a b s t r a c tAlthough Portugal has been deeply affected by the global financial crisis, the impact of the recession and subsequent austerity on health and to health care has attracted relatively little attention. We used several sources of data including the European Union Statistics for Income and Living Conditions (EU-SILC) which tracks unmet medical need during the recession and before and after the Troika's austerity package. Our results show that the odds of respondents reporting having an unmet medical need more than doubled between 2010 and 2012 (OR = 2.41, 95% CI 2.01-2.89), with the greatest impact on those in employment, followed by the unemployed, retired, and other economically inactive groups. The reasons for not seeking care involved a combination of factors, with a 68% higher odds of citing financial barriers (OR = 1.68, 95% CI 1.32-2.12), more than twice the odds of citing waiting times and inability to take time off work or family responsibilities (OR 2.18, 95% CI 1.20-3.98), and a large increase of reporting delaying care in the hope that the problem would resolve on its own (OR = 13.98, 95% CI 6.51-30.02). Individual-level studies from Portugal also suggest that co-payments at primary and hospital level are having a negative effect on the most vulnerable living in disadvantaged areas, and that health care professionals have concerns about the impact of recession and subsequent austerity measures on the quality of care provided. The Portuguese government no longer needs external assistance, but these findings suggest that measures are now needed to mitigate the damage incurred by the crisis and austerity.

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This paper describes an acculturative integration approach that stresses the contribution of liberation psychology. Immigrant integration is a challenge for receiving countries in the Western world due to the frequent asymmetrical and oppressive conditions suffered by newcomers in their new settlements. The cross-cultural perspective connects integration with psychological acculturation, emphasizing harmony between acquisitions of the new culture while maintaining cultural heritage, and creating opportunities for intergroup relationships. In turn, liberation psychology permits an understanding of the acculturative transition as an empowerment and self-construction process by which immigrants acquire a new vision of the world and of themselves, transforming both structural conditions and themselves. From this perspective we conceptualize acculturative integration as the process by which newcomers become an accepted part of the new society through a reflexive and evaluative process, changing their social references and position, rebuilding their social and personal resources, and achieving a new agency in coherence with their new challenges and goals. In this process, they acquire critical thinking about unequal conditions, gain capacities to respond to the inequalities, and take effective actions to confront them. We illustrate this process using the narratives of nine Moroccan women who are living in asymmetrical and oppressive local contexts in Andalusia, the southern-most region of Spain.

Needs assessment models have been generally focused on the identification and prioritization of needs, analysing formal resources available in the community as possible solutions for existing problems. These kinds of models have assumed that formal services are the primary source of support for individuals in need. However, a great deal of the investigations in the field of Social Psychology have shown that the main source of help and support when facing a problem is not formal organizations, but people's own informal networks. In this article, we therefore propose a needs assessment model that emphasizes the importance of analysing both formal and informal social resources. The application of this model to assess Moroccan immigrants' needs in the south of Spain shows the anticipated low level of utilization of formal services and programmes, one that contrasts with the high use of informal networks as an essential source of social support for this group of immigrants. These results reveal the limitations of traditional needs assessment models, and the importance of incorporating the analysis of informal social support as a key resource for need satisfaction, particularly in the case of immigrant populations.