Equal access to healthcare in national legislations: how do Croatia, Germany, Poland, and Slovenia counteract discrimination in healthcare?

BACKGROUND: The aim of the study was a comparative analysis of legislative measures against discrimination in healthcare on the grounds of a) race and ethnicity, b) religion and belief, and c) gender identity and sexual orientation in Croatia, Germany, Poland and Slovenia. METHODS: We conducted a search for documents in national legal databases and reviewed legal commentaries, scientific literature and official reports of equality bodies. We integrated a comparative method with text analysis and the critical interpretive approach. The documents were examined in their original languages: Croatian, German, Polish, and Slovenian. RESULTS: All examined states prohibit discrimination and guarantee the right to healthcare on the constitutional level. However, there are significant differences among them on the statutory level, regarding both anti-discriminatory legal measures and other legislation affecting access to healthcare for groups of diverse race or ethnicity, religion or belief, sexual orientation or gender identity. Croatia and Slovenia show the most comprehensive legislation concerning non-discrimination in healthcare in comparison to Germany and even more Poland. Except for Slovenia, explicit provisions protecting equal access for members of the abovementioned groups are insufficiently represented in healthcare legislation. CONCLUSIONS: The study identified legislative barriers to access to healthcare for persons of diverse race or ethnicity, religion or belief, sexual orientation or gender identity in Croatia, Germany, Poland and Slovenia. The discrepancies in the level of implementation of anti-discriminatory measures among these states show that there is a need for comprehensive EU-wide regulations, which would implement the principle of equal treatment in the specific context of healthcare. General anti-discrimination regulations should be strengthened by inclusion of anti-discrimination provisions directly into national legislation relating specifically to the area of healthcare.

Social diversity and access to healthcare in Europe: how does European Union's legislation prevent from discrimination in healthcare?

BACKGROUND: Social diversity can affect healthcare outcomes in situations when access to healthcare is limited for specific groups. Although the principle of equality is one of the central topics on the agenda of the European Union (EU), its scope in the field of healthcare, however, is relatively unexplored. The aim of this study is to identify and systematically analyze primary and secondary legislation of the EU Institutions that concern the issue of access to healthcare for various minority groups. In our research, we have concentrated on three features of diversity: a) gender identity and sexual orientation, b) race and ethnicity, and c) religion or belief. METHOD AND MATERIALS: For the purpose of this analysis, we conducted a search of database Eur-Lex, the official website of European Union law and other public documents of the European Union, based on specific keywords accompanied by review of secondary literature. Relevant documents were examined with regard to the research topic. Our search covered documents that were in force between 13 December 2007 and 31 July 2019. RESULTS: Generally, the EU legal system prohibits discrimination on grounds of religion or belief, racial or ethnic origin, sex, and sexual orientation. However, with regard to the issue of non-discrimination in access to healthcare EU secondary law provides protection against discrimination only on the grounds of racial or ethnic origin and sex. The issue of discrimination in healthcare on the grounds of religion or belief, gender identity and sexual orientation is not specifically addressed under EU secondary law. DISCUSSION: The absence of regulations regarding non-discrimination in the EU secondary law in the area of healthcare may result from the division of competences between the European Union and the Member States. Reluctance of the Member States to adopt comprehensive antidiscrimination regulations leads to a situation, in which protection in access to healthcare primarily depends on national regulations. CONCLUSIONS: Our study shows that EU antidiscriminatory law with regard to access to healthcare is fragmentary. Prohibition of discrimination of the level of European binding law does not fully encompass all aspects of social diversity.

JOURNAL AMHA - ACTA MEDICO-HISTORICA ADRIATICA

In this paper, the first 20 years of publication of the scientific journal AMHA - Acta medico-historica Adriatica (2002-2022) are presented and analysed. This journal has undoubtedly become and remained the central activity of the Croatian Scientific Society for the History of Health Culture, which has rapidly evolved into a globally esteemed journal in the history of medicine. The beginning and the context of publishing the journal with reference to the scientific conference "Rijeka and Its Citizens in Medical History" are presented, as well as the journal's profiling into a distinguished international scientific journal, co-publishing with the Faculty of Medicine (University of Rijeka) and its fast development in the later years. The analysis shows the growth of the journal's visibility through indexation in different international journal databases, the number and ratio of scientific articles and the variety of published material. Finally, a review of the potential future directions of development and the significance of this journal within the national, regional and international context is given.

Diversity awareness, diversity competency and access to healthcare for minority groups: perspectives of healthcare professionals in Croatia, Germany, Poland, and Slovenia.

Introduction: Due to cultural, language, or legal barriers, members of social minority groups face challenges in access to healthcare. Equality of healthcare provision can be achieved through raised diversity awareness and diversity competency of healthcare professionals. The aim of this research was to explore the experiences and attitudes of healthcare professionals toward the issue of social diversity and equal access to healthcare in Croatia, Germany, Poland, and Slovenia. Methods: The data reported come from semi-structured interviews with n = 39 healthcare professionals. The interviews were analyzed using the methods of content analysis and thematic analysis. Results: Respondents in all four countries acknowledged that socioeconomic factors and membership in a minority group have an impact on access to healthcare services, but its scope varies depending on the country. Underfunding of healthcare, language barriers, inadequate cultural training or lack of interpersonal competencies, and lack of institutional support were presented as major challenges in the provision of diversity-responsive healthcare. The majority of interviewees did not perceive direct systemic exclusion of minority groups; however, they reported cases of individual discrimination through the presence of homophobia or racism. Discussion: To improve the situation, systemic interventions are needed that encompass all levels of healthcare systems - from policies to addressing existing challenges at the healthcare facility level to improving the attitudes and skills of individual healthcare providers.

Caring for Transgender People in Healthcare: A Qualitative Study with Hospital Staff in Croatia.

Transgender and gender-diverse people have greater health risks due to increased social stress and face a disadvantaged position in the healthcare system as a result of the stigma associated with their gender identity. Due to the lack of research in Croatia on the position of transgender people in the healthcare system, this research was intended to supplement the knowledge about the experiences of hospital staff in the Croatian healthcare system when caring for patients with transgender identities. Qualitative research was conducted using an interview method. The participants (n = 10) were healthcare managers or hospital care team members. The collected data were processed through thematic analysis. The results show that some participants had had no encounters with transgender patients and those who had described them as unproblematic or had only encountered them at a level of basic healthcare. They also described how they perceive transgender people and their life circumstances. The participants described how they envision potential encounters with this group of patients and what they consider necessary to improve the position of this group within the healthcare system. In the discussion part of the article, we assess the need for additional training regarding hospital staff, especially in terms of diversity competence, and for an increase in the visibility of transgender patients.

The Labin Region, an ecologically vulnerable geographical area in Croatia: Mortality characteristics in an area polluted by industrial over a 40-year period.

The history of the Labin region in Croatia includes intensive industrial development with repercussions of pollution on environment and health. Assuming that prolonged exposure to polluted environments causes qualitative changes in mortality, the aim was to analyse the mortality characteristics of the population of the Labin Region for the 1968-2008 period based on data from the Croatian Bureau of Statistics. Public health and social opportunities in this geographical area carry a long-term burden of exposure to an industrial polluted environment with outcomes expressed by mortality or/and morbidity in the population. This study includes data on 11,903 deaths, most of which due to diseases of the circulatory, respiratory and digestive systems as well as neoplasms. In the third and fourth decade of the study period, a group of neoplasms showed significant increases, while the increase in respiratory diseases were more gradual. The female population died mostly from diseases of the circulatory and endocrine system as well as neoplasms, while the male population mainly died from diseases of the digestive system and external causes. This research provides guidelines that could create better public health, raising the quality of life and contribute to a future environmental protection in local communities by targeted policies.

Diversity Competency and Access to Healthcare in Hospitals in Croatia, Germany, Poland, and Slovenia.

Diversity competency is an approach for improving access to healthcare for members of minority groups. It includes a commitment to institutional policies and practices aimed at the improvement of the relationship between patients and healthcare professionals. The aim of this research is to investigate whether and how such a commitment is included in internal documents of hospitals in Croatia, Germany, Poland, and Slovenia. Using the methods of documentary research and thematic analysis we examined internal documents received from hospitals in these countries. In all four countries, the documents concentrate on general statements prohibiting discrimination with regard to healthcare provision. Specific regulations concerning ethnicity and culture focus on the issue of language barriers. With regard to religious practices, the documents from Croatia, Poland, and Slovenia focus on dominant religious groups. Observance of other religious practices and customs is rarely addressed. Healthcare needs of patients with non-heteronormative sexual orientation, intersexual, and transgender patients are explicitly addressed in only a few internal documents. Diversity competency policies are not comprehensively implemented in hospital internal regulations in hospitals under investigation. There is a need for the development and implementation of comprehensive policies in hospitals aiming at the specific needs of minority groups.

Mortality Characteristics of Two Populations in the Northern Mediterranean (Croatia) in the Period 1960⁻2012: An Ecological Study.

In the second half of the 20th century, the town of Bakar (Primorje-Gorski Kotar County, Croatia), where a coking plant was operational 1978⁻1994, experienced intensive industrialisation. The town of Mali Losinj (Primorje-Gorski Kotar County, Croatia) in this period based its economy on non-industrial sectors. The study goal was comparing mortality characteristics of these populations in the northern Mediterranean for 1960⁻2012. An ecological study design was used. Data were analysed for 1960⁻2012 for the deceased with recorded place of residence in the study area. Data on the deceased for 1960⁻1993 were taken from death reports, for 1994⁻2012 from digital archives of the Teaching Institute of Public Health, Primorje-Gorski Kotar County. Data on causes of death for 1960⁻1994 were recoded to the three-digit code of underlying cause of death according to the International Classification of Diseases (ICD⁻10). Among studied populations significant difference was found among the causes of deaths coded within ICD⁻10 chapters: neoplasms (particularly stomach carcinoma), mental and behavioural disorders and diseases of the respiratory system (particularly chronic obstructive pulmonary disease, (COPD)). Increase in mortality from neoplasms, increase in respiratory diseases for the area exposed to industrial pollution, also stomach carcinoma and COPD particularly in the town Bakar require further research.

[Scientific conference Rijeka and its citizens in Medical History 2000-2016]. / Znanstveni skupovi Rijeka i Rijecani u Medicinskoj povjesnici 2000.-2016.

This paper presents the form and content of the sixteen scientific conferences "Rijeka and its Citizens in Medical History" ("Rijeka i Rijecani u medicinskoj povjesnici") which were held in the period between 2000 and 2016 according to the archive data of the conference organizer Croatian Scientific Society for the History of Health Culture. It presents data about the beginning of science convention, some its organisational features and the number of participants. A total of 315 presentations, whose abstracts were published in individual conference's abstract books, were given at the sixteen conventions by 463 participants from Croatia and abroad. It is emphasized that the great number of the papers printed in extenso are published in the journal AMHA - Acta medico-historica Adriatica. Summarised quantity data on the number of presented papers, number of presenters and number of co-authored papers are given. Finally, a review of the significance of this convention within the regional, national and international aspect is given.

New contributions to the study of the life and work of Vinko Franciskovic (1919-1984), pioneer of Croatian cardiothoracic and transplantation surgery.

AIM: To explore personal biography of Vinko Franciskovic (1919-1984), to improve the understanding of the beginnings of Croatian cardiothoracic and transplantation surgery. METHODS: Comparative critical analysis of written published materials, archival materials and information collected through oral history interviews. RESULTS: Vinko Serafin Franciskovic was born in Praputnjak, a settlement of the eastern surroundings of Rijeka, Croatia. He was raised up in the Italian language and culture by hisaunt, a mother's sister and her husband. He went to the Royal Classical Grammar School Giovanni Prati in Trento. On July 15, 1943, he defended his thesis, titled A contribution to the surgical therapy of fractures of the femoral neck at the Faculty of Medicine, University of Padua. CONCLUSION: The represented data about Vinko Franciskovic's life, especially those concerning his secondary and higher education, explain some of his crucial personal traits and his later professional pathway.

[Medical elements in the sacral heritage of the Moscenice region]. / Medicinski elementi u sakralnom nasljedu Mosceniscine.

Sacral heritage, religious practices and customs, and the ethnomedical heritage of the Moscenice region have not had so far the attention of medico-historians, which represents the starting point of this paper. The research of the mentioned dimensions of medico-historical reality of Moscenice and its surrounding area has been conducted on three levels. Starting with the usual methodology, sacral inventory of certain churches and chapels from the Moscenice parish is analyzed from the perspective of the history of medicine. After that, the attention is first given to the religious practices motivated by health and then to other traditional forms and practices of health prevention and disease treatment - especially to those concerning people as well as those concerning animals. The scope of this research is to document and present the elements of medico-historical heritage of the Moscenice region based on religious and other traditional components, but with the intention to enrich the medico-historical mosaic of the eastern Istrian coastal region.

[Medical elements in the Parish Church of Saint George in Lovran (Croatia)]. / Medicinski Elementi u Zupnoj Crkvi Svetog Jurja u Lovran.

For some reason, the sacral heritage of Lovran and its surroundings has escaped the eye of medical historians, until now. seeing that the Parish Church of st George in Lovran holds a central position in this heritage, the authors provide an analysis of medical elements in the church. The analysis has focused on three aspects. The first aspect are medical elements, especially the anthropological features of characters depicted on the frescoes, which belong to the earliest and most representative of the whole region. The second are Glagolithic inscriptions relevant for the history of medicine and health culture. The third is the iconography of patron saints against a variety of diseases (featured on paintings, altars or sculptures), paying particular attention to relevant medical imagery of st George as the church's patron saint. relying on a well developed method for analysing medical elements in the sacral heritage of Croatia and abroad, the authors seek to fill the gaps in this medical historical mosaic by investigating the parish church of Lovran.