Learning from the COVID-19 pandemic among migrants: An innovative, system-level, interdisciplinary approach is needed to improve public health

Abstract

The effects of the COVID-19 pandemic are amplified among socially vulnerable groups, including international migrants, in terms of both disease transmission and outcomes and the consequences of mitigation measures. Migrants are overrepresented in COVID-19 laboratory-confirmed cases, hospital admissions, intensive care treatment and death statistics in all countries with available data. A syndemic approach has been suggested to understand the excess burden in vulnerable populations. However, this has not stopped the unequal burden of disease in Norway. Initially, the disease was mainly imported by Norwegians returning from skiing holidays in the Alps, and the prevalence of infection among migrants in Norway, defined as people born abroad to foreign parents, was low. Later, confirmed cases in migrants increased and have remained stable at 35–50% – more than twice the proportion of the migrant population (15%). To change this pattern, we need to understand the complex mechanisms underlying inequities in health and their relative and multiplying impacts on disease inequalities and to test the effect of counterfactual policies in order to reduce inequalities in disease burden. Yet, the current paradigm in the field of migration and health research, that is, the theories, research methods and explanatory models commonly applied, fail to fully understand the differences in health outcomes between international migrants and the host population. Here, we use the Norwegian situation as a case to explain the need for an innovative, system-level, interdisciplinary approach at a global level.

Economic Migrants and Clinical Course of SARS-CoV-2 Infection: A Follow-Up Study

“…Likewise, the higher hospitalization rates in EM would apparently not be in accordance with the phenomenon known as the "healthy immigrant effect" [35], although this gap in health levels between EM and natives has been questioned in Spain and other European countries [36]; moreover, controlling for comorbidity using propensity scores also raises the suspicion that it is not associated pathologies that increase the probability of hospitalization in EMs. Therefore, given that comorbidity, socioeconomic and demographic factors cannot be identified as responsible for the association between EM status and the risk of being hospitalized for COVID-19, one can only speculate, as has been recently suggested [37], whether language and cultural barriers, lack of knowledge about the functioning of the health system, sociopolitical conditioning factors or genetic and biological susceptibility might be behind these differences.…”

Strongyloides and COVID-19: Challenges and Opportunities for Future Research

“…A study from Norway found that 35–50% of the confirmed cases of COVID-19 were in migrants, despite them only making up about 15% of the general population. [ 43 ]. Migrant workers are overrepresented in lower paid jobs and crowded living situations, and as such, are more vulnerable to the spread of COVID-19 [ 44 ].…”

‘Who is telling the truth?’ Migrants’ experiences with COVID-19 related information in Norway: a qualitative study

“…Such factors consequently increase the risk of health problems. Among migrants, as with other groups, socioeconomic factors increased the risk and severity of COVID-19, exacerbating existing health inequalities during the pandemic [13-16]. However, in addition to socioeconomic factors, other aspects, unrecognised at the time, came into play, which resulted in increased health disparities among migrants during the pandemic [17].…”