Lesson 4 Social dimensions of Health

Lesson 4a: Intercultural Mediation in Health Care: the Role of Migrant Clinicians

According to the action plan of the WHO in Europe (2016), any communication barriers must be addressed and health systems must be strengthened in order to promote the health of migrants and refugees.

Migrant clinicians are working to provide the highest standard of mental and behavioral health care using practices and language that are supportive of patient’s personal experiences.

Clinicians must be aware of patterns of migration and resilience factors in order to plan any intervention strategies.

Intercultural mediators are employed to resolve linguistic and cultural barriers in a variety of health-care contexts.

The beneficial impact of intercultural mediators is hindered by:

  • lack of professionalization
  • insufficient training
  • non-systematic implementation of intercultural mediation programmes

Further research into the effectiveness of intercultural mediators in health care and the development of strategies that guarantee access to intercultural mediators in health care will improve the quality of health care for refugees and migrants.

Mediator is a person who improves communication and understanding between people in order to reduce linguistic and socio-cultural differences.


  • Prevent and reduce conflicts between patients and providers.
  • Assist healthcare providers to meet the needs of the immigrant populations.
  • Undertake various intercultural mediation programs, putting emphasis on:
    • language differences;
    • the development of cultural skills;
    • the empowerment of the patient.

Lesson 4b: Special Issue: Immigrant Women

Women migrate at a rate similar to men, but migration affects them differently.

You can find more information in Module 6 Gender related Health“.

  • limited access to contraception;
  • pregnancy termination;
  • heightened levels of discrimination;
  • gender-based violence.
  • low birth weight baby;
  • infant mortality;
  • maternal mortality;
  • a high probability of giving birth without a health professional.

Female immigrants’ negative life experiences –infertility and perinatal loss, poverty, discrimination, violence, unemployment and isolation – also impact on women’s mental health and wellbeing.

Lesson 4c: Violence

Sexual and intimate partner violence (S/IPV) is a widespread problem among immigrant and refugee communities with serious health and safety implications.

S/IPV may include any form of power and control, physical, sexual, verbal, mental, or economic, primarily against women by her current or former partner/ spouse.

Women often suffer in silence for fear of losing their jobs or enduring legal ramifications like being reported to immigration.

  • Cultures of origin make it increasingly difficult to come forward and report these abuses.
  • Freepik.com
    Language barriers
  • Economic hardship
  • Isolation from communities
  • Support networks
  • Freepik.com
    During migration, women are especially vulnerable to trafficking.
  • Trafficking victims are coerced into working.
  • In the case of sex trafficking, women are forced into prostitution or the sex entertainment industry.
  • Trafficked victims may be coerced into working in industries such as agriculture, sweatshop factory work, and domestic, janitorial, or restaurant work.
  • Clinicians must be aware of the possibility that patients may be the victim of trafficking.