Refugees face various nutritional challenges during and after migration. This cross-sectional, mixed-methods study seeks to investigate the prevalence of undernutrition and obesity among refugees in Geneva, and to identify barriers to healthy eating. Anthropometric measurements of 354 adult refugees were collected between 2017 and 2019 by trained nurses and dietitians. Seven focus group discussions totaling 51 participants, refugees and social workers, investigated conceptions and needs regarding diet. The mean Body Mass Index is 24.6 ± 4.8 kg/m2. Women are disproportionately affected by obesity compared to men (p < 0.001). Weight gain post-migration is correlated positively with length of stay in Geneva (p < 0.001). Major obstacles to healthy eating are economic and linguistic. For participants, cooking workshops and free physical activities are highly needed interventions. Post-migration lifestyle interventions should be implemented to prevent weight gain in this population. Such interventions must be multi-level, to overcome structural, social and behavioral barriers to healthy eating.
Le coup d’État du 24 avril 1617 marque l’invention d’un nouveau personnage littéraire : le favori. Dès 1617, des fictions narratives transposent sous le voile de l’allégorie la funeste destinée de Concini et légitime, par leur discours pathétique et leur visée eschatologique, le geste royal. Cependant, à mesure que l’écho de l’événement s’éloigne, les romans prennent une tournure plus critique et déjouent les ressorts du discours et de l’interprétation historiographiques officiels. En tressant les strates temporelles, en entrelaçant fiction et référence historique, ils forgent de nouveaux concepts politiques et dessinent des filiations historiques significatives.
Background Health promotion goes beyond the health sector. Municipalities, the local public authorities in Switzerland, have a crucial role to promote population health in all their decisions. Initially developed by Promotion Santé Valais, the label “Healthy municipality” exists in the canton of Vaud since 2015. The label takes stock of existing measures in health promotion and prevention in all sectors and incentivise new interventions. The labelling process respects different criteria and is validated by an external committee. It is voluntarist, free of charge for the municipality but requires time and intersectoral communication. This abstract explores equity in the uptake of the label. Results In Vaud, 17 municipalities have been labelled “healthy”. Two external evaluations by Swiss universities highlighted that small villages are less involved in the label than urban areas. To achieve health equity, we need to identify and approach municipalities with limited human and financial resources, that might be less active in health promotion and/or whose population is socioeconomically disadvantaged. Preliminary results indicate that municipalities below 1000 inhabitants, in rural areas, should be targeted first. We are currently investigating the barriers and facilitators for them to enrol in the label. Lessons As labels rewarding healthy cities are expanding worldwide, it is important to document and reflect on who benefits from them, and who does not. Our practice is now focusing more on villages in rural areas, with less resources than urban settings. We investigate their needs regarding the type of support that we, public health professionals, can provide. Proportionate universalism principles should also apply to advocacy for health promotion, at the municipality level. Key messages To achieve health in all policies, the role of municipalities is essential. More efforts in health promotion should target specifically small and rural municipalities, with limited resources.
La crise de la COVID-19 a mis en évidence les vulnérabilités et inégalités sociales de santé préexistantes. Elle a également montré le rôle des collectivités territoriales dans l’implémentation des recommandations de santé publique, qu’il s’agisse de prévenir la propagation du virus ou de promouvoir la santé de chacune et chacun. En Suisse, dans le canton de Vaud, les communes ont réagi promptement mais différemment selon les ressources et l’expertise à disposition. Bien que toutes ces actions soient louables, avec une réponse asymétrique, le risque de créer, voire de renforcer des inégalités territoriales de santé est néanmoins bien présent. Pour promouvoir la santé de manière équitable, efficiente et durable, nous devons renforcer les stratégies de promotion de la santé, assurer une meilleure coordination au niveau local, et développer une approche multisectorielle de la santé. Créer un groupe de coordination et d’accompagnement des communes en matière de promotion de la santé est une approche prometteuse.
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