Results and Strategies for a Diversity-Oriented Public Health Monitoring in Germany

Abstract

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.

Investigating people’s attitudes towards participating in longitudinal health research: an intersectionality-informed perspective

“…The analysis in this paper has therefore shown that attitudes towards participation in health research are contingent on a range of personal biographies, culturally sanctioned ideals and values, and shaped by the complex intersections of social location and experience. Our anti-categorical and comparative approach as well as our understanding of cultural processes as underlying all social behaviour [ 54 ], rather than simply as a prism for minority ethnic status or ‘hard-to-survey populations’ [ 42 ] makes visible the specific and situated practices informed by both oppression and privilege. Indeed, while some participants identified as migrants or narrated experiences of nativist exclusion, they fully participated in predominant value systems and discursive frames.…”

“…This was exacerbated by the means of invitation, i.e. sending written letters exclusively in German, known to be ineffective for reaching individuals with insufficient German language skills [ 63 , 42 , 62 ]. Despite justified critique of an ‘ethnic matching’ or ‘race'-of-interviewer-effects’ approach that assumes a one-dimensional and static approach to social location [ 27 ], pairing respondents and interviewers with the same country of origin, ethnicity or language has often been recommended to improve the inclusion of diverse communities [ 42 ].…”

“…sending written letters exclusively in German, known to be ineffective for reaching individuals with insufficient German language skills [ 63 , 42 , 62 ]. Despite justified critique of an ‘ethnic matching’ or ‘race'-of-interviewer-effects’ approach that assumes a one-dimensional and static approach to social location [ 27 ], pairing respondents and interviewers with the same country of origin, ethnicity or language has often been recommended to improve the inclusion of diverse communities [ 42 ]. Given both our intersectional approach that aims to consider multiple dimensions of social identity simultaneously but also because of logistical limitations, we did not deploy such an approach; this, however, may have reproduced the exclusion of marginalised positions whose embodied knowledge, experiences and value systems may well produce different results to those represented in this paper.…”

“…In cohort studies, women aged 75 and older and women aged 35 and younger are often underrepresented groups amongst women [ 35 ], and the influence of a steady partnership on response proportions differs by sex/gender [ 66 ]. However, most analyses of social heterogeneity have either exclusively focused on specific subgroups [ 61 67 4 37 42 ] or have been quantitative and descriptive in nature, missing to engage the complex and situated nature of study participation (also see [ 29 ]. Intersectionality scholarship has focused on the interactions between different social categories and the structural causes they are proxies for, shaping individual experience and (health) inequities [ 14 17 15 ].…”

Editorial – Migration and health: Moving towards diversity-oriented public health monitoring at the Robert Koch Institute

“…Only by considering this diversity, is it possible to make differentiated statements about the health status of people with a history of migration. Thus, it is necessary not only to compare broadly categorised groups in analyses of public health data, such as people with or without a migration background, but also to consider aspects such as socio-economic situation, duration of residence, reasons for migration, German language proficiency, or experiences of discrimination in a differentiated manner [ 4 ].…”