A major strength of the social and health interventions for immigrants in Padua was the ability to create a network and to work in partnership. In this case, all the actors that worked with the immigrant population in Padua worked as part of a network. The network was reinforced by the local context, where health and social integration was already present. Some lessons learned through the activities in Padua described above may be applicable in other European contexts.
The fi rst lesson learned is about the importance of communication and information management. Communication is an essential instrument for building social capital. Local Health and Social Authority No. 16 and the Municipality of Padua promoted the use of a network for internal communication, external communication and the sharing of information of public utility. This helped create the conditions required for service implementation.
The second lesson is about the need for cross-disciplinary governance that integrates public, private and third-sector actors and allows them to establish learning processes to strengthen skills. The High Professional Immigration Body provides direction and control, but makes room for other actors to contribute whenever they have the skills and experience to intervene. In the Italian context, this put into practice the subsidiary concept, based on the Italian Social Services Framework Law of 2000 (Parliament, 2000) that facilitates the harmonization of different stakeholder activities.
Finally, the third lesson learned is that the analysis of the target group’s needs should shape the defi nition and implementation of services. In Padua, interdisciplinary social workers assess the needs of the immigrant community. These social workers engage the immigrant population directly and are the main channel for assessing needs. They have the opportunity, through direct contact with the immigrants, to monitor their requirements and subsequently share them during the coordination round tables convened by the High Professional Immigration Body. This has enabled the interventions to be designed in a way that is sensitive to emerging needs, with particular attention given to the demands of the most vulnerable target groups of immigrants.
References
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11. Latvia: reducing the impact of poverty on health
Silvia Pablaka Department of Health Care, Ministry of Health
Reducing poverty and social exclusion are among the key long-term goals of Latvia’s social policy. The Public Health Strategy of Latvia highlights social and economic problems including inequality, poverty and social exclusion as major determinants of ill-health.
This case study provides information on poverty and socioeconomically disadvantaged groups in Latvia, primarily drawing from data sources available in late 2007 and early 2008. It also describes how the Latvian health system works to meet the needs of vulnerable population groups, in particular through the Regulations of the Cabinet of Ministers on Health Care Organization and Financing Procedure and the exemption of patients of socioeconomically and otherwise disadvantaged population groups from having to make contributions for health care.
In 2007, 21% of Latvia’s population lived below the poverty threshold. Poverty affects children and youth most severely. It affects them through their living conditions, possibilities to obtain quality health care and education, professional opportunities, and integration into the labour market. In 2006, 21% of Latvia’s children (aged 0–17 years) were at risk of impoverishment.
In relation to this, in 2007 the risk of impoverishment for large families was 46%, and for single-parent families it was 34%.
In Latvia, unemployment (one of the risk factors for social exclusion) affects mainly the long-term unemployed, unemployed youth and the unemployed of pre-retirement age. Unemployment increases the risk of social exclusion, because it increases the risk of impoverishment and prohibits people from gaining adequate income. Poverty among job seekers in Latvia is 54%.
On 1 January 2007, the Regulations of the Cabinet of Ministers on Health Care Organization and Financing Procedure came into force. This legislation states that a person who is not in the register of a family doctor (about 5% of the total population) will receive primary health care services and prophylactic tests from state emergency medical services. Also, to ensure health care accessibility, the following groups are exempt from patient contributions: children up to 18 years of age; pregnant women and women during the postnatal period (until day 42); the poor; participants in the National Resistance Movement; people who suffered because of the accident at the Chernobyl nuclear power plant; TB patients; people with mental disorders (receiving psychiatric treatment); and people receiving care at state social centres and local government rest homes. Likewise, patient contributions are not required for: emergency medical assistance, if the patient is in critical condition; vaccination within the framework of the state immunization programme; receiving a preventive examination; and receiving treatment for various infectious diseases.
Taking into consideration that extended treatment can impoverish a patient, the state has also established a ceiling for patient contributions. In addition, it has taken measures to ensure financial accessibility to necessary pharmaceuticals.
In Latvia, action on the upstream determinants of health includes activities to promote the inclusion of target groups into the labour market, to improve their financial situation and to facilitate their access to necessary services (including education), thus promoting their social inclusion.