This research used tuberculosis (TB) as a lens to elucidate how migration, settlement, local agency and support networks influence migrants’ health in New Zealand. The study also examined specific characteristics of TB such as delays in diagnosis and the stigma attached to the disease to gain a broader understanding of TB experience for migrants in New Zealand. The research addressed these aims through the analytical framework of political ecology and incorporation of interviews, participant observation and media analysis. Participants in the research included immigrants from Mainland China, South Korea, and India, and New Zealand health care professionals. The study found that immigration policies, social discrimination and isolation have created structural inequalities between dominant host populations and Asian migrants in New Zealand. These inequalities compounded settlement problems such as language difficulties and limited employment opportunities, resulting in low income levels and perceived stress for Indian, Korean and Chinese people, which has affected their health and well being. Transnational policies and experiences of health care systems in immigrants’ countries of origin and in New Zealand strongly influenced health seeking behaviour of migrants, along with structural barriers such as lack of Asian health care professionals and interpreting services. Local cultural and biological factors including health cultures and physical symptoms also affected these practices. In relation to TB, structural processes along with clinic doctor-patient relationships and social stigmas created barriers to diagnosis and treatment. Factors that facilitated access to health care in general, and TB diagnosis and treatment in particular, included the use of support networks, particularly local General Practitioners from countries of origin, and Public Health Nurses, along with flexible TB treatment programmes. This study shows that the incidence and experience of TB is shaped by migration and settlement processes. It also builds upon other medical anthropological studies that have employed political ecology by demonstrating its usefulness in application to developed as well as developing countries. In addition, the study contributes to the growing area of Asian migration research in New Zealand, illustrating that migration and settlement processes are complex and need to be understood as multidimensional, thus demonstrating advantages in approaching them from a political ecological framework. / Human Research Council, University of Auckland

This research used tuberculosis (TB) as a lens to elucidate how migration, settlement, local agency and support networks influence migrants’ health in New Zealand. The study also examined specific characteristics of TB such as delays in diagnosis and the stigma attached to the disease to gain a broader understanding of TB experience for migrants in New Zealand. The research addressed these aims through the analytical framework of political ecology and incorporation of interviews, participant observation and media analysis. Participants in the research included immigrants from Mainland China, South Korea, and India, and New Zealand health care professionals. The study found that immigration policies, social discrimination and isolation have created structural inequalities between dominant host populations and Asian migrants in New Zealand. These inequalities compounded settlement problems such as language difficulties and limited employment opportunities, resulting in low income levels and perceived stress for Indian, Korean and Chinese people, which has affected their health and well being. Transnational policies and experiences of health care systems in immigrants’ countries of origin and in New Zealand strongly influenced health seeking behaviour of migrants, along with structural barriers such as lack of Asian health care professionals and interpreting services. Local cultural and biological factors including health cultures and physical symptoms also affected these practices. In relation to TB, structural processes along with clinic doctor-patient relationships and social stigmas created barriers to diagnosis and treatment. Factors that facilitated access to health care in general, and TB diagnosis and treatment in particular, included the use of support networks, particularly local General Practitioners from countries of origin, and Public Health Nurses, along with flexible TB treatment programmes. This study shows that the incidence and experience of TB is shaped by migration and settlement processes. It also builds upon other medical anthropological studies that have employed political ecology by demonstrating its usefulness in application to developed as well as developing countries. In addition, the study contributes to the growing area of Asian migration research in New Zealand, illustrating that migration and settlement processes are complex and need to be understood as multidimensional, thus demonstrating advantages in approaching them from a political ecological framework. / Human Research Council, University of Auckland

This research used tuberculosis (TB) as a lens to elucidate how migration, settlement, local agency and support networks influence migrants’ health in New Zealand. The study also examined specific characteristics of TB such as delays in diagnosis and the stigma attached to the disease to gain a broader understanding of TB experience for migrants in New Zealand. The research addressed these aims through the analytical framework of political ecology and incorporation of interviews, participant observation and media analysis. Participants in the research included immigrants from Mainland China, South Korea, and India, and New Zealand health care professionals. The study found that immigration policies, social discrimination and isolation have created structural inequalities between dominant host populations and Asian migrants in New Zealand. These inequalities compounded settlement problems such as language difficulties and limited employment opportunities, resulting in low income levels and perceived stress for Indian, Korean and Chinese people, which has affected their health and well being. Transnational policies and experiences of health care systems in immigrants’ countries of origin and in New Zealand strongly influenced health seeking behaviour of migrants, along with structural barriers such as lack of Asian health care professionals and interpreting services. Local cultural and biological factors including health cultures and physical symptoms also affected these practices. In relation to TB, structural processes along with clinic doctor-patient relationships and social stigmas created barriers to diagnosis and treatment. Factors that facilitated access to health care in general, and TB diagnosis and treatment in particular, included the use of support networks, particularly local General Practitioners from countries of origin, and Public Health Nurses, along with flexible TB treatment programmes. This study shows that the incidence and experience of TB is shaped by migration and settlement processes. It also builds upon other medical anthropological studies that have employed political ecology by demonstrating its usefulness in application to developed as well as developing countries. In addition, the study contributes to the growing area of Asian migration research in New Zealand, illustrating that migration and settlement processes are complex and need to be understood as multidimensional, thus demonstrating advantages in approaching them from a political ecological framework. / Human Research Council, University of Auckland

This research used tuberculosis (TB) as a lens to elucidate how migration, settlement, local agency and support networks influence migrants’ health in New Zealand. The study also examined specific characteristics of TB such as delays in diagnosis and the stigma attached to the disease to gain a broader understanding of TB experience for migrants in New Zealand. The research addressed these aims through the analytical framework of political ecology and incorporation of interviews, participant observation and media analysis. Participants in the research included immigrants from Mainland China, South Korea, and India, and New Zealand health care professionals. The study found that immigration policies, social discrimination and isolation have created structural inequalities between dominant host populations and Asian migrants in New Zealand. These inequalities compounded settlement problems such as language difficulties and limited employment opportunities, resulting in low income levels and perceived stress for Indian, Korean and Chinese people, which has affected their health and well being. Transnational policies and experiences of health care systems in immigrants’ countries of origin and in New Zealand strongly influenced health seeking behaviour of migrants, along with structural barriers such as lack of Asian health care professionals and interpreting services. Local cultural and biological factors including health cultures and physical symptoms also affected these practices. In relation to TB, structural processes along with clinic doctor-patient relationships and social stigmas created barriers to diagnosis and treatment. Factors that facilitated access to health care in general, and TB diagnosis and treatment in particular, included the use of support networks, particularly local General Practitioners from countries of origin, and Public Health Nurses, along with flexible TB treatment programmes. This study shows that the incidence and experience of TB is shaped by migration and settlement processes. It also builds upon other medical anthropological studies that have employed political ecology by demonstrating its usefulness in application to developed as well as developing countries. In addition, the study contributes to the growing area of Asian migration research in New Zealand, illustrating that migration and settlement processes are complex and need to be understood as multidimensional, thus demonstrating advantages in approaching them from a political ecological framework. / Human Research Council, University of Auckland

This thesis aims to provide insight into how academic institutions teach health care professionals about cultural influences on mental health and clinical encounters, as well as how health care providers implement these ideas in their work. Fifteen semi-structured interviews were conducted with mental health care providers in Hamilton. Providers varied significantly in their definition and experience of cultural competence. Few providers had received training in cultural competence, and the experiences of those who had received such training were generally not congruent with what is described in the literature. While the literature describes a shift towards a skills-based paradigm, health care education appears to continue to focus on knowledge and attitudes. Many providers are more familiar with other frameworks for addressing cultural issues; however, these have important implications for quality and access to care for migrant and newcomer individuals. / Thesis / Master of Science (MSc)

No

Migration has become an important feature of health labour markets due to the global shortage of health professionals. While there exists an extensive Labour Economics literature studying the general migration, policy development remains hampered by limited research undertaken in the health sector. This thesis fills some of that gap by examining the economic influences on and impacts of the migration of health professionals. The migration of skilled health professionals has exhibited strong sectoral properties, such as the motivation of career development and various regulatory regimes. We incorporate these features into the self-selection model by Borjas and Bratsberg (1996) and examine factors that influence the scale and skill composition of the migration flow. Our model suggests that the restrictive relicensing regime and work permit requirements for non-EEA professionals adopted by the British government to maintain practice standards and secure employment opportunities for native graduates, could only limit the migration from countries with higher returns to skills. The effect is ambiguous for most donor countries, which provide lower returns to skills.Using the administrative data derived from the Scottish dental system, we also examine the impacts of health professional migration within EU on the host country by investigating the performance of EEA dentists contracted under the Scottish NHS in terms of retention and treatment provision. A discrete-time survival analysis has been applied to characterize the time trend of the retention and identify factors associated with the likelihood of a dentist leaving the NHS. We also compare treatments provided by migrant and non-migrant dentists by estimating a difference-in-differences model. Unobserved heterogeneity in dentists is controlled using fixed effects.Our results suggest that EEA health professionals can be a good substitute to British graduates. They provide marginally different treatments and exhibit strong assimilation within two years post-entry. However, a constant issue we have found is their high turnover rates in the NHS: half of them left the service by the 26th month following entry. The primary policy recommendation of our analyses is that there is need for the government to develop recruitment initiatives so as to retain migrant dentists. Our results suggest hazards of leaving are significantly associated with dentists’ age-at-entry, arrival cohort and patient composition, but not with dentists’gender, country and practice deprivation. These findings potentially help to set evidence-based targets for international recruitment programmes

<b>Background:</b> Perinatal depression is a significant contributor to maternal morbidity and mortality worldwide. Left untreated, perinatal depression has severe and far-reaching consequences for women, their families and wider society. Migrant women, including labour migrants and refugees, may be particularly prone to developing perinatal depression as a result of multiple stressors associated with displacement. Despite the vast majority of global migration flows occurring within low- and middle-income countries, evidence from these regions is severely lacking. This research addresses this imbalance by examining perinatal depression in migrant women living on the Thai-Myanmar border: a resource-poor setting of political tension and socio-economic disadvantage. <b>Aims:</b> This research aims to review the existing evidence around perinatal depression among migrant women from low- and middle-income settings; identify an appropriate tool to detect perinatal depression in migrant women on the Thai-Myanmar border; determine the prevalence of, and risk factors for, perinatal depression in this setting; explore women's experiences of perinatal depression; and develop recommendations for policy and practice. <b>Methods:</b> A sequential-exploratory mixed-methods design was used. The research included the following five study components: a systematic literature review; a validation study to identify a culturally-acceptable and appropriate assessment tool; a prospective cohort study of migrant women on the Thai-Myanmar border followed-up from the first trimester of pregnancy to one month post-partum; in-depth interviews with a subgroup of women with severe perinatal depression; and an informal exploration of stakeholder views. <b>Findings:</b> The systematic review found a wide range in prevalence of perinatal depression among migrant women and confirmed the absence of studies conducted in low-and middle-income destination countries. A total of 568 migrant women on the Thai-Myanmar border participated in the prospective cohort study, of whom 18.5% experienced moderate-severe depression and 39.8% experienced depression of any severity during the perinatal period. Almost a third (29%) of women reported suicidal ideation. Interpersonal violence (OR 4.5), experience of trauma (OR 2.4), a self-reported history of depression (OR 2.3) and perceived insufficiency of social support (OR 2.1) were significantly associated with perinatal depression. Lives of women with severe perinatal depression were characterised by difficult partner relationships, alcohol use among partners and interpersonal violence. A lack of mental health services currently limits the effective management of perinatal depression in this setting. Alongside training of health staff, primary, secondary and tertiary prevention efforts are required to effectively address perinatal depression on the Thai-Myanmar border.

Health financing policies implemented by nations around the world vary based on who receives coverage and what health system resources are covered. Although, many health systems are attempting to move towards Universal Health Coverage, part of their populations continue to incur out-of-pocket payments for using all or some health services. Some health systems restrict health insurance for certain migrant populations, providing coverage for emergency care only, or none at all. Other health systems fail to provide coverage for prescription drugs, leaving those without the ability to pay out-of-pocket for medications behind. The lack of financial protections against catastrophic or impoverishing healthcare expenditures for these patients may deter them from seeking the care they need or increase the risk of severe financial hardships. This dissertation addresses these migrant and drug coverage gaps by examining the impacts of health financing policies and how these can be changed to move health systems towards Universal Health Coverage. First, this dissertation examines restrictions to refugee health policy in Canada by conducting an interpretive policy analysis to reveal how political actors strategically use causal stories to enact policy change. Second, quantitative studies assessing the effects of health insurance on migrants’ health-related outcomes are systematically reviewed. Third, this dissertation explores a provincial health system without universal prescription drug coverage to establish associations between health services use, prescription drug coverage and immigrant category. Finally, given migrants experience health outcome and health services utilization disparities, an exploratory analysis of factors that impede or assist migrants’ access to prescription drugs is conducted to uncover how these factors influence their health. While each study is distinct, together, these chapters build on each other using mixed methodological approaches to identify ways that address health financing policy gaps to reduce health inequities, build inclusive and cost-effective health systems and strengthen global health security. / Dissertation / Doctor of Philosophy (PhD)

Oral health plays an integral role in our general health, wellbeing, and quality of life. Practicing evidence-based oral hygiene behaviors prevent oral diseases and improve systemic health. The burden of preventable oral diseases persists worldwide and weighs particularly heavy on specific population groups. While many studies have explored oral health among those of advanced age, children, and minority groups, there are a very few exploring the oral health care needs of postsecondary students, specifically those born outside of the United States (U.S.). Recognizing this gap in the literature, this study sought to gain a better understanding of oral health access among non-US born postsecondary students with a goal of identifying factors affecting their oral health behaviors. To achieve the objectives of this explorative study, a cross-sectional study design was implemented. A 30-question survey was provided to individuals born outside the U.S. and currently enrolled in postsecondary educational institutions. Descriptive statistics was presented, and a quantitative analysis was performed. The study results suggest that foreign-born postsecondary students may perceive oral health care in the U.S as inaccessible due to economic barriers such as costs and lack of insurance. Moreover, it was found that this population is less likely to visit a dentist because they cannot find a "convenient time" or because they believed their "mouth is healthy". Factors associated with perceived improvements in oral hygiene behaviors included enrollment in postsecondary education and the number of years they've resided in the U.S. Conversely, factors associated with a decline in perceived oral hygiene behaviors included school-induced stress and acculturative stress. It was also found that on-campus dental clinics were less frequently utilized than off-campus dental clinics, with many preferring to receive oral health care outside of the U.S. Citizenship status was also found to be a factor influencing student's oral health seeking behaviors.