Refugees and local health policy. A qualitative study using the example of substance use

Edited by: Andrea Rumpel

The connection between flight migration and health is related to social policy in Germany. When taking in refugees, primary medical care was important from the outset. But now other topics are becoming relevant, such as prevention and health promotion.

In health policy - as well as in other fields of social and integration policy - the municipality's importance and scope for influence are growing. On the one hand, it is responsible for on-site health care and the Prevention Act assigns them a key role in terms of a lifeworld approach in health promotion and disease prevention. With a view to equal health opportunities and general services for all residents, local authorities cooperate with local actors. On the other hand, a great variety of different local approaches can be observed, also in the area of ​​addiction support and prevention.

Compared to the German majority population, refugees have a higher prevalence of physical and psychological impairments. This also applies to the area of ​​addiction support. Specialists in accommodation come into contact with the issue of substance use among citizens and, according to initial figures, refugees are using substances to an increasing extent. The scientific expertise on this is patchy, but it becomes clear that access to the health system has multiple peculiarities (e.g. legal framework) and barriers (e.g. language) for refugees. Together with the higher prevalence of refugees, from the point of view of social policy there are above all questions of access to the target group of refugees and vice versa by the target group.

The focus of the project is on the question of what leads to the use or non-use of local addiction-specific health services for refugees, what barriers arise when using addiction support offers as a whole and whether, for example, the structures of the offers, the local differences in access, the type of communication or a different understanding of health and addiction are an obstacle to access.

In order to answer these questions, both the perceived barriers and requirements for the addiction support system are examined, as well as the (different) communal handling of health and health services for refugees. For this purpose, the view of refugees with regard to health care in the case of substance use is reconstructed in three municipalities with the help of (biographical) narrative conversations. In addition, ethnographic approaches and expert interviews highlight the local perspective.

The aim of this work is to identify the wishes and needs of refugees as well as structural barriers and needs that lead to the use or non-use of municipal health services. Possible gaps in community health care are highlighted as well as successful approaches.