You studied political science and then ran an international education and counseling center for immigrant women in Berlin for 11 years. How did you get into health sciences from there?
My interest in health sciences developed during my work at the counseling center, because many women and families also sought counseling for health problems they couldn't handle on their own because language communication didn't work, they didn't know who to turn to, or they didn't understand diagnosis or therapy. Care around pregnancy and childbirth, questions about children's health, work-related illnesses, chronic illnesses, and even mental health issues were brought to us. My interest in health sciences developed because I wanted to look more closely at the structural level beyond the individual case. The valuable practical experience combined with concrete questions moved me to public health and back to science.
Migration and health are your main research areas. How did this come about?
When I started working on the topic of migration and health, there were only a manageable number of publications. The book „Health for All“ published by Jürgen Collatz et al. in 1985 motivated me to do further research on this topic. Thus, I wrote my master's thesis on the health care of immigrants and then pursued the topic from 1996 as a research associate at the Charité in public health research projects together with Matthias David, who at that time was an assistant physician in the gynecological clinic at the Campus Virchow-Klinikum and is now a professor at the Charité. When I moved to the Alice Salomon Hochschule Berlin as a professor in 2004, we continued this productive collaboration.
You founded the Berlin research group „Migration and Health“. What is its goal?
The motivation for our research group „Migration and Health“ was to use the potential for cooperation between different disciplines, ways of thinking and perspectives experienced in the joint research projects and to identify needs for action through health care research in a previously neglected area and thus influence the improvement of health care for all in the immigration society. We have carried out various research projects on the topic, continue to involve and qualify students and doctoral candidates in medicine, social work and health sciences in research, have developed further education programs for health professionals, organized specialist conferences and much more. The interdisciplinary cooperation between medicine, health professionals, social scientists and social workers has broadened the view beyond their own horizons and inspired all participants again and again.
As principal of the Alice Salomon University of Applied Sciences Berlin, you were particularly committed to opening the university to so-called „non-traditional students“. What prompted this at the time and how was the project implemented?
Access to higher education for children from non-academic backgrounds and the permeability of educational pathways were important concerns for me and other colleagues at ASH Berlin. When suitable funding programs were announced, we didn't wait long to put our ideas on paper. For example, in the BMBF program „Open University - Advancement through Education“ we were able to develop and test the B.Sc. Interprofessional Health Care - online, which is geared towards professionals in the health care professions, on a research basis and establish it as a regular degree program at ASH Berlin in 2019. Another major task and opportunity for our university was the development of the consecutive M.Sc. Public Health in collaboration with the Technical University and the Charité, which has been based at the Berlin School of Public Health since 2015. A special feature for the Berlin M.Sc. Public Health is the interdisciplinary and cross-institutional cooperation. Thus, the specific profile of ASH Berlin as a university of applied sciences with focal points such as social determinants of health, intersectionality, diversity, the importance of early childhood for health and the interprofessional cooperation of the health professions also flows into the qualification of the master's students.
„To this day, language barriers affect the right to information and education in health and social services...“
Where does Germany stand in terms of diversity in health and social care? What still needs to be done in Germany regarding the issue of migrant health?
To date, language barriers have impeded the right to information and education in health and social services, because there is a lack of reliable structures and funding for qualified language mediation. For professionals and immigrants with little knowledge of German, good communication is an essential prerequisite for equal participation, for the quality of care and advice, and for the professionals' ability to act professionally. There is an urgent need for action in Germany to counter discrimination based on language barriers. When the Migrant Integration Policy Index (MIPEX) was expanded to include the area of health for the first time in 2015, we were able to determine that, compared to other countries, Germany was just in the lower midfield in terms of equality for migrants in the health sector. Five central problem areas were identified: (1) the right to health care services is limited by §4 AsylbLG, (2) attempts are being made to compensate for structural deficits in the care of migrants through temporary and regionally limited "intercultural" projects of various actors, (3) there is a lack of comprehensive strategies and measures at the political and institutional level, (4) the data situation is deficient and there is a high need for research, especially in the area of health care research, and (5) health professionals are not sufficiently prepared for diversity. Not much has changed since then, as the MIPEX 2020 evaluations show.
You have done a lot of research on immigrant women and pregnancy and childbirth. What were key findings?
It's impossible to summarize so briefly, because immigrant women are a very heterogeneous group. It is necessary to differentiate more precisely and also to look at the interactions with other social determinants of health and other contextual factors of the health care system. One of our studies showed that, despite socioeconomic disadvantages, immigrant women have similar or better obstetric indicators overall compared to women without migration experience. In contrast, the care situation of newly immigrated and refugee women presents problems, as their specific prerequisites and needs (e.g., with regard to linguistic communication) are not satisfactorily addressed by the care system.
You are currently conducting research in the research group „Refugee Migration to Germany: A 'Magnifying Glass' for Broader Challenges in Public Health“ funded by the German Research Foundation (DFG) in the PROREF project and leading the additional project PROREF - Mental Health. Are there already results?
With the PROREF project, we are following up on an earlier study on perinatal health in Berlin and trying to close existing gaps in knowledge regarding newly immigrated and refugee women. The project is designed in a mixed-methods approach with a cooperative project management by Matthias David at Charité and me at ASH Berlin. The quantitative part of the study has now included 3200 women who gave birth in three Berlin maternity hospitals. Immigrant and refugee women are represented here according to their share of the population. In the qualitative part of the study, in-depth interviews were conducted with 33 refugee women from 19 countries of origin and 80 professionals involved in the care of pregnancy and childbirth in Berlin, Brandenburg and North Rhine-Westphalia. PROREF-Mental Health analyzes psychological and psychosocial aspects in the context of pregnancy, birth and life with the newborn among Arabic-speaking women. We are still in the middle of the evaluations, but some first results of the qualitative study are presented in the current alice Magazine (p.33-35).
Are these your last projects before retirement or do you already have further plans?
Now I guess a more self-determined phase of life is coming my way. I have always enjoyed teaching and exchanging ideas with students, colleagues and staff at ASH, as well as supervising final theses, but I am happy to forego the evaluation and grading of performance records and lengthy committee meetings. There is still a lot to complete even after the funding for the PROREF project has ended. The consolidation of the results of the two study strands, the supervision of the PhD students and publications will certainly keep us busy for a while and I will also remain connected to our working group „Migration and Health“. Together with Prof. Dr. Jalid Sehouli and Dr. Ute Siebert, I have just started a new project at the Charité called „Empowerment for Diversity“, which is funded by the Mercator Foundation for 3 years. Together with committed cooperation partners in health care institutions as well as at universities, colleges and vocational schools, competencies and structures for diversity justice and equal opportunities in health care are to be further developed and tested in order to structurally counteract existing risks of discrimination and racism in health care in Germany. A nationwide network of relevant institutions and actors will be established for sustainable implementation in policy and practice.
Knipper M, Razum O, Borde T, Brenne S, Kluge U, Markus I. Migrant Integration Policy Index Health Strand. Country Report Germany. 2017, International Organization for Migration. equi-health.eea.iom.int/images/MIPEX/GERMANY_MIPEX_Health.pdf)& Migrant Integration Index 2020; https://www.mipex.eu/