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Newly arrived migrants in Sweden risk facing ill health. Politicians at the local and regional levels are involved in many decisions regarding the social determinants of health. The aim of this study was to explore politicians' views on different societal actors' responsibility and possibility to promote newly arrived migrants' health. Data were collected through online questionnaires completed by 667 politicians from municipality and regional councils in northern Sweden. Bivariate analysis was performed using the Wilcoxon signed-rank test. Multivariate analyses were performed using cluster analysis and binary logistic regression analysis. The results show that politicians generally rate societal actors' responsibility and possibility to promote the general population's health higher than newly arrived migrants' health. Moreover, they consider societal actors' responsibility to be greater than their possibility to promote health. Factors significantly contributing to politicians' high ratings of societal responsibility and possibility are attitude (odds ratio [OR] = 2.156, 95% confidence interval [CI]: 1.306-3.558), specific knowledge of newly arrived migrants' health status (OR = 1.528, 95% CI: 1.005-2.323), personal interest in public health (OR = 2.452, 95% CI: 1.460-4.119), being a municipality politician (OR = 1.659, 95% CI: 1.031-2.670) and being female (OR = 1.934, 95% CI: 1.333-2.806). This study shows that politicians generally rate societal responsibility and possibility to promote newly arrived migrants' health rather high. Personal characteristics are important for politicians' high or low ratings of responsibility and possibility, suggesting insufficient structural support for politicians in health promotion.Politicians at the local and regional levels in Sweden have the opportunity to affect the health of the population in general and of newly arrived migrants specifically. The aim of this research project was to explore how politicians view societal responsibility and possibility to promote newly arrived migrants’ health. Data were collected through online questionnaires sent to politicians in municipality and regional councils in the north of Sweden. The results show that politicians rate societal responsibility and possibility to promote health relatively high, but higher for the general population than for newly arrived migrants. The findings further show that politicians consider societal actors’ responsibility to promote health to be greater than their possibility to do so. Factors that are important for politicians’ high ratings of societal responsibility and possibility to promote newly arrived migrants’ health are mainly personal characteristics, such as attitude, knowledge, personal interest in public health, being a politician in a municipality council and being female. This could indicate insufficient structural support for politicians in health promotion.

Background War-related injury is a growing clinical and public health concern in occupied Palestinian territory, especially in the Gaza Strip. However, little research has been done into the quality of care and management of war injuries in public hospitals. We explored the perceptions of health-care workers about these factors in Palestinian health-care facilities in Gaza. Methods This was a qualitative descriptive study. Data were obtained in four focus group discussions attended at public health facilities by 30 purposively selected health-care providers, comprising 14 head surgeons, and 16 head nurses, aged 38–55 years. A semi-structured topic guide was developed by the authors for the study based on earliest literature, and was critically reviewed by a panel of experts to ensure the trustworthiness of the qualitative guide and to minimise complexity and enhance clarity of the questions for participants. Audio recordings of discussions were transcribed verbatim, translated, and analysed with a thematic analysis approach. The study was approved by the Palestinian Health Research Council and facilitated by the Ministry of Health. Findings A consensus was expressed that, despite some positive aspects in the system, fundamental changes and essential improvements were needed to advance the care and facilitation of war injury management. Some respondents had serious concerns about the health-care system, suggesting that it needs to be comprehensively rebuilt. Unanimous views were expressed about the important barriers to effective management and quality of care: shortages of resources, medicines, and funding; underuse or absence of specific and unified clinical practice guidelines; no official commitment by the Ministry of Health to adopt updated clinical guidelines; few incentives and poor motivation, poor communications; blockade and siege; division of health systems in the country; overcrowding of patients with war injuries in hospitals with limited capacity; spreading of infection due to poor cleanliness; shortages in fuel and power supply; and low wages, which negatively affected staff motivation. Respondents also reported inadequate sharing of care and cooperation between different health-care facilities. Interpretation The perceptions about barriers to management of war injuries and the quality of care provided were similar across Palestinian health-care facilities in the Gaza strip. Our findings suggest that fundamental changes and comprehensive reform of the health-care system are needed to make the care of patients with war injuries more effective and efficient. One of the important strengths of this study is that it addressed the perspective and opinions of different key health professionals, which made it possible gain deeper and better understanding of how war injuries are managed in the Palestinian health system. In addition, the outcomes of the study were based on diverse information. However, the analysis of the qualitative data may represent challenges, and be more complicated and time consuming than a quantitative approach. Funding None.

Background and aim Early action is important for promoting newly arrived migrants’ health. Politicians are major actors in decision-making that affects health outcomes in the population. Therefore, the aim of this study was to explore local and regional politicians’ considerations of newly arrived migrants’ health in political decision-making: whether politicians reflect on or discuss the effects of decision-making specifically on newly arrived migrants’ health, whether considerations differ between municipality and regional politicians, and how knowledge and attitudes are associated with such considerations. Subject and methods A cross-sectional quantitative study was conducted. A total of 667 municipality and regional politicians from northern Sweden responded to a questionnaire developed based on interviews with politicians. Bivariate analyses were performed using χ2 tests, the independent samples t-test, and the Wilcoxon signed-rank test. Multivariate analysis was performed using binary logistic regression. Results Politicians considered the effects on newly arrived migrants’ health significantly less frequently than those on the total population’s health. Regional politicians discussed such effects more often than municipality politicians. Knowledge (odds ratio [OR] = 1.343), attitude (OR = 5.962), previous experience working on public health issues (OR = 1.784), and female gender (OR = 1.787) were positively associated with considering effects on newly arrived migrants’ health in decision-making. Conclusion Politicians play important roles in health promotion, and most consider health-related effects in their decision-making. However, about a third do not consider such effects. General health-related knowledge and attitude are important factors that could be affected or changed during political assignments.

Background Although the political context is recognized as an important determinant of health, there is limited research on politicians' role in health promotion. No fitting questionnaire to study the subject could be identified, therefore a new questionnaire was developed. Methods An inductive approach was used and the first step was semi-structured interviews with six politicians. They represented two different municipalities and four different political parties from different sides of the Swedish political spectrum. The interviews focused on the politicians’ view on their role, responsibility and possibility to promote health. The data was analysed by means of qualitative content analysis. Five categories were created with several sub-categories each. The categories formed the sections of the questionnaire. Statements and questions were created to cover all the sub-categories. The statements were assigned Likert-scales (strongly agree to strongly disagree) for answers and some of the sentences were turned into questions. Lastly, face validity of the questionnaire was tested by the interviewees who filled out the questionnaires, two by thinking aloud as they did and three by filling out the online version of the questionnaire and leaving comments on the questionnaire. Results This resulted in a questionnaire with five sections focused on: Politicians view on health and health promotion; to affect health as a politician; collaboration between actors; the politics of health; the municipality/region organisation and prerequisites. Conclusions The questionnaire opens up for explorative studies on politicians' view on their role, responsibility and possibility to promote health. It is currently being used in a study exploring local and regional politicians in the north of Sweden and their role in health promotion. Key messages Politicians’ view on their role in health promotion is of importance to explore. The developed questionnaire can be used to study politicians’ role in health promotion.

Background Previous research has indicated that migrants risk facing inequities both internationally and in Sweden; integration policies are therefore important to study. How health is described in policies affects how health interventions are approached. A discourse analysis offers a way of understanding how health is framed within the integration policies of the Establishment Program. The aim was to critically analyse the health discourses used in Swedish and European Union (EU) integration policies. Methods A critical discourse analysis, inspired by Fairclough, was performed on integration policies related to Sweden, on local, regional, national and the EU level. The policies of the Establishment Program, which focuses on newly arrived migrants (refugees, persons of subsidiary protection and their relatives who arrived through family reunification), were chosen for the analysis, and 17 documents were analysed in total. Results The analysis of the documents showed that although no definition of health was presented, health discourses were expressed in the form of the medicalization of health and the individualization of health. This not only by the terminology used, but also in how the healthcare sector was considered responsible for any health related issue and how individual health behaviours were of focus in interventions to promote health. Conclusions A pathogenic approach to health was visible in the policies and individual disease prevention was the main health focus. The results showed similarities to previous research highlighting how a particular understanding of health in a neoliberal context is formed. Key messages Health as a resource is missing in the integration policy documents. Viewing health as an individual quality puts the responsibility of promoting health on the individual.

Background The political context of health promotion is important, however politicians' role has been sparsely researched. The aim was to explore whether politicians reflect on health effects of newly arrived migrants during political decision-making. Methods In total 667 politicians from municipalities and regional councils in the north of Sweden answered a web-based survey in 2019. The variable self-reported reflection of health effects during decision making in the last three months, focused on newly arrived migrants and the general population in the area, was used for analysis. Differences between political groups were analysed through Chi-squared test and differences in focus between the general population and newly arrived migrants were analysed by Wilcoxon Signed Rank Test. Results Preliminary results indicate that out of the participants 29,0% reported reflection on health effects for newly arrived migrants in large parts of their decisions, 50,5% having done so a few times, while 20,5% did not reflect. The politicians from the regions reported to a higher degree, compared to the municipality politicians, to have reflected on health effects (p = 0,003, Cramer's V = 0,136). Politicians more often considered the health effects of the general population in their decisions than for newly arrived migrants (z=-0,006, p Conclusions Not all politicians reflect on the health effect of their decisions, especially not for newly arrived migrants' health. Politicians in the municipalities, responsible for many of the social determinants of health, did so to a lesser degree than the politicians in the regions, responsible for the healthcare system. The potential for politicians to promote health is thus not realized and political decisions can unintentionally affect health. Key messages Only a relatively small part of politicians considers health effects for newly arrived migrants in large parts of their decision-making. Municipality politicians, whose political decisions affect many determinants of health, consider health effects in a lesser degree than regional politicians do.

Marwan Mosleh, 1, 2 Yousef Aljeesh, 3 Koustuv Dalal, 1, 4 Charli Eriksson, 5 Heidi Carlerby, 1 Eija Viitasara 1 1Department of Health Sciences (HLV), Public Health Science, Mid Sweden University, Sundsvall, Sweden; 2Ministry of Health, Gaza, Palestine; 3International Public Health Medicine, Islamic University, Gaza, Palestine; 4Department of Epidemiology, Biostatistics, and EBM; Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty, Kazakhstan; 5Department of Public Health, Stockholm University, Stockholm, SwedenCorrespondence: Marwan Mosleh Tel +970599859122Email Marwan.mosleh@miun.seBackground: Palestine, like other low-income countries, is confronting an increasing epidemic of non-communicable disease (NCD) and trend of war injury. The management of health problems often presents a critical challenge to the Palestinian health system (PHS). Understanding the perceptions of healthcare providers is essential in exploring the gaps in the health system to develop an effective healthcare intervention. Unfortunately, health research on management of NCD and war injury has largely been neglected and received little attention. Therefore, the study aimed to explore the perspectives of healthcare providers regarding NCD and war injury management in the PHS in the Gaza Strip.Methods: A qualitative study approach was used, based on four focus group discussions (FGDs) involving a purposive sampling strategy of 30 healthcare providers from three main public hospitals in Gaza Strip. A semi-structured topic guide was used, and the focus group interviews data were analyzed using manifest content analysis. The study was approved by the Palestinian Health Research Council (PHRC) for ethics approval.Results: From the healthcare providers perspective, four main themes and several sub-themes have emerged from the descriptive manifest content analysis: functioning of healthcare system; system-related challenges; patients-related challenges; strategies and actions to navigating the challenges and improving care. Informants frequently discussed that despite some positive aspects in the system, fundamental changes and significant improvements are needed. Some expressed serious concerns that the healthcare system needs complete rebuilding to facilitate the management of NCD and war-related injury. They perceived important barriers to effective management of NCD and war injury such as poor hospital infrastructure and logistics, shortage of micro and sub-specialities and essential resources. Participants also expressed a dilemma and troubles in communication and interactions, especially during emergencies or crises. The informants stressed the unused of updated clinical management guidelines. There was a consensus regarding poor shared-care/task sharing, partnership, and cooperation among healthcare facilities.Conclusion: Our findings suggest that fundamental changes and significant reforms are needed in the health system to make healthcare services more effective, timely, and efficient. The study disclosed the non-use of clinical guidelines as well as suboptimal sectorial task-sharing among different stakeholders and healthcare providers. A clear and comprehensive healthcare policy considering the gaps in the system must be adopted for the improvement and development of care in the PHS.Keywords: NCD, management, Palestinian health system, perception, war injury

As a group, newly arrived migrants in Sweden face inequities in health compared to the general population. Successful promotion of population health requires awareness of and focus on health from several sectors of society. In light of this, the aim was to study the views of local authority officials on collaboration in health promotion activities for newly arrived migrants. Data was collected through five focus group interviews with 23 local authority officials working with the integration of newly arrived migrants in the Establishment Program in a municipality or at the Employment Services in northern Sweden. An inductive qualitative latent content analysis was performed, and the analysis showed that the participating officials considered health promotion as desirable in the Establishment Program, but it also raised complex issues within the existing organisations. The officials described unclear roles, but also possible changes to the organisation that would improve the possibility of working to promote health. The present study adds to the relatively limited knowledge of health promotion in integration activities and offers clinical relevance for policymakers through the officials’ suggestions for improvements in the Establishment Program. It also raises important questions for further research.

There is a need for more knowledge about positive health determinants in the school setting. The overall aim of this study was to analyse if positive self-reported health is associated with experiences of school among high-school students. Data originated from the health dialogue questionnaire answered by students in grade 1 of high school. A total of 5035 students participated from the academic years 2013 to 2016. Logistic regression with positive odds ratio (POR) was used to analyse associations between positive self-reported health and school experiences. There was an association between positive self-reported health and school experiences among students. Positive mental health was the strongest predictor for positive school experiences. To frequently participate in Physical Education, have a positive body image and satisfactory sleep nearly doubled the students’ odds for positive school experiences. The results also revealed gender differences; boys more often reported positive experiences of school and positive health than girls. Positive self-reported health is associated with positive experiences of school, particularly mental health. Moreover, these findings have significant implications for how students experience school and demonstrate the importance of including health-promoting interventions in systemic school improvement, meeting both girls’ and boys’ needs.

Officials' reflections about health promotion and power relations among newly arrived migrants

Health promoting factors for newly arrived migrants - Experiences from rural and urban municipalities

Local authority officials' collaboration in health promotion activities for newly arrived migrants

Authority officials' views on organisation and collaboration in health promotion for new arrivals in Sweden

Authority officials' views on health promotion and power relations among new arrivals in northern Sweden

How population density and type of the municipality in Sweden influences health promotion activities for newly arrivals

Background: Resulting from conflicts, millions of peoples have been forced to leave their countries of origin. In Sweden, the Employment Agency is responsible for making decisions of immigrants’ residence in municipalities and in co-operation with these allow the immigrants’ establishment in the society. Preventive interventions among migrants and refugees, and health interventions in heterogeneous populations show that increased participation in society has positive imprints on health development. A new country includes getting acquaintance with non-familiar cultures. For example, other expectations on rules of gender, sickness, and illness. Recent years the low density populated areas in northern Sweden have received a high number of refugees in comparison with their population size. The purpose of this study was to explore how officials the Employment Agency and a selection of municipalities reflect over and define health promoting factors in their meetings with newly arrived. Methods: All officials (N 68) in one of the four northern counties were invited to recording their reflections on health promoting factors close to their meetings with newly arrived. The officials recorded how they defined health promoting factors according to the Audit method. The data collection of experiences of importance considering health promotion and social determinants was collected by five focus group interviews with twenty-three officials. Results: This study showed that the officials defined access to the health care, participation in the society, and sufficient collaboration between the authorities for not losing valuable time during the establishment period as imported factors for their clients’ opportunities for health. The officials take power among males for given, while they more often reflected over lack of power among women. However, the Swedish ideal of gender as equal quite often a challenge the newly arrivals.

This study aimed to analyze how bullying involvement is associated with the distribution of parental background and with subjective health complaints (SHC) among Swedish boys and girls. Data were c ...

Background: Negative impact on health from school disturbance due to asymmetric power relations such as discrimination and offensive treatment are frequent problems among students. This study sought to analyze associations between occurrence of discrimination at schools, participation and psychosomatic problems. Methods: Pupils in grades 6 - 9 in ten schools in a northern Swedish municipality participated in the study. The frequency of discrimination at school was measured by six items: sex; culture or ethnicity; disability; religion beliefs; sexual preferences; and any other form of discrimination. The Social and Civic Objectives Scale (SCOS) was used for an estimation of the level of participation. The pupils’ health was measured by the PsychoSomatic Problem (PSP) scale. Multivariate logistic regression models were used for estimation of increased risk of PSP. The formula Z = d/s(d) was used to test mediation. Results: Two thirds of the boys and three fourths of the girls reported occurrences of discrimination at schools (p = 0.001). Discrimination was a mediating factor between participation and PSP among boys and girls as the mediating formula Z = d/s (d) was > ± 2 SD, -2.59 for boys and -39.27 for girls. Independent of each other, low participation and discrimination were associated with increased risk of PSP. Conclusion: Discrimination was a mediating factor between participation and PSP. The mediating effect was stronger in girls than in boys. There is a need for school health promotion programs focusing on participation in terms of democratic processes, communication and cooperation in the classroom.

The general aim of this study was to explore the associations between foreign extraction and subjective health complaints (SHC) among school-aged children in Sweden. Data were obtained from the global cross-sectional survey Health Behaviour in School-aged Children (HBSC), 1997/1998, 2001/2002, and 2005/2006. A total of 11,972 pupils in grades 5, 7 and 9 participated in the survey. Logistic regression analyses were used to estimate remaining risk of SHC among the subgroups of pupils. The analyses were adjusted for socio-demographic indicators, grade and measurement year. Parental background: Swedish n = 9,585, mixed n = 1,263, and foreign n = 1,124. The results showed an increased risk of SHC among girls with a foreign background OR 1.27 (95% CI 1.04–1.55) compared with girls with a Swedish background and among girls in single-adult households OR 1.42 (95% CI 1.20–1.67) compared with girls in two-adult households. No such differences were shown among boys. A significantly increased risk of ill health remained in girls of foreign background after adjustment for socio-demographic indicators, grade and measurement year.

Aim: To analyse how health risk behaviours (HRB) are clustered and associated with parental background and family wealth among Swedish boys and girls. Methods: Data were collected from Health Behaviour in School-aged Children (HBSC), a global cross-sectional survey for 1997/98, 2001/02, and 2005/06. A total of 11,972 boys and girls in grades 5, 7, and 9 participated in the study. The pupils were categorised in subgroups according to parental background: Swedish (80.0%), mixed (10.6%), and foreign (9.4%). Cluster analyses were used to identify HRB profiles. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, parental background, and family affluence. Results: In total 11,232 pupils were identified and allocated to five cluster profiles, half of them in the cluster profile of low-risk behaviour. The most disadvantaged cluster was multiple HRB, which was characterised by high prevalence of smoking, drunkenness, low physical activity, and high soft-drink consumption. The cluster profile of multiple HRB was associated with both mixed background and foreign background in girls and with mixed background in boys. The cluster profile of inadequate tooth brushing was associated with foreign background in both boys and girls. The cluster profiles of multiple HRB and inadequate tooth brushing were associated with low family affluence in girls. Conclusions: The cluster profiles of multiple HRB and inadequate tooth brushing were associated with parental foreign extraction in boys and girls and with low family affluence in girls. Prevention programmes based on identified clusters of HRB, including consideration of impact of socio-demographic indicators, are needed.