governmental COVID-19 containment measures in both countries generated four stressors: employment loss, income loss, devaluation of employment status, and inability to send needed remittances. Moreover, sending remittances helped some migrants cope with concerns about loved ones in Venezuela. However, sending remittances became a social stressor when immigrants struggled to simultaneously sustain their livelihoods and send financial support to relatives experiencing hardships in Venezuela. For some immigrants, these adversities generated other stressors (e.g., housing instability) and symptoms of anxiety and depression. Broadly, for immigrants, the stressors of global crises transcend international borders and generate high stress, which strains their psychological well-being.</jats:p>
      2Scopus© Citations 9
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      3Scopus© Citations 8