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The refugee crisis in Europe: will it increase disparity in women′s health?

Diseases are biological events, but they are influenced by socio-economic and cultural factors. Differences in disease prevalence and associated morbidity/mortality are closely linked not only to genetic predisposition to disease, treatment response, environmental exposure, food habits and lifestyle factors, but also to unequal access to healthcare services due to communication barriers, poverty, cultural beliefs and preferences leading to differences in utilization of health services. Health disparities caused by differences that are avoidable are unfair and unjust. Although interventions leading to biological change, such as vaccination, are shown to be effective in preventing diseases, policies to improve population health often require socio-political change. The level of economic development, educational achievements and healthcare policy of a nation generally determine the health and wellbeing of its citizens. Nordic countries have been doing well in this regard, as they have conciously promoted race and gender equality avoiding social discrimination, and traditionally these nations have taken responsibility for providing universal access to education and health services to their citizens. However, Nordic countries have a more homogenous population compared with some other countries, such as the UK and USA. How much the current situation of an increasing number of European migrants will change the population demographics in the Nordic countries remains to be seen, but immigrants and ethnic minorities have been consistently shown to have poor health outcomes all around the world. Approximately 1.2 million people have sought asylum in the European Union since the start of 2014. According to the United Nations High Commissioner for Refugees, there were some 142,207 refugees in Sweden, 17,785 in Denmark, 47,043 in Norway, 11,798 in Finland and 104 in Iceland until the end of 2014 (1). In 2015, a total of 162,550 refugees sought asylum in Sweden, 20970 in Denmark, 31,145 in Norway, 32345 in Finland and 345 in Iceland (2). This recent influx of an unprecedented number of refugees to the Nordic countries will have an impact on health disparity unless appropriate measures are taken to meet the healthcare needs of this vulnerable population. Recent reports from Denmark show that refugees have higher morbidity from several mental health disorders in contrast to family reunification immigrants, whose morbidity from mental health disorders was lower than or similar to native Danes (3). Immigrants in general, and refugees in particular, seem to have a higher mortality from infectious disease. Interestingly, immigrants in Denmark had lower all-cause mortality and lower mortality from cancer, cardiovascular disease, and injuries (3). Sex differences have obvious implications for disease burden due to biological differences. For example, men cannot sustain birth trauma or die of complications of childbirth, whereas women have some special reproductive healthcare needs. Although women in general seem to live longer than men, at least in most developed countries, they appear to be disadvantaged in many other ways. Compared to men, women earn less, have higher rates of chronic illnesses, and are more at risk of depression and disability. Despite known differences in the prevalence of diseases and use of health services between men and women, few studies have examined the health disparities among men and women separately. Women’s health status in the Nordic counties is generally better than elsewhere in the world, but disparities do exist. Most of the health related inequities are associated with unequal access to resources and therefore not justifiable. The percentage of females and unaccompanied minors among asylum seekers has increased in recent years. This may have a further impact on health disparities and implications for planning resource allocation. Although healthcare systems are fairly similar across Scandinavia, spending on healthcare differs among Nordic counties too. Tackling the issue of health disparity is important and it will require political will and professional effort with a systematic approach to identify determinants of disparity and address the barriers to equitable healthcare. It will also require responsible allocation of resources and a recognition that the outcomes that really matter relate to