7.A. Round table: Sustainable health system responses to meet the chronic health care needs of refugees from Ukraine

Abstract Background Since Russia's reinvasion of Ukraine on 24 February, more than 5 million people have fled the country. Most have gone to the neighbouring countries of Poland, Slovakia, Hungary, Romania, and Moldova. This vulnerable population has significant healthcare needs. Among the most challenging to address will be chronic non-communicable diseases (NCDs), including mental disorders, as these require long-term, continuous care and access to medicines. NCDs are already the biggest contributor to disease burden among Ukrainian adults. About a third have hypertension and 7% have diabetes. Refugees are also at increased risk of mental disorders due to exposure to trauma and ongoing daily stressors. Host country health systems are faced with the challenge of ensuring accessible and affordable care for NCDs and mental disorders to this population. There is no consensus on the most effective and sustainable approaches for achieving this. Objectives This workshop will provide a platform for sharing knowledge to support host country health systems. The objectives of the workshop are to i) identify sustainable health system approaches to providing quality health care for NCDs and mental disorders to refugees from Ukraine, and ii) establish research priorities to support host country health system decision-making. Format The workshop will consist of a panel with 4 speakers, followed by a roundtable discussion. Each panel member will make a short presentation (5 min) related to health system responses for NCDs and mental disorders in refugee populations. They will highlight challenges faced in the current crisis and evidence of approaches that have worked in other refugee contexts. The roundtable discussion will focus on the adaptation of evidence-based approaches to countries hosting refugees from Ukraine, and the research needed to support this. Interventions will be made by representatives from countries hosting refugees, including from WHO country offices, and from the WHO Europe Migration and Health Programme. All workshop participants will be invited to contribute. The discussion will be chaired by Natasha Azzopardi-Muscat, Director of the Division of Country Health Policies and Systems, WHO European Regional Office. A report on the conclusions of the workshop, including research priorities to support host country health systems, will be published. Key messages • Health systems receiving refugees from Ukraine will face challenges in providing them long-term and affordable care for NCDs and mental disorders. • Drawing on evidence, the workshop will help to identify sustainable health system responses to NCDs and mental disorders, and priorities for research to support host country health systems. Introduction Adrianna Murphy LSHTM, London, UK Impact of the crisis in Ukraine on neighbouring health systems Kayvan Bozorgmehr Bielefeld University, Bielefeld, Germany Financing to meet the chronic health care needs of refugees Triin Habicht Senior Health Economist, WHO Barcelona Office for Health Systems Strengthening, Barcelona, Spain Implementing responsive integrated mental health care for refugees Sergiy Bogdanov Centre for Mental Health and Psychosocial Support, National University of Kyiv Mohyla Academy, Kyiv, Ukraine Ensuring continuous access to NCD treatment among refugees Sigiriya Aebischer Perone Geneva University Hospitals, Geneva, Switzerland

Educational inequalities in mortality are increasingly recognized as one of the main challenges for health policy.Studies comparing European countries have shown that such inequalities are substantial almost everywhere, but that there are important variations between countries, suggesting great scope for reduction.However, identifying this scope is difficult because it requires comparative information about the educational distribution of mortality rates, risk factors and relative risks.In this presentation I show how this can be done, by quantifying the impact of a theoretical equalization of the distribution of several known risk factors for mortality, in a comparative risk assessment approach.Harmonized data set on mortality (from register data) and risk factors (from survey data) by educational level for 21 European populations in the early 2000s were applied.The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions (PAF).The impact on inequalities in mortality was estimated applying two counterfactual scenarios: a theoretical upward levelling scenario in which it is assumed that inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which it is assumed that inequalities in a risk factor were to be reduced to those seen in the country with the smallest inequalities for that risk factor.The analysis shows how information on risk factors, mortality rates and relative risks can be combined from different data sources and provide a meaningful analysis of the European mortality burden that can be linked to educational inequalities in risk factors.The analysis also shows that upward levelling scenarios and best practice scenarios demonstrate a theoretical potential for reducing inequalities in mortality.

Background:
Since Russia's reinvasion of Ukraine on 24 February, more than 5 million people have fled the country.Most have gone to the neighbouring countries of Poland, Slovakia, Hungary, Romania, and Moldova.This vulnerable population has significant healthcare needs.Among the most challenging to address will be chronic non-communicable diseases (NCDs), including mental disorders, as these require long-term, continuous care and access to medicines.NCDs are already the biggest contributor to disease burden among Ukrainian adults.About a third have hypertension and 7% have diabetes.
Refugees are also at increased risk of mental disorders due to exposure to trauma and ongoing daily stressors.Host country health systems are faced with the challenge of ensuring accessible and affordable care for NCDs and mental disorders to this population.There is no consensus on the most effective and sustainable approaches for achieving this.Objectives: This workshop will provide a platform for sharing knowledge to support host country health systems.The objectives of the workshop are to i) identify sustainable health system approaches to providing quality health care for NCDs and mental disorders to refugees from Ukraine, and ii) establish research priorities to support host country health system decision-making.

Format:
The workshop will consist of a panel with 4 speakers, followed by a roundtable discussion.Each panel member will make a short presentation (5 min) related to health system responses for NCDs and mental disorders in refugee populations.They Organised by: Bielefeld University (Germany) Chair persons: Nora Gottlieb (Germany), Seth M Holmes (USA) Contact: lforst@uic.edu The agriculture and meat-processing sectors employ, largely, (im)migrant workers in Germany, the Netherlands, and the USA.Deemed ''critical infrastructure,'' workers in the food supply chain (FSC) were particularly vulnerable to SARS-CoV-2 infection due to poor adaptation of policies and practices related to health, immigration, and work.The pandemic has shone a light on preexisting inequalities and risks related to precarious and hazardous work, particularly for (im)migrant workers.We conducted harmonized policy analyses in North-Rhine Westphalia, Germany, in the Netherlands, and in Illinois, USA on measures taken during the pandemic and how they affected migrant workers.These three regions host large businesses in meat-processing and agriculture.They saw significant COVID-19 outbreaks, with widespread health, social and economic repercussions.Public health effects included higher risk for all communities in the region; social effects included local lockdown measures; economic effects included food supply problems, euthanized animals, and financial losses due to the temporary closure of businesses.In our workshop, we will deliver three brief presentations on (im)migration, labor, and occupational safety and health policies during the COVID-19 syndemic in Germany, the Netherlands, and the USA.We present results of our analysis, highlighting similarities and differences between the EUmember states Germany and the Netherlands, on the one hand, and the US, related to the employment and exploitation of migrant workers from the global South/East in the global North/West.We highlight issues to be addressed in future global emergencies.The pandemic has prompted occupational safety and health measures in the FSC.However, agroindustrial sectors in Western Europe and the US heavily rely on precariously employed workers (e.g., seasonal, temporary and/or subcontracted workers).This may impact the extent to which preventive measures ''work'' for these populations: even when good policies are formulated, information exchange, collaboration, and enforcement by relevant agencies and immigration authorities is critical.Without such cooperation, the realization of stronger social protection of (im)migrant workers is are left to the good will of the employer.Structural drivers in the form of policies related to mobile labor, (im)migration and employment, superimposed on segmented labor markets and discriminatory practices, drove significant morbidity among (im)migrant workers.The following discussion will synthesize insights from the three contexts, and provide an opportunity to brainstorm with workshop participants to facilitate cross-national collaboration on this issue.

Key messages:
Food supply chain workers are at the intersection of discrimination in health, employment, and migration.
Comparative analysis provides a rich framework to guide management of vulnerable sectors, workers and workplaces during future pandemics.
Abstract citation ID: ckac129.405Labor migration, the food supply chain and the COVID-19 syndemic: Germany, Netherlands, and the USA

Ingrid Junwirth
I Jungwirth 1 , M Glassner 1 1 Society and Economics, Rhine-Waal University, Kleve, Germany Contact: Ingrid.Jungwirth@hochschule-rhein-waal.de In Germany, the COVID-19 syndemic has brought questions regarding precarious labor migration in the food supply chain (FSC) to the forefront of the public debate.An analysis of responses to COVID-19-related challenges in agriculture and