Статті в журналах з теми "Health inequality of opportunity migrants Europe"

Having initially welcomed more than a million refugees and forced migrants into Europe between 2015 and 2016, the European Union’s (EU’s) policy has shifted toward externalising migration control to Turkey and Northern Africa. This goes against the spirit of international conventions aiming to protect vulnerable populations, yet there is widespread indifference toward those who remain stranded in Italy, Greece and bordering Mediterranean countries. Yet there are tens of thousands living in overcrowded reception facilities that have, in effect, turned into long-term detention centres with poor health and safety for those awaiting resettlement or asylum decisions. Disregard for humanitarian principles is predicated on radical inequality between lives that are worth living and protecting, and unworthy deaths that are unseen and unmarked by grieving. However, migration is on the rise due to natural and man-made disasters, and is becoming a global issue that concerns us all. We must therefore deal with it through collective political action that recognises refugees’ and forced migrants’ right to protection and ensures access to the health services they require.

Introduction. Economic inequality, political instability and globalization have contributed to the constant growth of the migration phenomenon in recent years. In particular, a total of 4.2 million people migrated to Europe during 2019 and most of them settled in Germany, France and Italy. Objectives. The objective of this study was to conduct a systematic review of studies analyzing the oral health condition among migrants from middle- and low-income countries to Europe and assessing the eventual association between their sociodemographic and socioeconomic characteristics and oral health status. Materials and Methods. A systematic review was conducted in PubMed, Cochrane Library, Scopus and Science Direct databases. After titles, abstracts and full-text examination, only 27 articles were selected on the basis of inclusion criteria and consequently included for quality assessments and data extraction. Results. Most of the studies reported a higher prevalence of caries experience, a poorer periodontal health and more difficulties in accessing dentalcare services among migrant groups compared with the non-migrant population. Inequalities were mostly associated with ethnic background, economic condition and social grade. Conclusion. Our review demonstrates the lack of dental health among migrants, underlining that their cultural beliefs and their social and economic living conditions could influence their oral health.

BackgroundSuicide has been decreasing over the past decade. However, we do not know whether socioeconomic inequality in suicide has been decreasing as well.AimsWe assessed recent trends in socioeconomic inequalities in suicide in 15 European populations.MethodThe DEMETRIQ study collected and harmonised register-based data on suicide mortality follow-up of population censuses, from 1991 and 2001, in European populations aged 35–79. Absolute and relative inequalities of suicide according to education were computed on more than 300 million person-years.ResultsIn the 1990s, people in the lowest educational group had 1.82 times more suicides than those in the highest group. In the 2000s, this ratio increased to 2.12. Among men, absolute and relative inequalities were substantial in both periods and generally did not decrease over time, whereas among women inequalities were absent in the first period and emerged in the second.ConclusionsThe World Health Organization (WHO) plan for ‘Fair opportunity of mental wellbeing’ is not likely to be met.Declaration of interestNone.

Background: The migratory flow from the African continent to Europe is intense and the European countries should apply a humanitarian, health and social response to this emerging problem. Migrants coming from Africa to Europe are a very vulnerable population. Healthcare professionals should be prepared for answering their needs from a transcultural approach, which requires a better understanding of this phenomenon. Thus, the aim of this study was to improve nursing and healthcare professionals’ awareness and better understanding of migrant life experiences during the migration journey. An exploratory descriptive qualitative research was conducted. In-depth interviews were conducted involving four key informants and content analysis were performed with the transcriptions. Results: Three themes merged: life situations in their countries of origin; motivations that led them to undertake the migratory journey; and experiences they lived during the migratory journey. The results described the dramatic experience and motivations for crossing the strait of Gibraltar from Africa to Europe, including feelings, fears, hopes and lived experiences. The determination of immigrants to fight for a better life opportunity and the physical damage and psychological consequences they suffer were revealed. Conclusions: This study would help healthcare professionals to better understand this complex reality and deliver culturally adapted care. Knowledge of the starting reality of these populations can help health professionals to incorporate a cross-cultural approach that improves the relational, ethical and affective competences to provide quality care to the migrant population, as well as the development of health measures to fight against inequalities suffered by these population groups.

Using cross-national data, we analyze the effects of economic participation and opportunity, educational attainment, political empowerment, legislating reserved seats for female political candidates, and prevalence of domestic violence victimization on lethal violence against women across 39 nations. These significant factors have been studied individually with little work on their comparative, unique effects on femicide. Our paper makes such a comparison. The dependent variable, femicide by intimate partners and family members, is constructed using data from the United Nations Office on Drugs and Crime and the World Bank Group. All data are for the year 2011, a year that also corresponds to available data in the sources for our independent variables. These sources are the 2011 World Economic Forum Global Gender Gap Report, the United Nations Statistics Division, International Institute for Democracy and Electoral Assistance, and the Organisation for Economic Co-operation and Development. Our resulting sample size is 39 countries from five regions of the world: Northern and Eastern Europe (n = 7), Southern and Western Europe (n = 11), Asia and Oceania (n = 7) Africa (n = 2), and the Americas (n = 12). The unit of analysis is nation and the total number of cases of femicide by intimate partners and family members from the nations is 2,067,450,894. Our study supports backlash theory and finds in nations where educational attainment and percent women reporting domestic violence are higher, and in nations having legislated quotas for female political participation, the incidents of femicide by intimate partner and family members increase. Counter to most previous research, we find no relationship between economic participation and opportunity or political empowerment and femicide by intimate partners and family members.

Backgrounds The prevalence of loneliness increases among older adults, varies across countries, and is related to within-country socioeconomic, psychosocial, and health factors. The 2000–2019 pooled prevalence of loneliness among adults 60 years and older went from 5.2% in Northern Europe to 24% in Eastern Europe, while in the US was 56% in 2012. The relationship between country-level factors and loneliness, however, has been underexplored. Because income inequality shapes material conditions and relative social deprivation and has been related to loneliness in 11 European countries, we expected a relationship between income inequality and loneliness in the US and 16 European countries. Methods We used secondary cross-sectional data for 75,891 adults age 50+ from HRS (US 2014), ELSA (England, 2014), and SHARE (15 European countries, 2013). Loneliness was measured using the R-UCLA three-item scale. We employed hierarchical logistic regressions to analyse whether income inequality (GINI coefficient) was associated with loneliness prevalence. Results The prevalence of loneliness was 25.32% in the US (HRS), 17.55% in England (ELSA) and ranged from 5.12% to 20.15% in European countries (SHARE). Older adults living in countries with higher income inequality were more likely to report loneliness, even after adjusting for the sociodemographic composition of the countries and their Gross Domestic Products per capita (OR: 1.52; 95% CI: 1.17–1.97). Discussion Greater country-level income inequality was associated with higher prevalence of loneliness over and above individual-level sociodemographics. The present study is the first attempt to explore income inequality as a predictor of loneliness prevalence among older adults in the US and 16 European countries. Addressing income distribution and the underlying experience of relative deprivation might be an opportunity to improve older adults’ life expectancy and wellbeing by reducing loneliness prevalence.

Objectives: The Arabic-speaking population is increasing in Europe and North America. Evidence suggests that Arab migrants have a greater risk of adverse birth outcomes than nonmigrants, but the risk of stillbirth is largely understudied. We examined inequality in stillbirth rates between Arab women and the French and English majority of women in Quebec, Canada. Methods: We conducted a retrospective study of all births in Quebec from 1981 through 2015. We computed stillbirth rates by period and cause of death, and we used log binomial regression to estimate the association between Arabic mother tongue and stillbirth, adjusted for maternal characteristics. Results: Stillbirth rates per 1000 births overall were lower among women with Arabic mother tongue (3.89) than among women with French or English mother tongue (4.52), and rates changed little over time. However, Arabic-speaking women from Arab countries had a higher adjusted risk of stillbirth than French- or English-speaking women (risk ratio = 1.23; 95% confidence interval, 1.07-1.42). Congenital anomalies, termination of pregnancy, and undetermined causes contributed to a disproportionate number of stillbirths among women with Arabic mother tongue compared with the French- and English-speaking majority. Conclusions: Arabic-speaking women from Arab countries have higher risks of stillbirth compared with the French and English majority in Quebec. Strategies to reduce stillbirth risk among Arabic speakers should focus on improving identification of causes of death.

Parent training programs (PTPs) have been used extensively in Anglo-Saxon countries, but less so in Southern Europe. Several characteristics of families have been linked to effective parenting and positive development of children, but few studies have examined the social determinants of the effectiveness of PTPs. The Parenting Skills Program for families (PSP) is a PTP from Spain. This study aimed to identify the social characteristics (sex, age, country of birth, marital status, educational level, and employment status) of parents that determine the success of the PSP in relation to social support, parenting skills, parental stress, and negative behaviors among children. A quasi-experimental study with a prepost design with no control group was used. We conducted a survey before (T0) and after the intervention (T1). Sample size was 216. We fit multiple logistic regression models. Parenting skills increased more among parents with a lower educational level. Parents’ stress decreased more among parents who had a lower educational level, were unemployed, and were men. Social support increased among parents who were younger, unemployed, or non-cohabiting. We found no significant differences in the effect on children’s negative behaviors according to the social factors evaluated. The PSP is effective for socioeconomically diverse families, but the success differs according to the parents’ social profile. Unlike most previous studies, the results were better among more socially disadvantaged people, highlighting the potential of this kind of intervention for reducing the social inequality gap between groups.

Introduction: In the past, health inequalities were not prioritised in the political agenda of Barcelona. The change of city government (2015) was an opportunity to develop a Surveillance System for Social Health Inequalities in the city, which is described in this article. Methods: The design of the Surveillance System formed part of the Joint Action for Health Equity in Europe (JAHEE), funded by the European Union. Various steps were considered by the experts to set up the System: define its objectives, target population, domains and indicators, and sources of information; perform data analysis; implement and disseminate the system; define the evaluation; and perform regular data updates. Results: The System considers the following domains: social determinants of health, health-related with behaviours, use of healthcare, and health outcomes, and includes eight indicators. As axes of inequality, the experts chose sex, age, social class, country of origin, and geographical area. The Surveillance System for Social Health Inequalities is presented on a website including different types of figures. Conclusion: The methodology used to implement the Surveillance System can be used to implement similar systems in other urban areas around the world.

It is often taken for granted that women who sell sex are vulnerable, that welfare services can and should alleviate this vulnerability, and as such, being defined as ‘vulnerable’ can be beneficial and associated with special rights that would otherwise be inaccessible. At the same time, ongoing debates have demonstrated that establishing individuals and groups as vulnerable tends to mask structural factors in inequality and has negative consequences, among them an idea that the path to ‘non-vulnerability’ lies in changing the ‘afflicted’ individuals or groups, not in structures or in addressing unequal access to resources. In this article, we take this as a starting point and discuss challenges for the welfare state in meeting the varied and often complex needs of sex sellers. Based on qualitative research with service providers in specialised social and health services in Norway, we examine access and barriers to services among female sex sellers as well as how vulnerability is understood and shapes what services are available. An important feature of modern prostitution in Norway, as in the rest of Western Europe, is that sex sellers are predominantly migrants with varying migration status and corresponding rights to services. This has influenced the options available to address prostitution as a phenomenon within the welfare state and measures that have previously been helpful for domestic women in prostitution are not easily replicated for the current target population. A starting point in a theoretical understanding that considers vulnerability to be a human predicament (rather than the exception to the rule or a deficit in individuals or groups) allows for a discussion that highlights the centrality of structural conditions rather than a need for change in the individual. In order to understand the limitations of the welfare state in addressing modern prostitution as such, it is highly relevant to look at the structural origin of vulnerabilities that may look individual.

The article presents an analysis of the unprecedented humanitarian crisis that arose as a result of COVID-19, and affected such important areas for society as health care, economics and labor relations. The purpose of the article was to analyze the challenges facing the world community through COVID-19, to describe the scenarios for further development of society in the post-quarantine period and to identify ways to solve the problems caused by the pandemic. The author did not set the task to outline a real program of action and change. These key issues are the subject of constant discussion. States still have the opportunity to rethink the social contract, placing environmental sustainability, justice and humanitarian solidarity at the heart of the post-quarantine reconstruction and renewal program. It is shown that the humanitarian crisis has been complicated by the instability of the economic situation, growing inequality and instability, both domestically and internationally, which threatens to increase social protests and dismantle the usual ways. It has been shown that policies aimed at denationalizing the economy, supporting large capital, reducing budget spending on social programs, and establishing the dominance of transnational corporations have failed to respond adequately to the challenges of the pandemic, and have exposed large-scale problems a single person. The problems that arose as a result of COVID-19 and affected international institutions were analyzed; were caused by vulnerability and unpreparedness for a health pandemic; have led to growing socio-economic inequality both within countries and internationally; exacerbated food security issues for developing countries; gender issues, labor relations issues, etc. It is shown that the principles of neoliberalism, on which the developed countries of Europe and America have been based for the last 70 years, were questioned, which actualized the search for models, scenarios and ways of further development of individual states and the world community as a whole. The article presents scenarios for further development of states in the post-quarantine period. These scenarios range from the preservation of the principles of neo-liberalism to the spread of left-wing models of social development. In addition, the article identifies conditions that can help countries embark on the trajectory of an optimistic scenario.

Abstract Introduction Health inequalities and antimicrobial resistance (AMR) present public health challenges. National guidance highlights the role of pharmacy professionals in reaching patients at risk of health inequalities.1 Pharmacy teams have the opportunity to involve their patients in shared decision-making and promote antimicrobial stewardship.2 An evidence gap exists regarding the association between factors that commonly contribute to health inequalities and antibiotic use amongst populations and risk of developing antibiotic-resistant infections. Aim To investigate the association between health inequalities, antibiotic use and risk of antibiotic-resistant infections in high-income countries, allowing pharmacy professionals to better understand the challenges and their role in tackling health inequalities and AMR. Methods Factors that commonly contribute to health inequalities and included in this review were: (i) Protected characteristics (age, ethnicity, disability, gender, sexual orientation); (ii) Socio-economic characteristics (employment status, deprivation, education, income, insurance); (iii) Vulnerable groups (migration status, sex workers, people who inject drugs (PWID), the homeless); (iv) Geography (region, urban or rural dwelling). The PRISMA-ScR was followed. Systematic literature searches were performed on OVID Embase and Medline and included published papers between January 2010 and April 2021. Exclusion criteria were research undertaken in low- or middle-income countries, viral (including COVID-19) and fungal infections and tuberculosis. Regular co-author meetings provided second checking of extracted data. Results Antibiotic use: Fifty-eight of 402 papers were included; most were from the USA (n=34) followed by the UK (n=12). Fifty papers focused on one or more protected characteristics, 37 on socio-economic characteristics, 21 on geography and 6 on migration status. Sample findings: In England, areas of high deprivation had increased antibiotic prescribing, with most deprived areas showing increased rates of broad-spectrum antibiotic use. In the USA, patients from rural areas were more likely to have nitrofurantoin for urinary tract infections inappropriately prescribed compared to urban dwellers. Antibiotic-resistant infections: Ten of 137 papers were included; the majority from the USA (n=6). Six papers focused on ethnicity, three on age and one each on deprivation, income, migration status, PWID and geography. Sample findings: In the USA, African American and Hispanic patients had higher rates of methicillin-resistant Staphylococcus aureus (MRSA) compared to patients of other ethnicities. Immigrants had lower rates of MRSA infections, but higher rates of methicillin-susceptible S. aureus wound infections, compared to USA-born citizens. Across Europe, E. coli infections resistant to aminoglycosides had strong association with income inequality. Discussion/Conclusion There is evidence for an association between health inequalities and antibiotic use, and health inequalities and risk of antibiotic-resistant infections. Further research is needed to understand how differences in antibiotic use affect AMR spread amongst populations. A study limitation includes addressing each health inequality individually without investigating how they may interact together to affect antibiotic use and infection resistance patterns. A strength is use of the PRISMA-ScR reporting guideline and systematic literature search. The pharmacy profession is trusted by the public3 and ideally placed in community and hospital settings to raise awareness of how health inequalities impact infection management and resistance rates, as well as advocate for equity of access in Core20PLUS populations. References 1. National Institute for Health and Care Excellence, Community pharmacies: promoting health and wellbeing. 2018: https://www.nice.org.uk/guidance/ng102/chapter/Recommendations 2. O'Hare A, Harvey E, and Ashiru-Oredope D. Patient safety spotlight: how pharmacy teams can help minimise antimicrobial resistance. Regulate. 2022 3. Crossley, K. Public perceives pharmacists as some of the most trusted professionals. Pharmacy Times. 2019;18

Abstract Rural-urban migrants, though facing unique social and institutional constraints, remain a largely overlooked population in research on health inequality in China. This study applies the inequality of opportunity (IOp) framework to investigate health inequality among children in China. Instead of comparing only urban and rural children, we include rural-urban migrants. Drawing upon three waves of a nation-wide survey, we find that migrant children in China remain disadvantaged in terms of health when compared to urban and rural children. The decomposition of the determinants indicates that while the direct influence of hukou, China’s household registration system, on IOp in health is low and has decreased, particularly between 2007 and 2013, one’s province of residence still matters. Parental health contributes substantially to IOp in health, which likely is an indirect effect of hukou that creates barriers for migrant parents in regard to accessing healthcare. The policy implication of these findings is that although the direct influence of hukou has decreased, when coupled with the continued lack of local government support for the welfare of migrant workers, it perpetuates health inequalities.

Abstract Objectives Europe is a destination for many migrants, a group whose proportion of the overall population will increase over the next decades. The cardiovascular (CV) risk distribution and outcomes, as well as health literacy, are likely to differ from the host population. Challenges related to migrant health status, cardiovascular risk distribution and health literacy are compounded by the ongoing coronavirus disease 2019 (COVID-2019) crisis. Methods We performed a narrative review of available evidence on migrant CV and health literacy in Europe. Results Health literacy is lower in migrants but can be improved through targeted interventions. In some subgroups of migrants, rates of cardiovascular disease (CVD) risk factors, most importantly hypertension and diabetes, are higher. On the other hand, there is strong evidence for a so-called healthy migrant effect, describing lower rates of CV risk distribution and mortality in a different subset of migrants. During the COVID-19 pandemic, CV risk factors, as well as health literacy, are key elements in optimally managing public health responses in the ongoing pandemic. Conclusions Migrants are both an opportunity and a challenge for public health in Europe. Research aimed at better understanding the healthy migrant effect is necessary. Implementing the beneficial behaviors of migrants could improve outcomes in the whole population. Specific interventions to screen for risk factors, manage chronic disease and increase health literacy could improve health care for migrants. This pandemic is a challenge for the whole population, but active inclusion of immigrants in established health care systems could help improve the long-term health outcomes of migrants in Europe.

Abstract Background Vulnerability and inequality are exacerbated in undocumented migrants, the most invisible to health systems. Objectives To estimate maternal and perinatal health needs in undocumented migrants and test a methodology for systematic monitoring & evaluation. Methods Population-based retrospective cohort study based on routine data through maternity records and temporary registration code in a sub-national Health Management Information System. Results 420924 deliveries including 1524 undocumented migrants having accessed maternity care through the NHS in Lombardy Region (Italy) from 2016 to 2021 were included. Demographics and social determinants: undocumented migrants were born in Europe (non-EU) (36%), Americas (30%), Africa (6%), Western Pacific (3%), South-East Asia (2%), Italy (2%), were stateless (7%); 52% had no/low schooling, 92% were unemployed and 52% non-married, compared to 15%, 20%, and 44% Italians. Obstetric history and antenatal care: 22% undocumented migrants had a previous abortion and 15% a previous cesarean delivery; 58% had ≥5 antenatal visits, 67% first ANC visit in trimester 1, 64% ≥ 2 ultrasounds incl. first in trimester 1, 6% full laboratory tests, compared to 90%, 97%, 97%, and 66% Italians. Intra-partum and perinatal care: 45% undocumented migrants delivered in a public hospital with neonatal intensive care unit; 69% had a normal delivery, 5% instrumental delivery, 10% and 27% emergency and total cesarean section; 2.6% neonates had emergency resuscitation and 49% were breastfed <2h from birth. Outcomes: 81% physiological pregnancies, 2.3% severe hemorrhage, 4.8% intra-uterine growth retardation, 9.3% pre-term delivery, 17% small for gestational age, 7% low birth weight, 0.6% poor Apgar score, 3% malformations. Conclusions Maternal and perinatal health was poor in undocumented migrants, varying by birthplace. Social determinants, health coverage and outcomes showed vulnerability and inequality compared to the general population. Key messages • Tailored interventions are needed: outreach health promotion on safe motherhood and neonatal care, healthcare provider training, cultural mediation, translation, and functional language learning. • A systematic monitoring and evaluation system needs to routinely collect, integrate, and analyze data on key indicators.

Abstract Much of the focus on health inequality monitoring is based on aggregate descriptions at national levels where averages or proportions are compared. However, inequalities evolve from systematic differences in living conditions, circumstances, and opportunities between population groups within geographical entities. To be able to follow such trends in health, to detect less favourable trends at an early stage, and to reveal the trends in the population and in subgroups of the population, it is essential to have a national health inequality monitoring system (HIMS) in place. In fact, in line with the “no data, no problem” notion, one might even claim that the most essential part of combatting social inequalities in health is a well-functioning health inequality monitoring system. The Joint Action Health Equity Europe (JAHEE) is a Joint Action financed by the Third Health Programme 2014-2020 of the European Union. It represents an important opportunity for countries to work jointly to address health inequalities and achieve greater equity in health outcomes across all groups in society in all participating countries and in Europe at large. One of the aims with JAHEE and the specific focus of work package five (WP5) is to advance member states ability to monitor national health inequalities. The overall objective of the work conducted in JAHEE WP5 is to attract attention to and improve countries' capacity to monitor health disparities in a “do something, do more, do better” manner. The advancement of HIMS varies greatly between countries in Europe. Yet, there is scope for improvement in virtually all countries. In addition, challenges that impede the way health inequality monitoring can be conducted are often common across countries. These challenges cannot be eliminated within the course of a three-year EU project. The JAHEE project, however, offers an unique opportunity to move forward by working together in a structured work process that allow partner countries to share, build and transform available knowledge into concrete actions aimed at strengthening national health inequality monitoring systems in Europe. In this workshop, we will present the experiences from JAHEE WP5 and give examples on concrete actions and initiatives taken across Europe to challenge some of the barriers faced and to strengthen the national health inequality monitoring processes in Europe. There will be room for discussion between each presentation and in the end of the workshop. Key messages Raised awareness a politically committed system infrastructure to assure sustainability in health inequality monitoring. Raised awareness of need for agreed data but also agreed methods to compile data to measure inequalities within populations.

Abstract The proposed workshop “Developing interventions to improve migrants’ healthcare access in Europe” will present interim results from the cross-disciplinary MyHealth project to discuss them and the early lessons with policymakers, academics, funders and practitioners in the area of migration and health. MyHealth (Models to engage migrants and refugees in their health, through community empowerment and learning alliance) is a three-year project coordinated by Fundació Hospital de la Vall d’Hebrón, Institut de Recerca (VHIR), Barcelona, Spain and implemented by a consortium of eleven partners with the CHAFEA support in the framework of the 3rd EU Health Program. The goal of the MyHealth project is to improve the healthcare access of vulnerable migrants and refugees (VMR) newly arrived to Europe, by developing and implementing models based on the knowhow of a European multidisciplinary network. This project strongly relies on a participatory approach to ensure a beneficiary-centred approach in implementing a number of interconnected objectives. To ensure a meaningful involvement of the community we applied the Metaplan technique to identify health concerns and needs perceived by vulnerable immigrants and also by professionals from diverse backgrounds working with them at the four partnering sites (Barcelona, Berlin, Brno and Athens). The Metaplan© is a qualitative technique that involves first collecting ideas or information on cards, grouping the cards according to shared characteristics, and ultimately, using a voting system to rank individual ideas or groups of ideas. The research team used this methodology to validate the health needs of immigrants identified by the MyHealth needs assessment methodology and prioritize them, and to generate, categorize and prioritize suggested solutions. These results will be analysed to identify community health strategies and to implement pilot interventions most relevant for the cultural and social reality at each of the sites. Further, the effectiveness of these interventions as a dissemination model will be evaluated. As an innovative approach, the project uses a Learning Alliance methodology to engage multiple stakeholders in the research process through a series of interconnected networks. Each of the he partners aim to document and reflect on best practices for the improvement of the migrants’ access to healthcare and thus provides an opportunity for mutual learning for the consortium members and their respective networks. The workshop will feature presentations by MyHealth partners that will be followed by the moderated Q&A session with the panel of presenters. The workshop participants feedback will be additionally sought through a self-administered workshop evaluation questionnaire. The workshop will facilitate the information exchange and discussion between the MyHealth consortium partners and other ongoing initiatives to improve migrants’ healthcare in European countries. Key messages The community engagement in the development of interventions to facilitate the access to health services while ensuring quality care to migrants community is pivotal in health promotion initiatives. In spite of the notable variability across the sites, the ubiquitous barriers were associated with both host and migrant communities, for which the future interventions would need to account.

Abstract This workshop explores how health systems in Europe have responded to the so-called “refugee crisis” in 2015 and what lessons can be drawn for the future. Based on contributions to a Special Issue of Health Policy, it offers a platform for sharing examples from across Europe, facilitating cross-country learning. Although the arrival of large numbers of new migrants in Europe in 2015 was often portrayed as a crisis or a threat and has exposed a lack of preparedness and responsiveness in many countries, many things have worked well in the reception of and provision for newly arriving migrants. There have been instructive case studies and sometimes things worked well without further ado and for this reason went unnoticed. While the exact dynamics of future migratory movements are difficult to predict and depend on sometimes questionable “deals with the devil” at the EU's outside borders, refugees will continue to come to Europe and health systems have to be prepared to respond to their needs. This workshop aims to build on recent experience and inform current debates on how health systems can best respond. It provides examples from three European countries (Austria, Germany and Finland) that have been at the forefront of receiving migrants. The first presentation, on Finland, recalls how this country received one of the highest numbers of refugees per capita and how its parallel system of health services coped with this influx. The second presentation, using the example of one federal state in Germany, illustrates that there is sometimes considerable scope for action at the local level and provides examples of how this scope can best be used. The third presentation explores how mental health needs of refugees develop in the asylum process. It argues that for more cooperation on this issue and the existence of low threshold services. A final presentation, on Austria, illustrates the needs of undocumented migrants in Vienna. It argues that non-governmental organizations (NGOs) play a crucial role in providing accessible health services and that they can also help in public health surveillance and data collection. The workshop will provide opportunity for the audience to comment on and discuss presentations and to consider current policy options in Europe to better address the health needs of newly arrived migrants. It will also ask what barriers exist that existing good practices are not being taken up. The workshop will be of interest to public health researchers, practitioners and policy-makers working on migration-related issues across Europe. Key messages The workshop provides a forum for discussing European responses to the 2015 “refugee crisis”. It explores health policy options at the European and national level.

Abstract Background Social participation is an important aspect of social inclusion and affects health, wellbeing, equality and citizenship. Informal participation is particularly important for the inclusion and wellbeing of disabled people who are a growing demographic across Europe and the world (GBD, 2017). Despite some disability rights progress such as the UNCPRD, increasing foodbank use may reflect rising prevalence of social exclusion and inequality for some disabled people. Methods Analysis of data from all countries that participated in the European Social Survey Rounds 1-8, using Stata16, assessed the extent of a relationship between informal social participation and disability (defined as being hampered by disability or ill-health in daily activities), and over time. Logistic regression was used including possible confounding variables e.g. country variation. Preliminary Findings In most years, the data showed a significant negative association between disability severity and social participation, after accounting for potential confounders. For example, in 2016 people who reported 'no' disability (OR 1.678, CI 1.102948 - 2.551828) were more likely to socialise and to have higher levels of participation than people disabled 'a lot' (OR 1.253, CI 1.097011 - 1.431516). The association fluctuated slightly over time but no clear trend was yet identifiable. Conclusions It is likely that the relationship observed reflects real inequality in social participation among disabled people, suggesting persisting significant barriers to inclusion for disabled people, which can negatively impact on people's wellbeing and broader health systems. Analysis accounted for some personal and socioeconomic barriers but not cultural or environmental barriers. Inclusion and accessibility issues become an even more acute concern (and opportunity) for policy and practice relating to equality and wellbeing when facing climate chaos: more barriers to inclusion and increased disability prevalence. Key messages Inequality indicated by lower levels of social participation of people with disabilities remains a significant concern considering personal and social costs of social isolation. Successful social inclusion improves lives of people and communities here and now and can assist in developing resilience to climate change.

Abstract Social and economic inequality are chronic stressors that continually erode the mental and physical health of marginalized groups, undermining overall societal resilience. In this comprehensive review, we synthesize evidence of greater increases in mental health symptoms during the COVID-19 pandemic among socially or economically marginalized groups in the United States, including (a) people who are low income or experiencing homelessness, (b) racial and ethnic minorities, (c) women and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) communities, (d) immigrants and migrants, (e) children and people with a history of childhood adversity, and (f) the socially isolated and lonely. Based on this evidence, we propose that reducing social and economic inequality would promote population mental health and societal resilience to future crises. Specifically, we propose concrete, actionable recommendations for policy, intervention, and practice that would bolster five “pillars” of societal resilience: (1) economic safety and equity, (2) accessible healthcare, including mental health services, (3) combating racial injustice and promoting respect for diversity, equity, and inclusion, (4) child and family protection services, and (5) social cohesion. Although the recent pandemic exposed and accentuated steep inequalities within our society, efforts to rebuild offer the opportunity to re-envision societal resilience and policy to reduce multiple forms of inequality for our collective benefit.

Abstract Background Certain migrant groups are at an increased risk of psychotic disorders compared to the native-born population; however, research to date has mainly been conducted in Europe. Less is known about whether migrants to other countries, with different histories and patterns of migration, such as Australia, are at an increased risk for developing a psychotic disorder. We tested this for first-generation migrants in Melbourne, Victoria. Methods This study included all young people aged 15–24 years, residing in a geographically-defined catchment area of north western Melbourne who presented with a first episode of psychosis (FEP) to the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1 January 2011 and 31 December 2016. Data pertaining to the at-risk population were obtained from the Australian 2011 Census and incidence rate ratios were calculated and adjusted for age, sex and social deprivation. Results In total, 1220 young people presented with an FEP during the 6-year study period, of whom 24.5% were first-generation migrants. We found an increased risk for developing psychotic disorder in migrants from the following regions: Central and West Africa (adjusted incidence rate ratio [aIRR] = 3.53, 95% CI 1.58–7.92), Southern and Eastern Africa (aIRR = 3.06, 95% CI 1.99–4.70) and North Africa (aIRR = 5.03, 95% CI 3.26–7.76). Migrants from maritime South East Asia (aIRR = 0.39, 95% CI 0.23–0.65), China (aIRR = 0.25, 95% CI 0.13–0.48) and Southern Asia (aIRR = 0.44, 95% CI 0.26–0.76) had a decreased risk for developing a psychotic disorder. Conclusion This clear health inequality needs to be addressed by sufficient funding and accessible mental health services for more vulnerable groups. Further research is needed to determine why migrants have an increased risk for developing psychotic disorders.

Abstract Nationwide, more than 22% of births in France are to women who were born elsewhere. It is now well documented that overall, these women, like migrants throughout Europe, have higher perinatal and maternal risk levels than non-migrants. The mechanisms of these social inequalities in health have not yet been sufficiently and adequately explored. Access to and quality of care are likely to be intermediate factors in their explanation. This hypothesis is especially probable in view of recent work showing higher rates of inadequate prenatal and suboptimal perinatal care in some groups of migrant women compared to women born in France. This workshop aims to present and discuss a mixed-methods research program founded by the French National Research Agency (ANR). The program was designed to address and assess the role played by health professional's implicit bias (IB) in the provision of differential care that could explain disparities in maternal and perinatal health between certain groups of migrants and women born in France. The existence of these IB has been demonstrated in healthcare professionals in several specialties, mainly in North America, but never in the perinatal field nor in European settings. While this program has focused on care as diverse as cesarean section, epidural analgesia during labor, prevention and management of eclampsia, and Down syndrome screening, we propose to report on our approach through the issue of Down syndrome screening. IB has been shown to be less likely to induce differential care in highly protocolized emergency care settings. Conversely, non-emergency situations such as prenatal care, where there is nevertheless time pressure on health care professionnals, are more likely to be contexts for the existence of non-medically based differential care. Access to prenatal screening for Down's syndrome, where patient information plays a fundamental role, seemed to us to be a particularly interesting model for the study of differential care and the role played by IB. While the role of conscious and unconscious discrimination phenomena in the mechanisms of social health inequalities appears as increasingly probable, this workshop, based on data from a multidisciplinary research program, will shed additional light on these issues from the very concrete question of down syndrome screening. Researchers involved in this multidisciplinary project will present the results successively from epidemiological, qualitative sociological, and quantitative psycho-sociological approaches addressing differential care practices in Down syndrome screening. This mixed-methods approach will provide complementary insights into the research question. Our methods and results will then be discussed in an audience session led by moderators external to the project but experts in social health inequalities. Key messages Differential care between pregnant migrant women and native women has been evidenced in Down syndrome screening in France. Disparities in the use of Down syndrome screening according to women place of birth are almost partly related to differences in the opportunity of an informed choice.

Abstract Background Policy actions targeting diets and physical activity have been proposed as mechanisms for the prevention and control NCDs in Europe. While these actions have the potential to improve health at a population level, the impact of these policies in Europe is currently unknown. The aim of this study, as part of the wider Policy Evaluation Network, is to catalogue the data available for policy evaluation in Europe to inform the development of surveillance instruments. The catalogues will also provide an opportunity for key stakeholders to view the available EU indicators that can be employed to evaluate policies which influence diet, physical activity and sedentary behaviour. Methods A suite of key indicators was agreed by over 30 EU experts and PEN members in a workshop in September 2019. Variables in existing EU monitoring systems were suggested by workshop participants as measures for each key indicator. The mapping process involved an evaluation of how suitable the suggested variables were as measures for the indicators. This was done using a Likert scale (matched, somewhat matched, less matched, not matched). Results Diet (n = 72) and physical activity and sedentary behaviour (n = 65) related indicators, across all levels of the socio-ecological model were selected for the mapping process. 72% of diet indicators and 86% of physical activity and sedentary behaviour indicators were matched to at least one variable in an existing EU monitoring system. The majority of indicator-measure pairs were categorised as 'matched' on the Likert scale. Conclusions While there are gaps in the measurement of policy level indicators in domains such as inequality, funding and resources and governance, the majority of key policy indicators were mapped to measures in existing systems.Therefore, much of the evidence for evaluation of policies is readily available in Europe. Key messages By mapping the key indicators to variables in existing pan-European monitoring and surveillance systems we aim to document the data currently available for policy evaluation. The catalogue of mapped indicators will provide a tool for key stakeholders to aid in the evaluation and development of policies influencing diets, physical activity and sedentary behaviour in Europe.

Abstract Although long neglected, the themes of inequality and the differentiating consequences of structurally organized constraints and opportunities for individuals have recently become a major theme of scholars in aging and life-course studies. Beyond the evidence of intracohort patterns of cumulative dis/advantage in health and resources, recent societal trends of increasing inequality have added another dimension of theoretical interest and practical urgency to these concerns. These trends have been noteworthy both for the dramatic increase and for their planetary breadth, affecting Asia and Europe as well as America. Both researchers and popular writers have observed the growing importance of the precariat, an emerging subpopulation with tenuous connection to the primary economy encompasses individuals of every age. At the same time, individual agency and related concepts such as “choice” and “decision-making” continue regularly to appear as featured terms in studies of life course and related fields. Such concepts accord a strong explanatory force to the individual, and continue to be widely accepted as unproblematic and legitimate. This article examines the relevance of these two domains of life-course scholarship in analyzing an urgent contemporary problem—struggles associated with the “transition to adulthood” and the situation of young adults. Young people confronting this transition have been the focus of both the celebration of agency and of the growing attention on inequality and adversity and its effects on vulnerable periods and key transitions in the life course. Their situation provides an opportunity to resolve some of the tensions between perspectives that emphasize agency and those that emphasize inequality.

Abstract Objectives Develop 3-4 areas for intensified collaboration The Mediterranean region has a rich history and is home to some of the earliest civilisations. Today, the Mediterranean is often in the news as a result of tragic events and unrest including conflict and loss of lives at sea. Political meetings such as the South EU summit of Southern European leaders and the 5 + 5 EuroMed are useful events to highlight the priority policy issues of this region. Yet, health has rarely been at the forefront of the political agenda for the Mediterranean. The migrant crisis comes as a timely reminder that there exists a full continent on the other side of this sea and border countries from Africa, themselves in active processes of reform and change, should be seen as neighbours with whom the European public health community needs to collaborate. The purpose of this workshop is to shine a light on the health divide across the Mediterranean, to highlight key epidemiological, health systems and global health governance issues of priority to the region. It aims to stimulate an initial discussion for a public health research and policy focus on the Mediterranean region which could eventually lead to a call for action and a programme of activities at international level. Our neighbours share with us several public health challenges, from financing of health systems, epidemiological transition toward NCD diseases, environment and life style risks, human resources for health challenges and migrant issues from other parts of the continent. Marseille, as the conference location, provides a unique opportunity to debate and exchange with the three Maghreb countries facing the southern border of Europe. Key messages Maghreb health systems are in transition, all three rather different, but rather close to some European and EU health systems regarding financing, priorities, social and regional inequalities in access to health services, aging and NCD growth pressure. How can they become a part and contribute to the very active European Public Health analysis and benchmarks on optimizing health systems performance? Part of the health crisis regarding migrants in Europe is also an issue for health care systems in Maghreb countries. Are there ways to collaborate, to implement real collaborative and joint actions? Maghreb countries face a very specific crisis because of European policies of attracting health professionals: the brain drain is a significant issue, endangering the capacity of the Maghreb health systems. Do we foresee solutions to it? Maghreb countries face the same transition as Europe toward chronic diseases’ increased burden due to global changes in lifestyles and exposure to globalized health risks, But also thanks to improved health care and longer life expectancies. Fighting an increase in some risk factors can only be global or regional, with joint actions in need of forgetting the presence of the sea. Chronic disease is also an issue for international organizations: for example, such discussion could bring the three WHO regional officers involved around the Mediterranean Sea closer.

Each community’s title deed carries the indelible blood stains of our ancestors. (Watson, "Howard’s End" 2)IntroductionAccording to the Oxford English Dictionary, the term coalition comes from the Latin coalescere or ‘coalesce’, meaning “come or bring together to form one mass or whole”. Coalesce refers to the unity affirmed as something grows: co – “together”, alesce – “to grow up”. While coalition is commonly associated with formalised alliances and political strategy in the name of self-interest and common goals, this paper will draw as well on the broader etymological understanding of coalition as “growing together” in order to discuss the Australian government’s recent changes to land rights legislation, the 2007 Emergency Intervention into the Northern Territory, and its decision to use Indigenous land in the Northern Territory as a dumping ground for nuclear waste. What unites these distinct cases is the role of the Australian nation-state in asserting its sovereign right to decide, something Giorgio Agamben notes is the primary indicator of sovereign right and power (Agamben). As Fiona McAllan has argued in relation to the Northern Territory Intervention: “Various forces that had been coalescing and captivating the moral, imaginary centre were now contributing to a spectacular enactment of a sovereign rescue mission” (par. 18). Different visions of “growing together”, and different coalitional strategies, are played out in public debate and policy formation. This paper will argue that each of these cases represents an alliance between successive, oppositional governments - and the nourishment of neoliberal imperatives - over and against the interests of some of the Indigenous communities, especially with relation to land rights. A critical stance is taken in relation to the alterations to land rights laws over the past five years and with the Northern Territory Emergency Intervention, hereinafter referred to as the Intervention, firstly by the Howard Liberal Coalition Government and later continued, in what Anthony Lambert has usefully termed a “postcoalitional” fashion, by the Rudd Labor Government. By this, Lambert refers to the manner in which dominant relations of power continue despite the apparent collapse of old political coalitions and even in the face of seemingly progressive symbolic and material change. It is not the intention of this paper to locate Indigenous people in opposition to models of economic development aligned with neoliberalism. There are examples of productive relations between Indigenous communities and mining companies, in which Indigenous people retain control over decision-making and utilise Land Council’s to negotiate effectively. Major mining company Rio Tinto, for example, initiated an Aboriginal and Torres Strait Islanders Policy platform in the mid-1990s (Rio Tinto). Moreover, there are diverse perspectives within the Indigenous community regarding social and economic reform governed by neoliberal agendas as well as government initiatives such as the Intervention, motivated by a concern for the abuse of children, as outlined in The Little Children Are Sacred Report (Wild & Anderson; hereinafter Little Children). Indeed, there is no agreement on whether or not the Intervention had anything to do with land rights. On the one hand, Noel Pearson has strongly opposed this assertion: “I've got as much objections as anybody to the ideological prejudices of the Howard Government in relation to land, but this question is not about a 'land grab'. The Anderson Wild Report tells us about the scale of Aboriginal children's neglect and abuse" (ABC). Marcia Langton has agreed with this stating that “There's a cynical view afoot that the emergency intervention was a political ploy - a Trojan Horse - to sneak through land grabs and some gratuitous black head-kicking disguised as concern for children. These conspiracy theories abound, and they are mostly ridiculous” (Langton). Patrick Dodson on the other hand, has argued that yes, of course, the children remain the highest priority, but that this “is undermined by the Government's heavy-handed authoritarian intervention and its ideological and deceptive land reform agenda” (Dodson). WhitenessOne way to frame this issue is to look at it through the lens of critical race and whiteness theory. Is it possible that the interests of whiteness are at play in the coalitions of corporate/private enterprise and political interests in the Northern Territory, in the coupling of social conservatism and economic rationalism? Using this framework allows us to identify the partial interests at play and the implications of this for discussions in Australia around sovereignty and self-determination, as well as providing a discursive framework through which to understand how these coalitional interests represent a specific understanding of progress, growth and development. Whiteness theory takes an empirically informed stance in order to critique the operation of unequal power relations and discriminatory practices imbued in racialised structures. Whiteness and critical race theory take the twin interests of racial privileging and racial discrimination and discuss their historical and on-going relevance for law, philosophy, representation, media, politics and policy. Foregrounding contemporary analysis in whiteness studies is the central role of race in the development of the Australian nation, most evident in the dispossession and destruction of Indigenous lands, cultures and lives, which occurred initially prior to Federation, as well as following. Cheryl Harris’s landmark paper “Whiteness as Property” argues, in the context of the US, that “the origins of property rights ... are rooted in racial domination” and that the “interaction between conceptions of race and property ... played a critical role in establishing and maintaining racial and economic subordination” (Harris 1716).Reiterating the logic of racial inferiority and the assumption of a lack of rationality and civility, Indigenous people were named in the Australian Constitution as “flora and fauna” – which was not overturned until a national referendum in 1967. This, coupled with the logic of terra nullius represents the racist foundational logic of Australian statehood. As is well known, terra nullius declared that the land belonged to no-one, denying Indigenous people property rights over land. Whiteness, Moreton-Robinson contends, “is constitutive of the epistemology of the West; it is an invisible regime of power that secures hegemony through discourse and has material effects in everyday life” (Whiteness 75).In addition to analysing racial power structures, critical race theory has presented studies into the link between race, whiteness and neoliberalism. Roberts and Mahtami argue that it is not just that neoliberalism has racialised effects, rather that neoliberalism and its underlying philosophy is “fundamentally raced and produces racialized bodies” (248; also see Goldberg Threat). The effect of the free market on state sovereignty has been hotly debated too. Aihwa Ong contends that neoliberalism produces particular relationships between the state and non-state corporations, as well as determining the role of individuals within the body-politic. Ong specifies:Market-driven logic induces the co-ordination of political policies with the corporate interests, so that developmental discussions favour the fragmentation of the national space into various contiguous zones, and promote the differential regulation of the populations who can be connected to or disconnected from global circuits of capital. (Ong, Neoliberalism 77)So how is whiteness relevant to a discussion of land reform, and to the changes to land rights passed along with Intervention legislation in 2007? Irene Watson cites the former Minister for Indigenous Affairs, Mal Brough, who opposed the progressive individual with what he termed the “failed collective.” Watson asserts that in the debates around land leasing and the Intervention, “Aboriginal law and traditional roles and responsibilities for caring and belonging to country are transformed into the cause for community violence” (Sovereign Spaces 34). The effects of this, I will argue, are twofold and move beyond a moral or social agenda in the strictest sense of the terms: firstly to promote, and make more accessible, the possibility of private and government coalitions in relation to Indigenous lands, and secondly, to reinforce the sovereignty of the state, recognised in the capacity to make decisions. It is here that the explicit reiteration of what Aileen Moreton-Robinson calls “white possession” is clearly evidenced (The Possessive Logic). Sovereign Interventions In the Northern Territory 50% of land is owned by Indigenous people under the Aboriginal Land Rights Act 1976 (ALRA) (NT). This law gives Indigenous people control, mediated via land councils, over their lands. It is the contention of this paper that the rights enabled through this law have been eroded in recent times in the coalescing interests of government and private enterprise via, broadly, land rights reform measures. In August 2007 the government passed a number of laws that overturned aspects of the Racial Discrimination Act 197 5(RDA), including the Northern Territory National Emergency Response Bill 2007 and the Aboriginal Land Rights (Northern Territory) Amendment (Township Leasing) Bill 2007. Ostensibly these laws were a response to evidence of alarming levels of child abuse in remote Indigenous communities, which has been compiled in the special report Little Children, co-chaired by Rex Wild QC and Patricia Anderson. This report argued that urgent but culturally appropriate strategies were required in order to assist the local communities in tackling the issues. The recommendations of the report did not include military intervention, and instead prioritised the need to support and work in dialogue with local Indigenous people and organisations who were already attempting, with extremely limited resources, to challenge the problem. Specifically it stated that:The thrust of our recommendations, which are designed to advise the NT government on how it can help support communities to effectively prevent and tackle child sexual abuse, is for there to be consultation with, and ownership by the local communities, of these solutions. (Wild & Anderson 23) Instead, the Federal Coalition government, with support from the opposition Labor Party, initiated a large scale intervention, which included the deployment of the military, to install order and assist medical personnel to carry out compulsory health checks on minors. The intervention affected 73 communities with populations of over 200 Aboriginal men, women and children (Altman, Neo-Paternalism 8). The reality of high levels of domestic and sexual abuse in Indigenous communities requires urgent and diligent attention, but it is not the space of this paper to unpack the media spectacle or the politically determined response to these serious issues, or the considered and careful reports such as the one cited above. While the report specifies the need for local solutions and local control of the process and decision-making, the Federal Liberal Coalition government’s intervention, and the current Labor government’s faithfulness to these, has been centralised and external, imposed upon communities. Rebecca Stringer argues that the Trojan horse thesis indicates what is at stake in this Intervention, while also pinpointing its main weakness. That is, the counter-intuitive links its architects make between addressing child sexual abuse and re-litigating Indigenous land tenure and governance arrangements in a manner that undermines Aboriginal sovereignty and further opens Aboriginal lands to private interests among the mining, nuclear power, tourism, property development and labour brokerage industries. (par. 8)Alongside welfare quarantining for all Indigenous people, was a decision by parliament to overturn the “permit system”, a legal protocol provided by the ALRA and in place so as to enable Indigenous peoples the right to refuse and grant entry to strangers wanting to access their lands. To place this in a broader context of land rights reform, the Aboriginal Land Rights (Northern Territory) Act 2006, created the possibility of 99 year individual leases, at the expense of communal ownership. The legislation operates as a way of individualising the land arrangements in remote Indigenous communities by opening communal land up as private plots able to be bought by Aboriginal people or any other interested party. Indeed, according to Leon Terrill, land reform in Australia over the past 10 years reflects an attempt to return control of decision-making to government bureaucracy, even as governments have downplayed this aspect. Terrill argues that Township Leasing (enabled via the 2006 legislation), takes “wholesale decision-making about land use” away from Traditional Owners and instead places it in the hands of a government entity called the Executive Director of Township Leasing (3). With the passage of legislation around the Intervention, five year leases were created to enable the Commonwealth “administrative control” over the communities affected (Terrill 3). Finally, under the current changes it is unlikely that more than a small percentage of Aboriginal people will be able to access individual land leasing. Moreover, the argument has been presented that these reforms reflect a broader project aimed at replacing communal land ownership arrangements. This agenda has been justified at a rhetorical level via the demonization of communal land ownership arrangements. Helen Hughes and Jenness Warin, researchers at the rightwing think-tank, the Centre for Independent Studies (CIS), released a report entitled A New Deal for Aborigines and Torres Strait Islanders in Remote Communities, in which they argue that there is a direct casual link between communal ownership and economic underdevelopment: “Communal ownership of land, royalties and other resources is the principle cause of the lack of economic development in remote areas” (in Norberry & Gardiner-Garden 8). In 2005, then Prime Minister, John Howard, publicly introduced the government’s ambition to alter the structure of Indigenous land arrangements, couching his agenda in the language of “equal opportunity”. I believe there’s a case for reviewing the whole issue of Aboriginal land title in the sense of looking more towards private recognition …, I’m talking about giving them the same opportunities as the rest of their fellow Australians. (Watson, "Howard’s End" 1)Scholars of critical race theory have argued that the language of equality, usually tied to liberalism (though not always) masks racial inequality and even results in “camouflaged racism” (Davis 61). David Theo Goldberg notes that, “the racial status-quo - racial exclusions and privileges favouring for the most part middle - and upper class whites - is maintained by formalising equality through states of legal and administrative science” (Racial State 222). While Howard and his coalition of supporters have associated communal title with disadvantage and called for the equality to be found in individual leases (Dodson), Altman has argued that there is no logical link between forms of communal land ownership and incidences of sexual abuse, and indeed, the government’s use of sexual abuse disingenuously disguises it’s imperative to alter the land ownership arrangements: “Given the proposed changes to the ALRA are in no way associated with child sexual abuse in Aboriginal communities […] there is therefore no pressing urgency to pass the amendments.” (Altman National Emergency, 3) In the case of the Intervention, land rights reforms have affected the continued dispossession of Indigenous people in the interests of “commercial development” (Altman Neo-Paternalism 8). In light of this it can be argued that what is occurring conforms to what Aileen Moreton-Robinson has highlighted as the “possessive logic of patriarchal white sovereignty” (Possessive Logic). White sovereignty, under the banner of benevolent paternalism overturns the authority it has conceded to local Indigenous communities. This is realised via township leases, five year leases, housing leases and other measures, stripping them of the right to refuse the government and private enterprise entry into their lands (effectively the right of control and decision-making), and opening them up to, as Stringer argues, a range of commercial and government interests. Future Concerns and Concluding NotesThe etymological root of coalition is coalesce, inferring the broad ambition to “grow together”. In the issues outlined above, growing together is dominated by neoliberal interests, or what Stringer has termed “assimilatory neoliberation”. The issue extends beyond a social and economic assimilationism project and into a political and legal “land grab”, because, as Ong notes, the neoliberal agenda aligns itself with the nation-state. This coalitional arrangement of neoliberal and governmental interests reiterates “white possession” (Moreton-Robinson, The Possessive Logic). This is evidenced in the position of the current Labor government decision to uphold the nomination of Muckaty as a radioactive waste repository site in Australia (Stokes). In 2007, the Northern Land Council (NLC) nominated Muckaty Station to be the site for waste disposal. This decision cannot be read outside the context of Maralinga, in the South Australian desert, a site where experiments involving nuclear technology were conducted in the 1960s. As John Keane recounts, the Australian government permitted the British government to conduct tests, dispossessing the local Aboriginal group, the Tjarutja, and employing a single patrol officer “the job of monitoring the movements of the Aborigines and quarantining them in settlements” (Keane). Situated within this historical colonial context, in 2006, under a John Howard led Liberal Coalition, the government passed the Commonwealth Radioactive Waste Management Act (CRWMA), a law which effectively overrode the rulings of the Northern Territory government in relation decisions regarding nuclear waste disposal, as well as overriding the rights of traditional Aboriginal owners and the validity of sacred sites. The Australian Labor government has sought to alter the CRWMA in order to reinstate the importance of following due process in the nomination process of land. However, it left the proposed site of Muckaty as confirmed, and the new bill, titled National Radioactive Waste Management retains many of the same characteristics of the Howard government legislation. In 2010, 57 traditional owners from Muckaty and surrounding areas signed a petition stating their opposition to the disposal site (the case is currently in the Federal Court). At a time when nuclear power has come back onto the radar as a possible solution to the energy crisis and climate change, questions concerning the investments of government and its loyalties should be asked. As Malcolm Knox has written “the nuclear industry has become evangelical about the dangers of global warming” (Knox). While nuclear is a “cleaner” energy than coal, until better methods are designed for processing its waste, larger amounts of it will be produced, requiring lands that can hold it for the desired timeframes. For Australia, this demands attention to the politics and ethics of waste disposal. Such an issue is already being played out, before nuclear has even been signed off as a solution to climate change, with the need to find a disposal site to accommodate already existing uranium exported to Europe and destined to return as waste to Australia in 2014. The decision to go ahead with Muckaty against the wishes of the voices of local Indigenous people may open the way for the co-opting of a discourse of environmentalism by political and business groups to promote the development and expansion of nuclear power as an alternative to coal and oil for energy production; dumping waste on Indigenous lands becomes part of the solution to climate change. During the 2010 Australian election, Greens Leader Bob Brown played upon the word coalition to suggest that the Liberal National Party were in COALition with the mining industry over the proposed Mining Tax – the Liberal Coalition opposed any mining tax (Brown). Here Brown highlights the alliance of political agendas and business or corporate interests quite succinctly. Like Brown’s COALition, will government (of either major party) form a coalition with the nuclear power stakeholders?This paper has attempted to bring to light what Dodson has identified as “an alliance of established conservative forces...with more recent and strident ideological thinking associated with free market economics and notions of individual responsibility” and the implications of this alliance for land rights (Dodson). It is important to ask critical questions about the vision of “growing together” being promoted via the coalition of conservative, neoliberal, private and government interests.Acknowledgements Many thanks to the reviewers of this article for their useful suggestions. 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