A good summary of the situation in Switzerland

Spang T. and Zuppinger B., Switzerland: immigrants facing poverty and social exclusion – the Migration and Public Health Strategy, in: Poverty and social exclusion in the WHO European Region: health systems respond. Copenhagen, WHO Regional Office for Europe, 2010, pp.196-204

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Summary, p.196

Foreigners comprise about a fifth Switzerland’s population, and immigrants comprise about a third. Overall, there are inequalities in health status between immigrants and Swiss nationals. The immigrant population faces difficult socioeconomic and working conditions, uncertainties about residence status and greater exposure to risks to health, including unhealthy behavior. It also faces a lack of information, lower participation in sickness-prevention activities and various deficiencies in Switzerland’s health care system, such as lack of interpreting services and underdeveloped transcultural skills. Switzerland has recently increased its efforts to integrate foreigners and is elaborating appropriate cross-sectoral policies. 

The programme described in this case study is the Federal Offi ce of Public Health’s Migration and Public Health Strategy, which was implemented between 2002 and 2007 and has recently been refi ned and extended until 2013. The programme comprises activities and projects in fi ve areas: (1) education; (2) public information, prevention and health promotion; (3) health care provision; (4) therapy for traumatized asylum seekers; and (5) research. The case study describes the programme, providing information about its implementation, its effects and the lessons learned.The Migration and Public Health Strategy addresses health determinants, including access to the health system, discrimination and cultural attitudes. It also addresses health literacy, substance abuse, smoking, unsafe sex, eating habits and physical activity. To various degrees, it aims to ensure accessibility, acceptability and quality of health services.

The programme’s main achievements were to put immigrant health on the health system agenda and to raise the visibility of
problems and needs in this area. Various projects also contributed to direct improvements for the target group, the immigrant
population. The greatest challenge was to increase awareness of the issue among the diverse actors and stakeholders of the
Swiss health system and within the Federal Administration. Various educational activities have helped to build specific human
resource capacities (such as interpreters and nursing staff). Possible improvements have been identified at the strategic and
institutional level (such as agenda setting, mainstreaming the health of migrants as an issue to be addressed in policies and
programmes, and the creation of cross-sectoral networks), for greater involvement of key integration-policy actors and further
promotion of so-called cultural change in the health system.