2.O. Workshop: Initial health assessments and catch-up vaccination for forcibly displaced migrants to Europe

Abstract Objectives Recent crises in Ukraine, Afghanistan, Syria and other countries have, again, resulted in large populations of asylum seekers and other migrant groups arriving in Europe. However, European countries still grapple with questions about what level of health care should be offered to forcibly displaced people (emergency care, preventative care, multi-disease screening and catch-up vaccination?), and when and where in the migration trajectory provision should be made (should it be at borders, reception centres, once settled via the national health system, via specialist or routine services, or left to non-governmental organisations?), and what their subsequent level of right to access the mainstream health-care system should be. Countries do not have a uniform approach to the provision of health care for these populations, with some countries more inclusive than others, and wide discrepancies between evidence and implementation in policy and practice. In this workshop we will discuss current approaches, implementation, research and policy gaps, and models of good practice from the clinic to the community to ensure both the immediate and long-term health needs of these diverse mobile populations are met. Workshop plan The workshop will start with 10-minute presentations by each of the 4 speakers (to include a short Q&A after each talk). This will then move into a 20-minute audience discussion centred seeking specific feedback on examples of successful interventions, good practice, and lessons learned across EU/EEA countries in delivering multi-disease and catch-up vaccination and holistic and inclusive healthcare approaches. Key messages • Governments should develop clear short-term and long-term policy and evidence-led research strategies to ensure the equitable provision of health services. • Strategies must include multi-disease and catch-up vaccination approaches, alongside meaningful access to mainstream health systems.


Background:
There is consensus that caesarean delivery (CD) is a lifesaving procedure for both mother and child in emergency situations and that CD without medical indication should be avoided.However, the rate that optimally balances the risks and benefits of CD is unresolved.In 1985, the World Health Organization concluded that the CD rate should be no more than 10-15%; subsequent reviews relating CD rates to infant mortality show no benefits at the country-level for rates higher than 15-19%.However, stillbirth has not been investigated because comparable international stillbirth data are not readily available.

Methods:
We conducted an ecological study in 25 European countries from 2015 to 2019 utilizing data from routine birth data sources aggregated using the Euro-Peristat PHIRI federated data analysis protocol.We assessed country-level associations between CD rates and perinatal outcomes (singleton preterm birth, stillbirth at 24 weeks' gestational age, neonatal death) for all years using Pearson correlations, adjusted for clustering of years within country.Correlations were also estimated between linear trends over time in the indicators.

Results:
The median [range] of CD rates was 23.1% [16.2 to 56.9] in 21 participating countries, while these were 6.9% [5.3 to 11.9] for preterm birth, 3.3 per 1000 total births [1.8 to 7.6] for stillbirth and 1.9 per 1000 live births [0.7 to 6.1] for neonatal mortality.The CD rate was not associated with the stillbirth rate (clusteradjusted rho: -.01, P = .94)or with the neonatal mortality rate (rho:.27,P = .27).However, there was a strong positive correlation with the preterm birth rate (rho:.81,P<.001).Results were similar in time trend analyses.Conclusions: Higher CD rates were not associated with lower stillbirth or neonatal mortality rates, but were strongly correlated with higher preterm birth rates.This study suggests no benefits and indicates potential harms for higher CD rates in Europe.

Objectives:
Recent crises in Ukraine, Afghanistan, Syria and other countries have, again, resulted in large populations of asylum seekers and other migrant groups arriving in Europe.However, European countries still grapple with questions about what level of health care should be offered to forcibly displaced people (emergency care, preventative care, multi-disease screening and catch-up vaccination?), and when and where in the migration trajectory provision should be made (should it be at borders, reception centres, once settled via the national health system, via specialist or routine services, or left to nongovernmental organisations?), and what their subsequent level of right to access the mainstream health-care system should be.Countries do not have a uniform approach to the provision of health care for these populations, with some countries more inclusive than others, and wide discrepancies between evidence and implementation in policy and practice.In this workshop we will discuss current approaches, implementation, research and policy gaps, and models of good practice from the clinic to the community to ensure both the immediate and long-term health needs of these diverse mobile populations are met.
This year, we are celebrating 30 years of the European Public Health Association.But celebrating this after over two years of COVID-19 and the Russian reinvasion of Ukraine, invites us all to reflect on the use, misuse and non-use of public health.Over the years, our approach to public health has evolved.At the start of the 20th century, public health emphasized the inequalities created by the environments in which people lived, including housing, sanitation, and nutrition.By the end of the century, this extended to the political and commercial determinants of health and the concept of planetary health, which would later be encapsulated by the 2016 Vienna Declaration on Public Health.Given this comprehensive approach, supported by a much greater body of knowledge produced by many disciplines, public health should have been in the driver's seat when the world was hit with COVID-19.But it was not.Its expertise was often absent from COVID-19 response teams.Policies were often driven by panic in the face of visions of overwhelmed hospitals.Restrictions on mixing were essential until more was known about this new virus but there were failures to appreciate the impact that these measures would have on those already disadvantaged, many in precarious employment in public-facing jobs and overcrowded accommodation.As a consequence, existing health inequalities 15th European Public Health Conference 2022