Migrant Healthcare Workers During COVID-19: Bringing an Intersectional Health System-related Approach into Pandemic Protection. A German Case Study

Overview

Journal Front Public Health

Specialty Public Health

Date 2023 Aug 3

PMID 37533524

Authors

Ellen Kuhlmann

Marius-Ionut Ungureanu

Georg M N Behrens

Anne Cossmann

Leonie Mac Fehr

Sandra Klawitter

Marie Mikuteit

Frank Muller

Nancy Thilo

Monica Georgina Brinzac

Alexandra Dopfer-Jablonka

Affiliations

Soon will be listed here.

Abstract

Introduction: Migrant healthcare workers played an important role during the COVID-19 pandemic, but data are lacking especially for high-resourced European healthcare systems. This study aims to research migrant healthcare workers through an intersectional health system-related approach, using Germany as a case study.

Methods: An intersectional research framework was created and a rapid scoping study performed. Secondary analysis of selected items taken from two COVID-19 surveys was undertaken to compare perceptions of national and foreign-born healthcare workers, using descriptive statistics.

Results: Available research is focused on worst-case pandemic scenarios of Brazil and the United Kingdom, highlighting racialised discrimination and higher risks of migrant healthcare workers. The German data did not reveal significant differences between national-born and foreign-born healthcare workers for items related to health status including SARS-CoV-2 infection and vaccination, and perception of infection risk, protective workplace measures, and government measures, but items related to social participation and work conditions with higher infection risk indicate a higher burden of migrant healthcare workers.

Conclusions: COVID-19 pandemic policy must include migrant healthcare workers, but simply adding the migration status is not enough. We introduce an intersectional health systems-related approach to understand how pandemic policies create social inequalities and how the protection of migrant healthcare workers may be improved.

References

Burau V, Falkenbach M, Neri S, Peckham S, Wallenburg I, Kuhlmann E . Health system resilience and health workforce capacities: Comparing health system responses during the COVID-19 pandemic in six European countries. Int J Health Plann Manage. 2022; 37(4):2032-2048. PMC: 9087528. DOI: 10.1002/hpm.3446. View

Mbiba B, Chireka B, Kunonga E, Gezi K, Matsvai P, Manatse Z . At the deep end: COVID-19 experiences of Zimbabwean health and care workers in the United Kingdom. J Migr Health. 2021; 1-2:100024. PMC: 8352092. DOI: 10.1016/j.jmh.2020.100024. View

Fronteira I, Sidat M, Magalhaes J, Cupertino de Barros F, Delgado A, Correia T . The SARS-CoV-2 pandemic: A syndemic perspective. One Health. 2021; 12:100228. PMC: 7887445. DOI: 10.1016/j.onehlt.2021.100228. View

Magri G, Fernandez M, Lotta G . Inequality in the middle of a crisis: an analysis of health workers during the COVID-19 pandemic from the profession, race, and gender perspectives. Cien Saude Colet. 2022; 27(11):4131-4144. DOI: 10.1590/1413-812320222711.01992022. View

Deck R, Walther A, Staupendahl A, Katalinic A . [Limitations of Social Participation in General Population - Normative Data of the IMET based on a Population-Based Survey in Northern Germany]. Rehabilitation (Stuttg). 2015; 54(6):402-8. DOI: 10.1055/s-0035-1559670. View

Kuhlmann E, Brinzac M, Burau V, Correia T, Ungureanu M . Health workforce protection and preparedness during the COVID-19 pandemic: a tool for the rapid assessment of EU health systems. Eur J Public Health. 2021; 31(Supplement_4):iv14-iv20. PMC: 8576297. DOI: 10.1093/eurpub/ckab152. View

Jackson Preston P . We must practice what we preach: a framework to promote well-being and sustainable performance in the public health workforce in the United States. J Public Health Policy. 2022; 43(1):140-148. PMC: 8724584. DOI: 10.1057/s41271-021-00335-5. View

Martin C, Woolf K, Bryant L, Carr S, Gray L, Gupta A . Persistent hesitancy for SARS-CoV-2 vaccines among healthcare workers in the United Kingdom: analysis of longitudinal data from the UK-REACH cohort study. Lancet Reg Health Eur. 2022; 13:100299. PMC: 8730737. DOI: 10.1016/j.lanepe.2021.100299. View

Williams G, Jacob G, Rakovac I, Scotter C, Wismar M . Health professional mobility in the WHO European Region and the WHO Global Code of Practice: data from the joint OECD/EUROSTAT/WHO-Europe questionnaire. Eur J Public Health. 2020; 30(Suppl_4):iv5-iv11. PMC: 7526770. DOI: 10.1093/eurpub/ckaa124. View

10.

Uphoff E, Lombardo C, Johnston G, Weeks L, Rodgers M, Dawson S . Mental health among healthcare workers and other vulnerable groups during the COVID-19 pandemic and other coronavirus outbreaks: A rapid systematic review. PLoS One. 2021; 16(8):e0254821. PMC: 8336853. DOI: 10.1371/journal.pone.0254821. View

11.

Woolf K, Gogoi M, Martin C, Papineni P, Lagrata S, Nellums L . Healthcare workers' views on mandatory SARS-CoV-2 vaccination in the UK: A cross-sectional, mixed-methods analysis from the UK-REACH study. EClinicalMedicine. 2022; 46:101346. PMC: 8923694. DOI: 10.1016/j.eclinm.2022.101346. View

12.

Martin C, Pan D, Nazareth J, Aujayeb A, Bryant L, Carr S . Access to personal protective equipment in healthcare workers during the COVID-19 pandemic in the United Kingdom: results from a nationwide cohort study (UK-REACH). BMC Health Serv Res. 2022; 22(1):867. PMC: 9255515. DOI: 10.1186/s12913-022-08202-z. View

13.

Kuhlmann E, Lotta G, Fernandez M, Herten-Crabb A, Fehr L, Maple J . SDG5 "Gender Equality" and the COVID-19 pandemic: A rapid assessment of health system responses in selected upper-middle and high-income countries. Front Public Health. 2023; 11:1078008. PMC: 9935821. DOI: 10.3389/fpubh.2023.1078008. View

14.

Blumel M, Spranger A, Achstetter K, Maresso A, Busse R . Germany: Health System Review. Health Syst Transit. 2021; 22(6):1-272. View

15.

Bossavie L, Garrote-Sanchez D, Makovec M, Ozden C . Do immigrants shield the locals? Exposure to COVID-related risks in the European Union. Rev Int Econ. 2022; . PMC: 9115417. DOI: 10.1111/roie.12609. View

16.

Behrens G, Cossmann A, Stankov M, Schulte B, Streeck H, Forster R . Strategic Anti-SARS-CoV-2 Serology Testing in a Low Prevalence Setting: The COVID-19 Contact (CoCo) Study in Healthcare Professionals. Infect Dis Ther. 2020; 9(4):837-849. PMC: 7472691. DOI: 10.1007/s40121-020-00334-1. View

17.

Qureshi I, Gogoi M, Al-Oraibi A, Wobi F, Chaloner J, Gray L . Factors influencing the mental health of an ethnically diverse healthcare workforce during COVID-19: a qualitative study in the United Kingdom. Eur J Psychotraumatol. 2022; 13(2):2105577. PMC: 9364733. DOI: 10.1080/20008066.2022.2105577. View

18.

Greer S, Dubin K, Falkenbach M, Jarman H, Trump B . Alignment and authority: Federalism, social policy, and COVID-19 response. Health Policy. 2022; 127:12-18. PMC: 9674559. DOI: 10.1016/j.healthpol.2022.11.007. View

19.

Hayward S, Deal A, Cheng C, Crawshaw A, Orcutt M, Vandrevala T . Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review. J Migr Health. 2021; 3:100041. PMC: 8061095. DOI: 10.1016/j.jmh.2021.100041. View

20.

Woolf K, McManus I, Martin C, Nellums L, Guyatt A, Melbourne C . Ethnic differences in SARS-CoV-2 vaccine hesitancy in United Kingdom healthcare workers: Results from the UK-REACH prospective nationwide cohort study. Lancet Reg Health Eur. 2021; 9:100180. PMC: 8287519. DOI: 10.1016/j.lanepe.2021.100180. View