The objective of this scientific work was to create and improve epidemiologic knowledge with respect to two vulnerable populations in an urban setting, undocumented migrants and detainees. Several studies were the first in Switzerland and/or Europe to determine specific health problems among these populations.15;20;21;75;78;162
The findings strengthened the sustainability of innovative projects promoted by the clinical units. Above all, the research was a critical support to help primary care physicians advocate for change and decrease health inequality by improving access to quality health care.
Future development needs can be proposed as follows:
1. Epidemiological research: Descriptive epidemiological research needs to be continued and also include qualitative studies which help to understand high risk behavior of certain subgroups. The sociodemographic composition of migrants and detainees (who are mainly migrants) are constantly changing in relation to complex combinations of social, ethnic, economic, and politically related factors which drive migration.179 Therefore, continuous description of the migrant population is essential to optimally adapt health care and prevention to changing needs.
2. Interventions on specific health-related topics and sound evaluations: Urban health professionals should address specific themes (e.g., contraception in undocumented migrants, efficient screening strategies for infectious diseases or harm reduction measures in prison) on the basis of research findings. These projects should use a participatory approach by implementation of the target population and should be thoroughly evaluated.
An important field of future research is related to efficacy of prevention measures.171
156
3. Education: Healthcare professionals and other players in the field of urban health need to improve their understanding of the high degree of complexity and diversity of cities and the health-related consequences of urban organization. Universities have to address these needs as well and should stimulate interdisciplinary approaches. Furthermore, primary care physicians should be in contact with disadvantaged populations during training. And finally, Universities and affiliated hospitals need to support healthcare workers, particularly those who work with disadvantaged populations, and offer them training in epidemiology and biostatistics which is critical for the realization and publication of research projects.
Conclusions
Since 2007, the majority of human beings have come to live in urban settings with growing influence on all spheres of human life. Public health had to adapt to the consequences of the rapid demographic shift towards cities where social and health inequalities are substantial.10;167;168 A major aspect in urban health refers to social cohesion and equity in access to health care, particularly for vulnerable populations.2;8
The presented epidemiologic research related to undocumented migrants and detainees helped not only to identify the health status of vulnerable populations and their difficulties in access to health care, but also to identify barriers in access to health care for the general population. This research helped to implement effective and sustainable projects which significantly improved access to health care for disadvantaged populations in Geneva. Further developments concern research on the efficacy of prevention measures among these populations and strengthen the training of healthcare professionals for specific aspects of urban health by stimulating interdisciplinary approaches and permitting contact with disadvantaged populations.
Healthcare professionals and particularly primary care physicians are well placed to understand the social realities, its health consequences and the health needs of the population. In consequence they should use their position and their expertise to advocate for change, also outside traditional medical areas. The increasing importance of urban centers on population health motivated WHO Europe to launch the WHO Healthy Cities movement to promote “health
157
in all policies”. Health, social justice and population well-being demands its place in the center of attention of future urban development.
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