Background: Studies on contextual effects on health often suffer from compositional bias and selective migration into contexts. Natural experiments among migrants may allow for the causal effect of contexts in generating health inequalities to be examined. We synthesised the evidence on and health from natural experiments among migrant populations. Methods: Systematic literature review searching the databases PubMed/MEDLINE, The Cochrane Library, Web of Science, CINAHL and Google Scholar for literature published until October 2022. 5870 studies were screened independently in duplicate using pre-defined criteria for inclusion: quantitative natural experiment methodology, migrant study population, context factor as treatment variable and health or healthcare outcome variable. Synthesis without meta-analysis was performed following data extraction and quality appraisal. Findings: The 46 included natural experiment studies provide causal evidence for the negative effects of neighbourhood disadvantage on physical health and mortality, while finding mixed effects on mental health. Studies comparing migrants with those that stayed behind demonstrate the detrimental effects of migration and adverse post-migratory contexts on physical health and mortality, while demonstrating favourable effects for mental health and child health. Natural experiments of policy contexts indicate the negative impacts of restrictive migration and social policies on healthcare utilization, mental health and mortality as well as the positive health effects when restrictions are lifted. Interpretation: Natural experiments can serve as powerful tools in reducing bias through self-selection. With careful consideration of causal pathways, results from migration contexts can serve as a magnifying glass for the effects of context for other population groups. Studies demonstrate the negative impacts for health which lie at the nexus of context and health. At the same time, they uncover the potential of health and welfare programs to counteract the disadvantages created by othering processes and promote healthy (post-migratory) contexts.
Ethnic diversity has been a topic of contention across the globe, contrasted with economic development, social security, and political stability. The link between health and ethnic diversity is not yet well established especially in low-middle- income countries. Our study aims to explore the association between ethnic diversity and all-cause mortality in rural areas of Burkina Faso. We used data from the Nouna Health & Demographic Surveillance System (HDSS) collected between 2000 and 2012. To derive Standardized Mortality Ratios (SMR), the observed number of deaths was compared to the expected deaths based on the entire HDSS taking into account sex, age, rainy season, calendar year, and village. SMR were calculated for ethnic and religious diversity on a village level (using the Simpson Index), sub-region, wealth, and distance to Healthcare Facilities (HCF). Furthermore, we modeled SMR with a multilevel random intercept Poisson regression considering individual ethnic and religious groups in addition to the above-mentioned village-level information. Village wealth (poorest fifth: SMR 1.07; 95% CI: 1.02–1.13, richest fifth: SMR 0.85; 95% CI: 0.82–0.88), distance to HCF (within the village: SMR 0.88; 95% CI: 0.85–0.91, further than 5km: SMR 1.13; 95% CI: 1.10–1.16), and sub-region showed significant associations with overall mortality. Villages belonging to the third with the highest ethnic diversity had lowered SMR (0.86; 95% CI: 0.84–0.89) compared to the entire HDSS, while those belonging to the lowest diversity third yielded elevated SMR (1.13; 95% CI: 1.09–1.17). The multilevel model confirmed the association. Our study showed that historically established ethnic diversity in rural areas of Burkina Faso was associated with lower all-cause mortality. Generally, the literature suffers from a lack of standardization in defining ethnic diversity, along with measuring it. More research is needed to understand this relation and to establish it in different settings.
Background Understanding the different types of health interventions that have been conducted for migrants and refugees is crucial for the improvement and implementation of future health interventions for these populations. This systematic review aimed to identify and to look at the scope and outcomes of health interventions focused on migrants and refugees in the main host counties in Southeast Asia which are Thailand, Singapore, and Malaysia. Methods This study was conducted in line with the PRISMA guidelines and its protocol has been submitted to PROSPERO. The following databases were searched until June 2021: PubMed, Web of Science, Science Direct, Cochrane, and Google Scholar. Studies were excluded if: 1) they were conducted outside Thailand, Singapore, and Malaysia; 2) had only had qualitative results; 3) were non-peer reviewed; 4) not written in English. Results The search yielded 8,266 studies, out of which 33 were included in the review. The majority of the studies (79%) were conducted in Thailand of which most were focused on migrants or refugees from Myanmar (85%). Besides two randomized controlled trials (RCTs) of mental health interventions, most Thai studies were observational (81%) and focused on infectious disease-related interventions (33%) or the evaluation of health-related programs (29%). Six studies were conducted in Malaysia (18%) of which 4 assessed mental health interventions in refugees. Three of these studies were RCTs, whereas 1 was an observational study. Only 1 study was situated in Singapore and was an RCT evaluating treatments for COVID-19 in migrant workers. Even in studies with similar interventions, outcomes were too diverse to conduct a meta-analysis. Conclusions The low number of studies highlights the gap in literature on health interventions for migrants and refugees, especially in Malaysia and Singapore. More rigorous and cohesive intervention-related research needs to be conducted in Southeast Asia. Key messages • More intervention-related research for migrant and refugee populations in the main Southeast Asian host countries is needed. • Interventions for migrant and refugee populations in host countries in Southeast Asia often do not follow the gold standard RCT study design, limiting the knowledge on their effectiveness.
Background Many studies on contextual health effects suffer from compositional bias and selective migration into neighbourhoods. Longitudinal natural experiments have the potential to overcome these limitations, and there are several opportunities for this research design in the migration context. We aimed to synthesize evidence from natural experiments among migrants studying the effect of contextual factors on health and healthcare. Methods Peer-reviewed literature in English or German was systematically searched in four major databases in December 2021. Following systematic abstract- and fulltext-screening, 32 studies were included for analysis. Evidence on contextual impacts on physical and mental health, mortality, and healthcare was narratively synthesized and quality appraisal conducted. Results We found four types of contextual health effects: factors of the place of residence in receiving countries (n = 6), migration-context interactions (n = 10), policy environments (n = 15) and cultural factors (n = 1). Results show the negative impacts of post-migratory contexts on physical health and mortality and the favourable impacts on child health. Impacts on mental health are mixed. Analyses of policy contexts indicate the negative impacts of restrictive migration and social policies on healthcare utilization, mental health and mortality as well as the positive effects when restrictions are lifted. Conclusions Natural experiments can serve as powerful tools in disentangling the effect of context on health and reducing bias through self-selection. Results demonstrate the negative impacts for health which lie at the nexus of migration and neighbourhood disadvantage. At the same time, studies uncover the potential of health, welfare and visa programs to counteract such disadvantages and create healthy post-migratory contexts. With careful consideration of causal pathways, results from migration contexts can serve as a magnifying glass for effects of context in other population groups. Key messages • Natural experiments can serve as powerful tools in disentangling the effect of context on health and reduce bias through self-selection. • Results show the negative impacts for health that lie at the nexus of migration and neighborhood disadvantage, as well as the potential of inclusionary policies to counteract them.
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