According to microcensus data, nearly one quarter of the German population has a migration background. This means that either themselves or at least one parent was born without German citizenship. Based on the currently available data and due to the underrepresentation of specific population groups, representative findings on the health of the total population residing in Germany are only possible to a limited degree. Against this backdrop, the Robert Koch Institute initiated the Improving Health Monitoring in Migrant Populations (IMIRA) project. The project aims to establish a migration-sensitive health monitoring system and to better represent people with a migration background in health surveys conducted by the Robert Koch Institute. In this context it is crucial to review and further develop relevant migration-sensitive concepts and appropriate surveying instruments. To achieve this, the concepts of acculturation, discrimination, religion and subjective social status were selected. This article theoretically embeds these concepts. Furthermore, we describe their application in epidemiology as well as provide a proposal on how to measure and operationalise these concepts. Moreover, recommendations for action are provided regarding the potential application of these concepts in health monitoring at the Robert Koch Institute.
Germany is a country of immigration; 27% of the population are people with a migration background (PMB). As other countries, Germany faces difficulties in adequately including hard-to-survey populations like PMB into national public health monitoring. The IMIRA project was initiated to develop strategies to adequately include PMB into public health monitoring and to represent diversity in public health reporting. Here, we aim to synthesize the lessons learned for diversity-oriented public health monitoring and reporting in Germany. We also aim to derive recommendations for further research on migration and health. We conducted two feasibility studies (interview and examination surveys) to improve the inclusion of PMB. Study materials were developed in focus groups with PMB. A systematic review investigated the usability of the concept of acculturation. A scoping review was conducted on discrimination as a health determinant. Furthermore, core indicators were defined for public health reporting on PMB. The translated questionnaires were well accepted among the different migrant groups. Home visits increased the participation of hard-to-survey populations. In examination surveys, multilingual explanation videos and video-interpretation services were effective. Instead of using the concept of acculturation, we derived several dimensions to capture the effects of migration status on health, which were more differentiated. We also developed an instrument to measure subjectively perceived discrimination. For future public health reporting, a set of 25 core indicators was defined to report on the health of PMB. A diversity-oriented public health monitoring should include the following: (1) multilingual, diversity-sensitive materials, and tools; (2) different modes of administration; (3) diversity-sensitive concepts; (4) increase the participation of PMB; and (5) continuous public health reporting, including constant reflection and development of concepts and methods.
SARS-CoV-2, the coronavirus, spread across Germany within just a short period of time. Seroepidemiological studies are able to estimate the proportion of the population with antibodies against SARS-CoV-2 infection (seroprevalence) as well as the level of undetected infections, which are not captured in official figures. In the seroepidemiological study Corona Monitoring Nationwide (RKI-SOEP-2), biospecimens and interview data were collected in a nationwide population-based subsample of the Socio-Economic Panel (SOEP). By using laboratory-analyzed blood samples to detect antibodies to the SARS-CoV-2 virus, we were able to identify a history of vaccination or infection in study participants. By combining these results with survey data, we were able to identify groups within the population that are at increased risk of infection. By linking the RKI-SOEP-2 survey data with data from other waves of the SOEP survey, we will be able to examine the medium- to long-term impacts of the COVID-19 pandemic, including effects of long COVID, in diverse areas of life. Furthermore, the data provide insight into the population’s willingness to be vaccinated as well as related attitudes and conditions. In sum, the RKI-SOEP-2 survey data offer a better understanding of the scope of the epidemic in Germany and can help in identifying target groups for infection control in the present and future pandemics.
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