440 Adressing structural inequety for undocumented migrants in primary healthcare a multi-methodological study in Bologna

Abstract OP 10: Determinants of Health Disease and Interventions 2, B207 (FCSH), September 3, 2025, 15:45 - 16:45 Aim Decades of research have highlighted persistent health inequalities in Italy, particularly affecting undocumented migrants and socially marginalized individuals. However, little is known about how healthcare services either mitigate or perpetuate these disparities, as well as their impact on healthcare workers and patients. To investigate these dynamics, a participatory action research study was launched in Bologna in 2021 in collaboration with the local health authority (AUSL Bologna). Methods The research adopted a multi-methodological approach, combining: Results Between 2021 and 2023, observations of multidisciplinary teams and governance groups focused on migrant health enabled the identification of key equity-related challenges and three research-action priorities. Preliminary statistical analysis revealed that over 20,000 undocumented migrants sought care in Bologna between 2018 and 2022, influenced by factors like COVID-19 vaccination and the Ukrainian refugee crisis. The study also developed a methodology to identify undocumented migrants in health databases. The qualitative research mapped over 20 healthcare and social services, highlighting fragmented integration and organizational mechanisms contributing to inequality: Conclusion These mechanisms intersect with structural racism, discrimination, and healthcare privatization, affecting both patients and healthcare workers, generating frustration and ethical conflicts. Despite being preliminary, the findings underscore the importance of participatory, action-oriented research in addressing inequalities and informing health policy.