A handbook for policies to protect foreign child Salvatore Geraci and Mark Mazzetti Italian Society of Medicine of Migration. of
Stefano Geraci and Mark Mazzetti "If medicine is to achieve its full purpose, it must enter political life of his time in the large, and should include all the obstacles that hinder the smooth completion of the life cycle ". ... "Medicine is a social science and politics is medicine on a large scale," R. Virchow, German pathologist, 1848 The great German pathologist Virchow, the father of modern medicine, reminds us with these words, written in mid- nineteenth century, we can not think about protecting the health of large sections of the population without thinking politically. Degradation and that the policy themes of his debate reached in our country are such as to make us think with some contempt to its function. Yet politics is perhaps the highest point of attention to another, and its degradation in power struggles and abuse, violence we should not get used. Thinking about politics "high" is especially crucial when dealing with health and, in Italy today, protection of sensitive population groups, that without proper protection measures are likely to be even weaker. In Italy In early April, was published the news that a Nigerian child died 13 months (the fact dates back to about a month before) Cernusco hospital after being discharged from the emergency department and being admitted only after repeated insisted: "The nurses, the first time he was taken to hospital with the 118, they said they were not admitted because the health insurance card had expired," reads the complaint lodged by the girl's father. We do not know exactly what is but the news happened, regardless of its veracity, shows a weakness "more" of foreign children in Italy and that is the uncertainty in accessibility to health services. But this is just one fragile that they, innocent, suffer and that they should be avoided. Over 700,000 of the almost alive today than a million children under the children of foreign parents, of whom nearly 800,000 were born in this our country, were born in Italy and can, and should rightfully should perhaps be considered "new Italians ". Unfortunately it is not. Children "foreigners" (I put that term in quotes because in fact they are Italians in every respect, except civil rights) does not enjoy the protection they need for their healthy growth and mental and physical well-being of our future country. The fertility rate of Italian women is about 1.2 children, in other words, an Italian woman gives birth on average, during her childbearing age, 1.2 children. In fact, the fertility rate in Italy is a bit 'higher get to touch 1.4 children per woman, but this is enriched by the contribution of migrant women. The Italian stop a little lower. In demography is known as "replacement factor" to indicate the number of children that a woman must give birth to replace the deaths and maintain the number of members of a population. For Italy, this factor is about 2.1: every woman, that is, to give birth at least two children to replace themselves and their partners, more "something" to compensate for other losses, mainly infant mortality, which fortunately we have is very low. A simple look at the data tells us that in Italy "produce" little more than half of the children we serve to maintain a constant population: the obvious consequence is that every change of generation, we halve. We will be reduced from three generational transfers (more or less) one-eighth of those we are now, or we will be largely on the path of extinction. The only hope is that more and more people are Italianize and abroad to colonize our country to keep it alive and vital, to pass on our language and our culture. For this to protect the health of immigrant children also means protecting the future of Italy. In the debate that a few months ago has raised the proposal of the market share of 30% about the "management" education of the children of immigrants in recent months we have emphasized in the opinion of the Italian Society of Medicine of Migration to I am honored to which we belong, such proposals may be some choices of appropriate policies to promote the welfare of foreign children. Not surprisingly, a medical society (and others) wanted to emphasize the critical issues and make proposals that go beyond an approach strictly health: medical means for us to deal with public health, and - following the teaching of Virchow - deal with public health is to make policy. We believe that it is part of our job as health technicians identify the needs of the polis and to suggest actions that we think themselves useful. The proposals below focus on the policies being adopted to provide a possible future for foreign children and their families appear able and promising to have a positive impact on the bio-psycho-social health of children with foreign citizenship in Italy, are consistent with the Declaration of the Rights of the Child were developed in part as members in the Committee "Immigration and Health" at the Ministry of Health is already included in the recommendations made (unfortunately unsuccessfully) to the then Minister in 2007, and some are the result of new considerations on the basis of educational and social policies adopted by the Government last two years. For the health needs and health evidence and refer to the latest reports joint UNICEF and the Italian Caritas, both updates of the Working Group for the Convention on the Rights of the Child (CRC Group) and finally the technical and scientific publications Working Group of the National Child Immigrant Italian Society of Pediatrics. Here we focus on policy to provide certainty of a possible future for foreign children and their families. In fact one of the basic psychological needs during childhood and that of stability. Children need to know to have a safe place and a time in which to grow and build its own future. Immigration policies that keep families in precarious conditions, eg residence permits every year or two, involving children also uncertainty about the opportunity to continue their studies the following year, are potentially very harmful both for the psychological growth and for the sense of social belonging than to be Italians tomorrow. So are schools in which the inclusion and development of a sense of belonging are hampered by rules or resources (economic and educational) are not adequate. For this reason I propose here a ten-point, some of which we now unavoidable, in contrast with respect to certain choices and deal approved standards present government, but we reiterate with force and conviction, and policies relating to education and health but also suggest the basis for facing a peaceful social coexistence in a multiethnic society perspective, because we believe that the psychological and physical health of foreign children today (and that of the Italians of tomorrow) is precious and must be protected above all social, creating the conditions for them to grow calm, developing a sense of belonging to their homeland, which is also ours. 1. As in most countries of immigration is necessary structural change from jus sanguinis to jus soli in the granting of Italian nationality, born in Italy in a way that involves the acquisition of citizen status. Currently, born in Italy does not in fact following the acquisition of citizenship instead of the "blood", that is the status of the parents. The children of foreigners are so forced to grow up in a situation of discrimination against children of Italians to their peers, which do not agree with civil rights, despite their on the contrary, all parents share the duties of the Italians, first the payment of taxes. It is also necessary pPredisporre facilitated access for the acquisition of citizenship for foreign children who, although not born here, I have spent significant time, especially in education. Doing so not only are protective for the health of children, but may also include as an investment for the community: do not make it possible to disperse a capital of skills and financial cost to our country, who has incurred the costs of schooling of these children. E 'must also have procedures for acquiring citizenship, as well to be simple and guaranteed in legislation, even encounter a bureaucracy sufficiently slender. To date, the examination of the files get to take a little more than three years. 2. Ensuring long-term residence permits (at least five years) to families with children present, especially if these children are of school age (at least until completion of the 14th year of age), so as to ensure the possibility of a reasonable programming of their studies and at least the near future. 3. Schools must provide appropriate pathways into teaching of children newly immigrants who do not know the use of Italian. These pathways must be integrated into normal teaching classes (and not "special classes") using teacher support and additional hours for language learning, and at the same time fostering the integration of children into the normal class. All schools should be able to provide specific integration programs for newcomers, according to psycho-educational guidelines that are to be compiled on a national scale but must be flexible enough to adapt to local realities. These programs must be adequately funded, for example, capitation (funding to each school in proportion to the number of new foreign students included). 4. They must be prepared appropriate legislative devices so that on coming of age, or after completing their education, children attend school in Italy is no risk expulsion if they do not find immediately a contract of employment in order to issue a residence permit. As soon as they become adults, in fact, the children fall within the normal rules of adults, and can remain in the country only if studying, or have a stable job (though this is easy to get to 18 years is not worth to discuss it). Such legislation may also include, for example, for a ten year old boy the expulsion of an older brother with forced separation from them. 5. With the aim of promoting mental health and prevent mental disorders, it is suggested to finance a specific expenditure item with the aim to promote measures to facilitate integration (school and social) of the children of foreign origin into Italian society, and to take your pet for a family reunion migrants in difficult times (especially when the separation from parents has been particularly prolonged). Doing so, spread throughout the territory, can help evitareprevenire, or at least manage, terms of psychological malaise. 6. Also for the promotion of mental health, it is necessary to facilitate family reunification. Currently living the parameters are highly restrictive and, if they were applied also to the Italians, many of us would forced to part with their children. In addition, the requirements should be modulated on the basis of links between partners, reducing them further if it is a simple family (parents and children), compared to situations where there are other people. It is also necessary to streamline the bureaucratic process: now between the demand for reunification, and its approval may pass 10-12 months. The introduction of the consent-consent may be helpful in this regard. Also appear promising social intervention can help in the management after they occurred (see paragraph 8 above) because sometimes the difficulties that families face are considerable. It also suggests allowing the reunification with the same rules for adult children below 21 years of age, and in all cases where this is necessary to separate the brothers do not (for example, if the ages were 22, 16 and 12 years). 7. Ensuring access to schools for the children of immigrants without residence permit, even outside of school: now the right is not granted to those under 6 years old or over 16. To do this you must also cancel the effects of. 10a of the Law 94/09 (the so-called "security" and their "crime of illegal immigration" set) in respect of these children and their parents, or permit the disclosure, as for the school, even without the submission of the residence permit. 8. Providing equal treatment in receiving economic benefits for the protection of women, maternity and child between Italians and foreigners with residence permit in order, this equality is currently approved only to holders of a residence card (permanent residence permit). 9. Enter the SSN of all children who are present across the country: presently the children of illegal immigrants do not enjoy this right, with the potential harm to their health. Some regions on their own, have begun to provide this assistance, but many more missing. 10. Extension of Permit Stay for pregnancy. Currently a permit is issued for the duration of pregnancy and the first six months after birth, after which triggered the expulsion of the woman and child. Understandably, many mothers prefer not to take this leave, which really becomes un'autodenuncia, and remain in the irregularity, not allowing them to enjoy the protection of motherhood interventions. The indicators of health outcomes related to childbirth are telling us that the children of foreign mothers are still very disadvantaged compared to the Italians because the pregnancies of their mothers are less protected. Extend the permit for 12 months pregnant with the possibility of transforming it later permission to work in protecting the health of babies and would be a further interevento protection for the future. As you can see, to call the currency, the question of the "30%" (or any other hypothetical share), it is quite minor, compared to policy choices more or less easy to adopt but undoubtedly the most effective, both for promote the health of children of Italian origin who favor the process of mutual integration which also affect their classmates Italians. It goes without saying that a certain quota of the number of entries is essential, not to subvert the normal pattern of educational programs, and in the best way to follow the new students, the problem is, however, rather marginal, since the vast majority of pupils of foreign origin, as we have said, was born in Italy or has appropriate knowledge of the national language. To conclude: good laws make good health. The task of health workers, not only to cure diseases, but also to ensure that good standards to protect public health, especially when the health of children is at stake, a real, valuable investment for the future of the country. "... The health measures for migrants who are well managed, including public health, promote the welfare of all and can facilitate the integration and participation of migrants in host countries by promoting inclusion and understanding, contributing to the cohesion, increasing development "(Declaration of Bratislava at the end of the 8th Conference of European Ministers of Health, 2007).