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The Covid-19 pandemic has had a major impact on migrants and ethnic minorities (MEMs). Socio-economic factors and legal, administrative and language barriers are among the reasons for this increased susceptibility. The aim of the study is to investigate the impact of Covid-19 on MEMs compared to the general population in terms of serious outcomes. We conducted a systematic review collecting studies on the impact of Covid-19 on MEMs compared to the general population in the WHO European Region regarding hospitalisation, intensive care unit (ICU) admission and mortality, published between 01/01/2020 and 19/03/2021. Nine researchers were involved in selection, study quality assessment and data extraction. Of the 82 studies included, 15 of the 16 regarding hospitalisation for Covid-19 reported an increased risk for MEMs compared to the white and/or native population and 22 out of the 28 studies focusing on the ICU admission rates found an increased risk for MEMs. Among the 65 studies on mortality, 43 report a higher risk for MEMs. An increased risk of adverse outcomes was reported for MEMs. Social determinants of health are among the main factors involved in the genesis of health inequalities: a disadvantaged socio-economic status, a framework of structural racism and asymmetric access to healthcare are linked to increased susceptibility to the consequences of Covid-19. These findings underline the need for policymakers to consider the socio-economic barriers when designing prevention plans.

Background During 2016–17, national guidelines were developed in order to provide evidence-based recommendations on health assessments for migrants and asylum seekers upon their arrival in Italy. Methods Scientific literature published between 2005 and 2016 was searched in different databases. A free search was also performed on international organizations’ websites in order to identify additional relevant documents. A multidisciplinary panel discussed the resulting evidence and formulated recommendations. Results Evidence-based recommendations were formulated: signs and symptoms of specific diseases should to be actively searched for active TB, malaria, STI, intestinal parasites, diabetes, anaemia. In case of other health conditions (latent TB, HIV, HBV, HCV, STI, strongyloides, schistosoma, diabetes), testing should be offered to asymptomatic subjects coming from endemic areas or exposed to risk factors. Mass screening is recommended for anaemia and hypertension; a pregnancy test should be considered, while inclusion in cervical cancer screening and vaccination programs is recommended. A modulated, progressive approach was developed, covering an initial evaluation during rescue operations, a full medical examination at first line reception stage and the referral to national health services during second line reception. Conclusions It is important to produce and periodically update guidelines on these issues and local peculiarities should be taken into account in their design and implementation. Guidelines can not only support economic sustainability, but also counteract stigmatization dynamics.

Limited evidence exists on migrants with disability. A comprehensive assessment is mandatory required to organize specific services within the community and reception centers. The present study explores needs of refugees and asylum seeker within a community-based inclusive development framework.To interview migrants, in this study we used the Community-Based Rehabilitation Indicators (CBR-Is) developed by the World Health Organization.The sample consisted of 41 people with disability and 59 without disability. Sample was homogeneous for gender and age. Our findings reveal how migrants with disability experienced poor outcomes in each domain of CBR-Is, namely health, education, livelihood, social end empowerment.Differences between migrants with and without disabilities have some distinctive features. However, both groups are influenced by the social determinants of health: in addition to health issues, challenges in social life, livelihood and empowerment also clearly emerge. Different stakeholders are invited to promote inclusive communities, facilitating access to social and health services.

During the pandemic, most governments around the world temporarily closed educational institutions to contain the spread of the Coronavirus Disease 2019 (COVID-19). The objective of the present study is to evaluate the efficacy of an e-learning course on COVID-19 transmission for healthcare university students, in order to advance the preparedness of healthcare university students against contracting COVID-19 within the general university population. The e-learning course was run using a free web service for education. Access to the course was limited to participants enrolled in degree courses related to healthcare professions within the Italian university system. A specific and validated questionnaire was administered at two different times (pre-test and post-test). A paired sample t-test was then used to evaluate their knowledge on COVID-19. Furthermore, a questionnaire measuring their satisfaction was distributed. Data were analyzed from a qualitative point of view. The course was made available from March to July 2020. Over 25,000 students from different Italian universities and various backgrounds participated in the course. The analysis of final test scores revealed that approximately 97% of participants acquired new knowledge and skills on COVID-19, with a statistically significant improvement (p < 0.05). Therefore, it is possible to state that most students enrolled in degrees relating to healthcare at Italian universities are adequately trained with respect to COVID-19 knowledge. Furthermore, students declared a high satisfaction rate both with the course content, and with the management of the telematic platform used.

Health conditions of asylum seekers and immigrants during the COVID-19 pandemic have worsened: the analysis in this chapter refers to the first wave of the pandemic (until August 2020). Early evidence from Anglo-Saxon countries, which showed a disproportionate impact for the foreign population and “ethnic minorities”, was confirmed also by the Italian data of resident foreigners. In addition, management problems were found with respect to the infection containment in the reception facilities and phenomena of social stigmatization were highlighted. The impact was generally worst for socially disadvantaged groups, the available data support a non-biological origin but linked to the role of social determinants, highlighting a theme of equity.

Issue Migrants have suboptimal vaccination coverage compared to the general population in destination countries due to several factors -administrative barriers or lack of legal entitlements to health -health system barriers (language, lack of cultural sensitivity and community engagement capacity, vaccination costs) -lack of trust in the health system and misconceptions about vaccines due to misinformation or beliefs Problem Countries should develop national policies and ensure an inclusive, free of charge and proactive vaccination offer to migrants, irrespective of their legal status; and to extend this approach beyond the current pandemic and the sole COVID-19 vaccine Results To achieve COVID-19 global herd immunity all population groups, including migrants, needs to access vaccination. Tailored vaccination strategies, once devised, shall be applied to routine national vaccination plan to tackle health inequalities Lessons The following actions shall be implemented at national level Action 1. Develop tailored and equitable approaches for PH vaccination services targeting migrants through: -free of charge access -decentralization and outreach capacity of the health system -innovative service delivery models (mobile clinics, combined health services, mass vaccination) -health personnel and migrants participatory approach and engagement strategies Action 2. Increase staff engagement through: -increasing health personnel's difference sensitivity -strengthening health personnel's communication capacities Action 3. Increase migrants' health and vaccine literacy through: -establishing vaccine literacy education programmes and strategies -offering health promotion educational interventions Action 4. Monitor progress of inclusive vaccination offer by: -setting strategic goals, targets and indicators for national vaccination plans -expanding immunization information systems to monitor vaccination coverage, with appropriate disaggregation by migration status core variables Key messages Explicitly and proactively include migrants and displaced communities in vaccination plans and set up, test and implement new approaches in primary prevention and vaccination services. Extend this approach beyond the current pandemic and the sole COVID-19 vaccine in order to enhance preparedness to present and future health threats.

Community-based rehabilitation (CBR) is a multi-sectorial community strategy for guaranteeing that people with disabilities enjoy the same rights and opportunities as all other community members. CBR is organized in a five-component matrix—namely, health, education, social, livelihood, and empowerment. To measure the effectiveness of CBR, the World Health Organization (WHO) has developed standardized indicators. The objective of the present study is to translate and validate the CBR indicators (CBR-Is), providing preliminary evidence of their use for disability in Italy. After obtaining permission from the WHO, the CBR-Is followed a process of translation and cross-cultural adaptation according to international guidelines. An examination of internal consistency and reliability was than performed. The intra-rater reliability was estimated using the Intraclass Correlation Coefficient with a 95% confidence interval. In order to measures the differences between people with and without disabilities, an independent sample t-test was used for quantitative indicators. The Italian version of the CBR-Is (IT-CBR-Is) was administered to 234 people. The internal consistency showed a good value, with a Cronbach’s alpha coefficient of 0.862, and the intra-rater reliability analysis showed solid values for each domain (range: 0.723–0.882). Statistically significant differences between people with and without disabilities were found for each domain of the CBR matrix—namely, health, social, education, livelihood, and empowerment. The IT-CBR-Is are consistent and reliable measures when used to investigate disability in a community-based inclusive development perspective. National stakeholders can now have specific indicators to implement services and actions for people with disabilities.

It is notable that indoor environment quality plays a crucial role in guaranteeing health, especially if we consider that people spend more than 90% of their time indoors, a percentage that increases for people on low income. This role assumes even further significance when dealing with distressed urban areas, vulnerable areas within cities that suffer from multiple deprivations. The community-based interdisciplinary research-action group of the University La Sapienza focused on a complex in the outskirts of Rome. The aim was to assess the correlations between architectural aspects of the indoor environment, socio-economic conditions, such as lifestyles and housing conditions, and eventually health outcomes. The intent of providing a comparative methodology in a context where official data is hard to find, led to the integration of social, health, and housing questionnaires with various environmental software simulations. What emerged is that underprivileged housing conditions, characterized by mold, humidity, unhealthiness, thermohygrometric discomfort, architectural barriers, and overcrowding, are often associated with recurrent pathologies linked to arthritis, respiratory diseases, and domestic accidents.

to describe hospitalisation, access to emergency care, and mortality of people living in marginalized urban areas which include public housing buildings in the North-West suburb of Rome, and to compare the results with those observed among people living in the neighbouring area.cross sectional study.resident population in the XIII and XIV Municipality of Rome, subdivided into five urban areas, in 2011-2018.hospitalisation, access to emergency care, and mortality rates and rates ratios based on hospital discharges and emergency department visits derived from the Health Information Systems and from the Mortality Registry of Lazio Region (Central Italy), stratified by urban areas.the results show a higher use of hospital assistance and emergency care services as well a higher mortality among residents of urban areas characterized by marginalization and social disadvantage in the North-West suburb in Rome, compared to the surrounding area. The association is stronger for the residents of ex-Bastogi, a compound particularly marginalised and socially disadvantaged, where excesses in hospitalisation, emergency care admission, and mortality of +60%, +150%, and +140%, respectively, occurred.the excesses of hospital use, emergency care visits, and mortality observed among the residents of marginalized urban areas suggest the need to reorganize the preventive and primary care services considering the socioeconomic disadvantage in such housing contexts. The use of both qualitative and quantitative approaches allows to understand the complexity of such contexts.

Background Global health education (GHE) in Italy has spread since the first decade of 21st century. The presence of global health (GH) courses in Italy was monitored from 2007 to 2013. In 2019, a new survey was proposed to assess the availability of educational opportunities in Italian medical schools. Methods An online survey was carried out using a questionnaire administered to a network of interested individuals with different roles in the academic world: students, professors, and members of the Italian Network for Global Health Education. The features of courses were analysed through a score. Results A total of 61 responses were received from affiliates of 33 out of the 44 medical schools in Italy. The national mean of GH courses for each faculty was 1.2, reflecting an increase from 2007. The courses increased nationwide, resulting in a dispersed GHE presence in northern, central and southern Italy. One of the most critical points was related to the nature of “elective” courses, which were not mandatory in the curricula. Enrollees tended to be students genuinely interested in GH issues. Some community and service-learning experiences, referred to as GH gyms, were also detected at national and international levels. Conclusions GHE has spreading in Italy in line with the vision of the Italian Network for Global Health Education. Although progress has been made to disperse GH courses around the country, more academic commitment is needed to include GH in the mandatory curricula of medical schools and other health faculties.

Background Service-learning experiences, informed by the realities of poverty and marginalization, are important for the education of future health professionals in order to commit them to tackling health inequalities and working with underserved populations. At the Caritas Medical Centre for undocumented migrants and homeless in Rome, students obtain an educational experience of service. The aim of this study is to try to measure the long-term impact of this experience on the professional and life choices of the student participants. Methods A questionnaire was designed and distributed by email to all 19–29 years old participants in the experience. Responses were collected and analysed in a quantitative descriptive way and in a qualitative way using the knowledge, skills and attitudes model. Results One hundred and seven students responded from the total 763 questionnaires distributed. Ninety-five percent of participants expressed a very high overall satisfaction, 93% declared that the experience influenced his/her future personal choices, and 84% found that the experience influenced their professional choices. Results were arranged into 6 categories of comments: knowledge about the realities of migration, poverty, and marginalization; relational skills; collaborative skills; attitudes towards migrants, poor people and others; Attitudes towards future professions; Attitudes towards life. A final category was listed with self-reflective questions related to the experience. Conclusion This research shows the importance of service-learning experiences made during academic studies from young students of medicine and other faculties. Developing a relationship with marginalized and homeless people, within a voluntary service setting, can influence the future professional and personal choices of students. Universities should recognize the value of such experiences and establish partnerships with non-profit organizations to allow future health professionals to confront health inequities and commit themselves to their reduction.

Background: Global health education (GHE) in Italy has spread since the first decade of 21st century. The presence of global health (GH) courses in Italy was monitored from 2007 to 2013. In 2019, a new survey was proposed to assess the availability of educational opportunities in Italian medical schools. Methods: An online survey was carried out using a questionnaire administered to a network of interested individuals, with different roles in the academic world: students, professors, and members of the Italian Network for Global Health Education. The features of courses were analysed through a score.Results: A total of 61 responses were received from affiliates of 33 of the 44 medical schools in Italy. The national mean of GH courses for each faculty was 1.2, reflecting an increase from 2007. The courses increased nationwide, resulting in a dispersed GHE presence in northern, central and southern Italy. One of the most critical points is related to the nature of “elective” courses, which are not mandatory in the curricula: enrollees tend to be students genuinely interested in GH issues. Some experiences of community and service-learning experiences, referred to as GH gyms, were also detected at national and international levels.Conclusions: GHE is spreading in Italy, coherently with the vision of the Italian Network for Global Health Education. Although progress has been made to disperse GH courses around the country, more academic commitment is needed to insert GH in the mandatory curricula of medical schools and other health faculties.

Background The Universal Health Coverage (UHC) proposes that an ideal health system must be able to extend the health coverage to the whole population (universality), to guarantee all the necessary services (globality) and to do it without additional direct costs for the people (free of charge). The achievement of the UHC represents the target 3.8 of the Sustainable Developed Goals. The World Health Organization and the World Bank have developed an index to monitor the UHC (an algorithm that contains 16 indicators of essential health services), while for financial protection they rely on the incidence of catastrophic expenditure on health (percentage of families in which the living expenses for health without reimbursement exceed the10% of consumption). Objectives To strengthen the Italian operators' knowledge about the accessibility to health services in Italy and in countries around the world utilizing the UHC index and the incidence of catastrophic expenditure. Results The National Center for Global Health of the Italian National Institute of Health (ISS) collected the documents and the data already produced and validated by the international scientific community. ISS in collaboration with the Department of Public Health and Infectious Disease of Sapienza University of Rome developed a workshop training program to bring the UHC concepts at national level in a simplified manner. This was developed in order to encourage a reflection and to strengthen the understanding of the complexity of the UHC. The framework and the program of the workshop will be presented during the conference. Conclusions Studying the UHC means focusing on the inequalities in health care. To increase the sensibility of professionals may be a resource to promote the health coverage for all in the national territory. Key messages Encouraging the discussion between professionals is possible to understand the complexity of the UHC. The achievement of the UHC may happen only through the improving of the knowledge about it.

The Social Determinants of Health (SDHs) are well known for their interaction on health outcomes and they can have a stronger impact on migrant health whom have higher probability to live in precarious living and working conditions compared to the hosting population. Migrant health is a public health issue which has to be considered taking into account the SDHs and complementary, including cultural issues is fundamental for addressing health equity in the society as a whole. Recognising this challenge, this study aims to evaluate the interactions between education and mental health of resident population in Italy, including Italians and immigrants. This study examined the respondents in 2014-17 to the Italian “Progressi delle Aziende Sanitarie per la Salute in Italia” (PASSI) surveillance system. The sample of 118,639 respondents is composed by the residing working adults aged 25-69 with Italian citizenship (n = 112,345) and foreign citizenship (n = 6,294). Looking at SDHs, if for Italians high level of education appears to be a protective factor of mental health in accordance with the international evidence (adjPR: tertiary education 0,87 95%IC 079-0,97), among immigrants higher level of education it is more associated with the presence of depressive symptoms (adjPR: tertiary education: 1.77 95%IC: 1.19-2.63). Longer the length of stay in Italy for PFPM immigrants higher the risk of depressive symptoms: adjPR for 10+ years: 5.1 95%IC: 1.29-4.3. The data show that high education could represent a risk factor for mental health of immigrants. Considering that health is related to the nature of society as well as to access to technical solutions, multicultural societies require culturally oriented interventions for tackling health inequities. This means developing evidence-based policies in order to tackle health inequalities in the population as a whole, including culturally oriented measures in the larger framework of developing diversity sensitive services. Key messages For some groups of population, such as migrants, high education could represent a risk factor for mental health. Developing diverse sensitive policies is needed in order to tackle health inequities in the population as a whole.

Background Global health education (GHE) is spreading in Europe and in other parts of the world. Since 2008, Sapienza University of Rome has offered activities to medical and other health profession students related to global health (GH), which is grounded in the theory of social determinants of health and inspired by social justice. The educational activities included elective courses as well as community and service-learning experiences, referred to as GH gyms. This study attempts to measure the long-term impact of these educational experiences, especially to demonstrate their influence on the perceived social responsibility of future health professionals. Methods A questionnaire was elaborated and tested on a small sample of participants. It was sent to participants by e-mail. Quantitative results were analysed through descriptive statistics and qualitative answers were carefully read and classified. Results A total of 758 students from different faculties took part to the educational experiences. Only 488 e-mail addresses were available. One hundred and five (21.5%) questionnaires were returned. Participation in GH gyms was perceived to have had a higher influence on future professional and personal choices, when compared to participation in elective GH courses. Conclusions The study shows that consideration of health and social issues related with inequities in health and the use of interactive teaching methodologies had important effects on social responsibility of a large number of students. As there could be a selection bias among respondents, more research is needed to understand the impact of GH educational experiences. The inclusion of global health education in health and social curricula and the use of interactive methodologies with a correct evaluation of results are the indications that emerge from this research, together with the necessity of a strong involvement of students, professors and the whole academic reality.

The crisis faced by the Western lifestyle model when dealing with problems associated with climate change and the new roles that cities and buildings must play in a world of globalisation fosters the rise of a new approach that marks a necessary turning point for our civilisation. For decades now, the fight against climate change has seen many of the world’s most important countries committing themselves to agreements—from the Kyoto Protocol of 1992 to the Paris COP21 in 2015—that are gradually getting better at establishing goals, strategies and actions for improving quality of life and protecting the entire planet, even if some venture doubts on the concrete possibility of achieving them.

The history of the urbanization process can determine the social identity of specific places and neighbourhoods. Understanding historical processes behind the physical environment of a city is the first step in an action-research in an urban setting. The characterisation of a neighbourhood, especially in a deprived and segregated urban context, requires a multidisciplinary approach that cannot be separated from a dedicated quantitative analysis, integrating various tools and approaches. In this study’s setting, defined by a high level of informality due to a history of exclusion from the surrounding area and a structural segregation from the city’s fabric, the integration of tools and point of views had to be used to detect and assess the presence of any inequalities in health. We used administrative health data, census information, and a customised version of a national health survey, integrating different baseline populations in order to develop a global vision of the state of health. This research also includes an evaluation of social determinants of health, hospitalisation rates and access to the emergency room, as well as the general self-perception of the population’s health compared to the surrounding neighbourhoods.

In some urban areas, there are veritable islands of spatial segregation, whose effects on health are current the subject of in-depth analysis. However, these studies involve disciplines and expertise that too often lack proper interaction. This action research project was developed through the community-based approach. Moreover, a research model and structured intervention were created in order to adequately grasp the complexity of the relationships among health disparities, socio-environmental and economic distress in an “ecological” perspective of health. The proper study of social determinants of health and their unequal spatial distribution can allow researchers to reach significant, fair and lasting solutions in order to challenge and reduce disparities in health.

Background Migrants represent a potential vulnerable group and adequate health protection, including vaccine preventable diseases prevention, should be ensured. The aim of this survey was to map national immunization policies and practices targeting asylum seekers, refugees and irregular migrants in EU/EEA countries. Methods A web-based cross-sectional survey was conducted in 28 EU and 2 EEA countries within the ECDC funded Vaccine European New Integrated Collaboration Effort (VENICE) Project in the period January-April 2018. Results All countries but one completed the survey and 28 countries offer vaccination to migrants. A national regulation/legal framework supporting migrant immunization is available in most countries. This is specifically established for migrants' health services for 5, part of the National Immunization Programme (NIP) for 15 and both for 3 countries. All the vaccinations included in the NIP appropriate for age are offered to children/adolescents in 27 countries and to adults in 13. In 15 countries offering only certain vaccinations to adults, priority is given to DT, MMR and polio. Vaccinations are mainly given at holding/community level and only 5 countries vaccinate at entry level. A vaccination card is delivered in 23/28 countries to children/adolescents and 24/28 to adults. Recording of individual data vary highly: for children/adolescents and adults, respectively, 15 and 12 countries use an electronic database, 5 and 4 use only paper registry, 2 and 3 use both electronic and paper registries, while 6 and 9 countries do not record information at all. Individual and aggregated data are not made available from the sites where vaccinations are delivered to other local or national institutions in 13 and 15 countries. Conclusions Although policies about immunization of migrants are available in most of EU/EEA countries, there are important differences as to their objectives and implementation, especially methods of recording and transmitting data. Key messages Given the survey results and the migrants’ mobility, it is important to share data within and across countries to better respond to migrants' immunization needs. Strengthening partnerships between countries of origin, transit and destination, and sharing documentation may ensure the completion of vaccination series and avoid unnecessary revaccinations.

Introduction Health and safety of foreign workers employed in agriculture and zootechny present several critical areas. The multidisciplinary project ’Livingstone’, funded by INAIL and carried out by several Italian universities, aims to address some of these critical issues. One of the project research line focuses on health professionals and has the objective to investigate their perception of the risks to which foreign workers are exposed and their training needs. Methods A 33 items questionnaire is being self-administered to social and health professionals of three Italian regions (Lazio, Lombardia and Campania) where agriculture is developed; the administration phase will last 13 months (2018, April - 2019, May). The questionnaire has been built starting from a literature review; a pilot study have been conducted in a pilot sample in Rome in March 2018. The questionnaire is composed by five sections: general, social and professional information; characteristics of the respondents’ foreign patients/users; knowledge about health problems of foreign patients and about possible obstacles in use of health services, with a specific focus on foreign patients working in agriculture and zootechny sector; perception about health and safety risks of these workers; training background and needs, included desired training contents and modalities. Results The research is ongoing. 238 answered questionnaires have been collected yet. 65 of the respondents are General Practitioners; the rest are other health and social professionals. The complete results will be shown during the congress. Conclusions This study will contribute to widen the knowledge about health professionals’ perceptions about problems and needs of foreign workers employed in agriculture and zootechny sector. Specific training addressed to social and health professionals will be developed from the observation of their current knowledge and from their reported needs. Key messages This study will contribute to widen knowledge about health professionals’ perceptions about problems and needs of foreign workers employed in agriculture and zootechny sector. Specific training addressed to social and health professionals will be developed from the observation of their current knowledge and from their reported needs.

The study reports an urban health investigation conducted in Bastogi, an outskirt of Rome (Italy) characterised by social marginalization and deprivation. Our aim was to analyse the health perception, health-related behaviours, and interaction with healthcare professionals of the inhabitants of Bastogi compared to the population living in the area of the same local health unit (ASL). The Progresses of Health Authorities for Health in Italy questionnaire (PASSI) was administered to a sample of 210 inhabitants of Bastogi. Data were analysed and compared to those of the ASL collected in 2017–2018. The socio-economic indicators showed an overall worse condition for the inhabitants of Bastogi, with a significantly higher proportion of foreign and unemployed residents and a lower educational level compared to the ASL. Significant differences in the prevalence of non-communicable diseases, mental health complaints, and participation in prevention strategies, including cancer screening, were found. The questionnaire showed a lower help-seeking behaviour and a lack of reliance on health professionals in Bastogi inhabitants. Our findings highlight how social determinants produce health inequities and barriers to accessing healthcare. The difficulties of conducting quantitative research in complex and hard-to-reach contexts, characterized by high social vulnerability, are outlined.