Migrant integration policies and health inequalities in Europe

Abstract

BackgroundResearch on socio-economic determinants of migrant health inequalities has produced a large body of evidence. There is lack of evidence on the influence of structural factors on lives of fragile groups, frequently exposed to health inequalities. The role of poor socio-economic status and country level structural factors, such as migrant integration policies, in explaining migrant health inequalities is unclear. The objective of this paper is to examine the role of migrant socio-economic status and the impact of migrant integration policies on health inequalities during the recent economic crisis in Europe.MethodsUsing the 2012 wave of Eurostat EU-SILC data for a set of 23 European countries, we estimate multilevel mixed-effects ordered logit models for self-assessed poor health (SAH) and self-reported limiting long-standing illnesses (LLS), and multilevel mixed-effects logit models for self-reported chronic illness (SC). We estimate two-level models with individuals nested within countries, allowing for both individual socio-economic determinants of health and country-level characteristics (healthy life years expectancy, proportion of health care expenditure over the GDP, and problems in migrant integration policies, derived from the Migrant Integration Policy Index (MIPEX).ResultsBeing a non-European citizen or born outside Europe does not increase the odds of reporting poor health conditions, in accordance with the “healthy migrant effect”. However, the country context in terms of problems in migrant integration policies influences negatively all of the three measures of health (self-reported health status, limiting long-standing illnesses, and self-reported chronic illness) in foreign people living in European countries, and partially offsets the “healthy migrant effect”.ConclusionsPolicies for migrant integration can reduce migrant health disparities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3095-9) contains supplementary material, which is available to authorized users.

Health consequences of the US Deferred Action for Childhood Arrivals (DACA) immigration programme: a quasi-experimental study

“…The findings of large effects on mental health are consistent with results from observational studies showing rising symptoms of anxiety and depression with policies that raise the risk of deportation. [7][8][9][10][11][12][13][14][15] These findings could be of considerable importance in the current policy environ ment, with the USA broadening the legal infrastructure and human resources base needed to deport undocumented immigrants and restrict the entry of new migrants. 24,41 Additionally-as of the time of writing-the future of the DACA programme itself seems to be in doubt.…”

“…[3][4][5][6] In particular, the results of studies from both the USA and European settings suggest that immigration policies that raise the risk of deportation or place limits on legal rights and access to social services might raise the risk of poor mental health outcomes, such as depression and anxiety, and curtail access to health care more generally. [7][8][9][10][11][12][13][14][15] In recent years, the USA has witnessed substantial changes in policies towards undocumented immigrants. In June, 2012, the US Government initiated the Deferred Action for Childhood Arrivals (DACA) programme, which provided temporary work permits and freedom from deportation to individuals who met specific eligibility criteria (panel).…”

“…More generally, studies linking policies targeting undocumented migrants to health outcomes are generally descriptive, with the underlying causality less clear. [7][8][9][10][11][12][13][14][15] This broader question has gained significance in recent months, as fundamental changes in US immigration policy are being debated. 24,25 In this study we aimed to examine the consequences of the US DACA programme on self-reported overall and mental health among undocumented immigrants of Hispanic origin (who represent the majority of DACAeligible individuals).…”

Skilled migration: a structural determinant of health

“…Skilled migrants make up approximately 67% of the total annual migrant intake into Australia (Australian Government 2017) and are generally in good health when they immigrate (Biddle, Kennedy & McDonald 2007;Jatrana, Pasupuleti & Richardson 2014). Studies recognise that this is due to the healthy migrant effect (migrant health being superior to that of the host population, through selection) and the salmon bias (migrants returning to their home countries due to illness, while the healthiest migrants remain in the country of settlement) (Giannoni, Franzini & Masiero 2016;Jatrana, Pasupuleti & Richardson 2014;Kearns et al 2017;Rechel et al 2013;Rivera, Casal & Currais 2016;Vang et al 2017). However, existing research suggests that skilled migrants face health, particularly mental health, challenges after setttlement and their health can worsen over time through acculturation (Biddle, Kennedy & McDonald 2007;Han & Chesters 2001;Jatrana, Pasupuleti & Richardson 2014;Pernice et al 2009;Verdonk 1979).…”

“…The literature demonstrates that social determinants of health (SDOH), including socioeconomic status and social exclusion, are implicated in causal pathways relating to the health of migrants (Giannoni, Franzini & Masiero 2016;Marmot et al 2012). SDOH include factors such as birthplace, living situation, and lifestpa development , as well as the broader systems shaping the conditions of FINAL daily life (WHO 2018).…”