Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis

Prevalence and associated factors for poor mental health among young migrants in Sweden: a cross-sectional study

BACKGROUND

Young migrants face multiple challenges that can affect their mental, sexual and reproductive health.

OBJECTIVE

To assess the prevalence of self-reported poor mental health and its associated demographic, post-migration and sexual risk behaviour factors among young migrants (aged 15-25) in Sweden.

METHODS

Data were drawn from a cross-sectional survey conducted with migrants aged 15-65 years old in Sweden between December 2018 and November 2019 (n = 6449). Among these, 990 participants aged 15-25 were eligible for the study. Mental health was measured using the Refugee Health Screener-13. Missing data indicator analysis and multivariable logistic regression models were conducted to estimate the association between mental health, sexual risk behaviour, demographic and migration-related variables.

RESULTS

Of the 990 participants, 59% reported poor mental health. Participants reporting poor mental health were more likely to be female (AOR:1.63, 95% CI:1.18-2.25), to have lived in Sweden more than three years (AOR:2.16, 95% CI:1.17-3.97), to engage in any sexual risk behaviour (AOR:1.99, 95% CI:1.25-3.17), and to live alone (AOR:1.95, 95% CI:1.25-3.03) or with friends they already knew (AOR:1.60, 95% CI:1.37-4.91). People arriving from the Americas (AOR:0.54, 95% CI:0.33-0.88), Asia (AOR:0.44, 95% CI:0.22-0.86), Europe (AOR:0.30, 95% CI:0.14-0.61) and Africa (AOR 0.37, 95% CI: 0.23-0.60) had lower odds of poor mental health than those arriving from Syria.

CONCLUSION

The prevalence of poor mental health among young migrants in Sweden was high, with specific subgroups (women, asylum seekers, people arriving from Syria, and those residing longer in Sweden) being particularly vulnerable. Our results indicate the interconnectedness between poor mental health and sexual risk behaviour in this population. Thus, policies targeting young migrants should ensure that healthcare services screen for both poor sexual and mental health at the same time.

Perinatal mortality among pregnant undocumented migrants in Norway 1999-2020: A register-based population study

BACKGROUND

Irregular legal status is a recognized health risk factor in the context of migration. However, undocumented migrants are rarely included in health surveys and register studies. Adverse perinatal outcomes are especially important because they have long-term consequences and societal risk factors are modifiable. In this study, we compare perinatal outcomes in undocumented migrants to foreign-born and Norwegian-born residents, using a population-based register.

METHODS

We included women 18-49 years old giving birth to singletons as registered in the Medical Birth Registry of Norway from 1999 to 2020. Women were categorized as 'undocumented migrants' (without an identity number), 'documented migrants' (with an identity number and born abroad), and 'non-migrants' (with an identity number and born in Norway). The main outcome was perinatal mortality, i.e., death of a foetus ≥ gestational week 22, or neonate up to seven days after birth. We used log-binominal regression to estimate the association between legal status and perinatal mortality, adjusting for several maternal pre-gestational and gestational factors. Direct standardization was used to adjust for maternal region of origin.

ETHICAL APPROVAL

Regional Ethical Committee (REK South East, case number 68329).

RESULTS

We retrieved information on 5856 undocumented migrant women who gave birth during the study period representing 0.5% of the 1 247 537 births in Norway. Undocumented migrants had a relative risk of 6.17 (95% confidence interval 5.29 ̶7.20) of perinatal mortality compared to non-migrants and a relative risk of 4.17 (95% confidence interval 3.51 ̶4.93) compared to documented migrants. Adjusting for maternal region of origin attenuated the results slightly.

CONCLUSION

Being undocumented is strongly associated with perinatal mortality in the offspring. Disparities were not explained by maternal origin or maternal health factors, indicating that social determinants of health through delays in receiving adequate care and factors negatively influencing gestational length may be of importance.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health

Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.

The legacy of immigration policies and employment exclusion: Assessing the relationship between employment exclusions and immigrant health

Restrictive federal and state immigration policies create conditions of employment exclusion that may negatively influence the health of immigrants. In particular, these policy effects are reflected in labor market and workplace experiences that determine the types of work and employment opportunities that immigrants are able to access and pursue. This study examines the relationship between both cumulative and individual measures of employment exclusion and self-rated health and psychological distress among Asian and Latino immigrants in California, and whether this relationship is modified by legal status. We used data from the Research on Immigrant Health and State Policy (RIGHTS) study (n = 2010). We used both multivariable logistic regression and linear regression models for our analyses. For cumulative models, labor market exclusion was associated with poor health (OR = 1.21, 95% CI: 1.01, 1.46). Workplace exclusion was also associated with poor self-rated health (OR = 1.45, 95% CI: 1.15, 1.82) and increased psychological distress (β = 0.69, 95% CI: 0.31, 1.07). For individual measures of employment exclusion, settling for a job - a labor market exclusion - and working in a dangerous job and experiencing wage theft - workplace exclusions - were associated with poor health and increased psychological distress. There was no evidence that the association between employment exclusions and health varied by legal status. These findings demonstrate that the combined effect of employment exclusions is detrimental to immigrant health. To improve population health, public health researchers should continue to interrogate the policy conditions at the federal, state, and local level that exclude immigrants from employment opportunities and workplace protections.

Downgraded dreams: Labor market outcomes and mental health in undocumented migration

Undocumented immigrant workers are particularly exposed to mental health risk factors, including occupational downgrading - i.e. the loss in occupational status upon arrival. This study breaks new ground by examining the relationship between occupational downgrading and mental health among this hard-to-reach population, offering the first-ever investigation of its kind. Leveraging a unique dataset collected by a primary care outpatient clinic in Milan, Italy, which combines medical evaluations with detailed occupational information, we construct a direct measure of occupational downgrading, which adds to the literature. We employ logistic regression models to estimate odds ratios (ORs) for mental and behavioral disorders. The study also offers fresh evidence on the socioeconomic and health status of a sizable sample of undocumented migrants. The study sample consists of 1738 individuals that had their first medical examination in 2017-18. Prevalence of mental health conditions is 5.58%. Data also highlight poor labor market integration: one third of individuals in the sample is employed, mostly in elementary occupations; 66.63% of immigrant workers experienced occupational downgrading. Regression results show that undocumented immigrants who undergo occupational downgrading are at considerably higher risk of mental disorders. ORs range from 1.729 (95% CI 1.071-2.793), when the model only includes individual characteristics determined prior to migration, to 2.659 (CI 1.342-5.271), when it accounts for all the available controls. From a policy perspective, our study underscores the need to consider the broader impact of policies, including restrictive entry and integration policies, on migrant health. Additionally, ensuring access to primary care for all immigrants is crucial for early detection and treatment of mental health conditions.

"We want our freedom back, that's our only need": a qualitative study of health and social needs among asylum seekers and undocumented migrants crossing the borders from Belarus to Lithuania

Background

The influx of undocumented migrants and asylum seekers into Lithuania, particularly during the COVID-19 pandemic, presents unique public health challenges. This study employs the Social Determinants of Health framework to explore the healthcare and social needs of this vulnerable population.

Methods

In May 2022, we carried out a qualitative study through semi-structured interviews with asylum seekers across four centers in Lithuania. Employing both purposive and snowball sampling techniques, we selected participants for our investigation. The study comprised 21 interviews-19 conducted in Arabic and 2 in English-with durations ranging between 20 and 40 min each. We audio-recorded all interviews, transcribed them verbatim, and subsequently performed a thematic analysis using Atlas.ti software. This process of design and analysis strictly followed the principles of thematic analysis as outlined by Braun and Clarke, guaranteeing methodological precision and rigor.

Findings

21 interviews revealed critical insights into the healthcare access challenges, mental health issues, and social integration barriers faced by the participants. Key themes included 'Healthcare Needs and the Impact of the COVID-19 Pandemic 'and 'Social needs and Aspirations Amidst Pandemic-Induced Uncertainty '. The findings highlight the multifaceted healthcare and social needs of asylum seekers, juxtaposed against significant barriers they face. Access to medical services is hindered by long waiting times and financial constraints, especially for specialized care such as dental services. Communication issues during medical appointments due to language barriers and the lack of gender-specific healthcare, such as access to gynecological services, further exacerbate the challenges. Additionally, the COVID-19 pandemic introduces hurdles such as limited testing, isolation measures, language-specific information barriers, and insufficient social distancing practices. Mental health has emerged as a critical concern, with asylum seekers reporting significant stress and emotional exhaustion due to uncertainty and restrictive living conditions. Social needs extend to delayed asylum application processes, inconsistent language education opportunities, inadequate clothing, and nutrition that lacks cultural sensitivity, and living conditions characterized by overcrowding and insufficient facilities. The restricted freedom of movement within asylum seeking centres severely impacts their psychological well-being, underscoring a deep longing for autonomy and a better life despite the myriad of challenges faced.

Discussion

The study illustrates the complex interplay between migration, health, and social factors in the context of a global pandemic. It highlights the need for culturally sensitive healthcare services, mental health support, and structured language education programs. Offering educational avenues alongside language courses for children and adults is essential for fostering social inclusion and securing economic prosperity. Addressing the challenge of language barriers is of utmost importance, as these barriers significantly impede undocumented migrants' and asylum seekers employment opportunities and their access to crucial services. The findings emphasized immigration as a health determinant and underscored the importance of inclusive health policies and advocacy for undocumented migrants and asylum seekers' rights and needs.

Conclusion

There is an urgent need for comprehensive policies and practices that are grounded in the principles of equity, compassion, and human rights. Additionally, advocating for practice adaptations that are culturally sensitive, linguistically inclusive, and responsive to the unique challenges faced by undocumented migrants and asylum seekers. As global migration continues to rise, these findings are crucial for informing public health strategies and social services that cater to the diverse needs of this vulnerable population.

A scoping review of academic and grey literature on migrant health research conducted in Scotland

BACKGROUND

Migration to Scotland has increased since 2002 with an increase in European residents and participation in the Asylum dispersal scheme. Scotland has become more ethnically diverse, and 10% of the current population were born abroad. Migration and ethnicity are determinants of health, and information on the health status of migrants to Scotland and their access to and barriers to care facilitates the planning and delivery of equitable health services. This study aimed to scope existing peer-reviewed research and grey literature to identify gaps in evidence regarding the health of migrants in Scotland.

METHODS

A scoping review on the health of migrants in Scotland was carried out for dates January 2002 to March 2023, inclusive of peer-reviewed journals and grey literature. CINAHL/ Web of Science/SocIndex and Medline databases were systematically searched along with government and third-sector websites. The searches identified 2166 journal articles and 170 grey literature documents for screening. Included articles were categorised according to the World Health Organisation's 2016 Strategy and Action Plan for Refugee and Migrant Health in the European region. This approach builds on a previously published literature review on Migrant Health in the Republic of Ireland.

RESULTS

Seventy-one peer reviewed journal articles and 29 grey literature documents were included in the review. 66% were carried out from 2013 onwards and the majority focused on asylum seekers or unspecified migrant groups. Most research identified was on the World Health Organisation's strategic areas of right to health of refugees, social determinants of health and public health planning and strengthening health systems. There were fewer studies on the strategic areas of frameworks for collaborative action, preventing communicable disease, preventing non-communicable disease, health screening and assessment and improving health information and communication.

CONCLUSION

While research on migrant health in Scotland has increased in recent years significant gaps remain. Future priorities should include studies of undocumented migrants, migrant workers, and additional research is required on the issue of improving health information and communication.

Can extended health communication improve newly settled refugees' health literacy? A quasi-experimental study from Sweden

Structural and contextual factors such as limited work and housing opportunities negatively affect the health and well-being of newly settled refugee migrants in receiving high-income countries. Health promotion initiatives aiming at strengthening health and integration have been tried out within the Swedish Introduction program for refugee migrants. However, longitudinal evaluations of these interventions are rare. The aim of the current study was to compare the effectiveness of a regular and an extended civic orientation course with added health communication and examine whether the latter would improve self-rated health and psychological well-being, health literacy and social capital among newly settled refugee migrants in Sweden. Pre- and post-assessment questionnaires were collected from the intervention group receiving the extended course (n = 143) and a control group receiving the regular course (n = 173). Linear mixed models and chi-square analyses showed a significant increase with a small effect size (0.21) in health literacy in the intervention group. However, there were no significant changes in emotional and practical support, general self-rated health or psychological well-being. The findings indicate that added health communication provided embedded in the civic orientation course can increase health literacy. However, further longitudinal studies are needed to confirm the sustainability of the observed effect and examine whether these short-term improvements in health literacy translate to long-term advances in health and integration.

Healthy Immigrant Effect or Under-Detection? Examining Undiagnosed and Unrecognized Late-Life Depression for Racialized Immigrants and Nonimmigrants in Canada

OBJECTIVES

Immigrants to Canada tend to have a lower incidence of diagnosed depression than nonimmigrants. One theory suggests that this "healthy immigrant effect (HIE)" is due to positive selection. Another school of thought argues that the medical underuse of immigrants may be the underlying reason. This unclear "immigrant paradox" is further confounded by the intersecting race-migration nexus.

METHODS

This population-based study analyzed data of participants (n = 28,951, age ≥45) from the Canadian Community Health Survey (2015-2018). Multivariable logistic regression was employed to examine associations between race-migration nexus and mental health outcomes, including depressive symptoms (Patient Health Questionnaire [PHQ-9] score ≥10).

RESULTS

Compared to Canadian-born (CB) Whites, immigrants, regardless of race, were less likely to receive a mood/anxiety disorder diagnosis (M/A-Dx) by health providers in their lifetime. Racialized immigrants were mentally disadvantaged with increased odds of undiagnosed depression (Adjusted odds ratio [AOR] = 1.76, 99% Confidence interval [CI]:1.30-2.37), whereas White immigrants were mentally healthier with decreased odds of PHQ depression (AOR=0.75, 99%CI: 0.58, 0.96) and poor self-rated mental health (AOR=0.56, 99% CI=0.33, 0.95). Among the subpopulation without a previous M/A-Dx (N = 25,203), racialized immigrants had increased odds of PHQ depression (AOR = 1.45, 99% CI: 1.15-1.82) and unrecognized depression (AOR = 1.47, 99% CI: 1.08-2.00) than CB Whites. Other risk factors for undiagnosed depression include the lack of regular care providers, emergency room as the usual source of care, and being home renters.

DISCUSSION

Despite Canadian universal health coverage, the burden of undiagnosed depression disproportionately affects racialized (but not White) immigrants in mid to late life. Contingent on race-migration nexus, the HIE in mental health may be mainly driven by the healthier profile of White immigrants and partly attributable to the under-detection (by health professionals) and under-recognition of mental health conditions among racialized immigrants. A paradigm shift is needed to estimate late-life depression for medically underserved populations.

Erratum: Increased number of live births by migrant mothers shows areal inequality in Japan: A descriptive study

[This corrects the article DOI: 10.1016/j.ssmph.2023.101531.][This corrects the article DOI: 10.1016/j.ssmph.2023.101447.].

Beyond Borders: Exploring the Quality of Life, Health-Seeking Behavior, and Perceived Barriers in Health Services Utilization Among Sudanese Immigrants in Egypt

BACKGROUND

The detention of immigrants has adverse effects on both their health and their overall quality of life. In migration conditions, there is a notable impact on health-seeking behavior.

OBJECTIVE

This study aims to explore the quality of life, health-seeking behavior, and perceived barriers to health services utilization among Sudanese immigrants in Egypt.

MATERIALS AND METHODS

The study employed a cross-sectional design to fulfill its objectives. A convenience sample comprising 385 Sudanese immigrants post-war was utilized. The researcher employed a structured questionnaire consisting of four parts: socio-demographic data, a quality of life questionnaire, an assessment of health-seeking behavior, and an exploration of the barriers faced by Sudanese immigrant participants in accessing health services.

RESULTS

The study on Sudanese immigrants post-war revealed diverse perceptions of overall quality of life, with 41.6% reporting satisfaction, 32.4% an average state, and 26.0% unsatisfactory conditions. Factors such as gender, educational level, financial situation, and the primary reason for relocating to Egypt significantly influenced these outcomes (p<0.05). Encouragingly, 57.1% of the immigrants exhibited positive health-seeking behavior. Noteworthy barriers to healthcare access included limited awareness of available services (60.5%), competing priorities like work (53.2%), insufficient financial resources (49.6%), and extended waiting times in healthcare facilities (45.5%). These findings underscore the complex interplay of factors affecting the well-being and health-seeking patterns of Sudanese immigrants in their new environment.

CONCLUSION

The research sheds light on key aspects of the well-being of Sudanese immigrants in Egypt, offering insights into their quality of life, health-seeking behavior, and perceived barriers to healthcare. The findings reveal a diverse spectrum of overall quality of life, with over a third expressing satisfaction, while a significant portion reported average or unsatisfactory levels. The study underscores the intricate influence of gender, educational level, financial situation, and the primary reason for immigration on the quality of life. Positive health-seeking behavior was observed in more than half of the participants, yet the identification of barriers to healthcare access signals challenges that warrant attention for enhancing overall health outcomes among this immigrant population. Implementing community-based health education programs plays a pivotal role in empowering immigrant Sudanese individuals in Egypt to make informed health choices and adopt healthy lifestyles.

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: A cross-sectional, population-based, multi-level analysis in a German federal state

Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany's 3rd largest federal state. Individual-level data on depression and anxiety as well as sociodemographic- and asylum-related covariates, were collected and linked to contextual geo-referenced data on housing environment ('Small-area Housing Environment Deterioration' index, number of residents, remoteness, urbanity, and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with > = 50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. We found statistically significant clustering in reporting anxiety on the level of accommodation centres. The model resulted in an intraclass correlation of 0.16 which translated into a median odds ratio of 2.10 for the accommodation-level effects. No significant clustering was found for symptoms of depression. The highest degree of deterioration, large accommodation size, remoteness, and district urbanity showed higher, but statistically not significant, odds for reporting anxiety or depression. District deprivation demonstrated higher odds for anxiety and lower odds for depression yet remained statistically insignificant for both. Evidence for contextual effects of housing environment on mental health of ASR could not be established but residual confounding by length of stay in the accommodation centre cannot be ruled out. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.

Transgender Youths and Sanctuaries for Gender-Affirming Care

This Viewpoint suggests ways state and local governments can support transgender youths seeking gender-affirming care amid continued passage of antitransgender legislation.

Using self-reported health as a social determinants of health outcome: a scoping review of reviews

Reducing disease prevalence rather than promoting health has long been the objective of significant population health initiatives, such as the social determinants of health (SDH) framework. However, empirical evidence suggests that people with diagnosed diseases often answer the self-reported health (SRH) question positively. In pursuit of a better proxy to understand, measure and improve health, this scoping review of reviews examines the potential of SRH to be used as an outcome of interest in population health policies. Following PRISMA-ScR guidelines, it synthesizes findings from 77 review papers (published until 11 May 2022) and reports a robust association between SDH and SRH. It also investigates inconsistencies within and between reviews to reveal how variation in population health can be explained by studying the impact of contextual factors, such as cultural, social, economic and political elements, on structural determinants such as socioeconomic situation, gender and ethnicity. These insights provide informed hypotheses for deeper explorations of the role of SDH in improving SRH. The review detects several gaps in the literature. Notably, more evidence syntheses are required, in general, on the pathway from contextual elements to population SRH and, in particular, on the social determinants of adolescents' SRH. This study reports a disease-oriented mindset in collecting, analysing and reporting SRH across the included reviews. Future studies should utilize the capability of SRH in interconnecting social, psychological and biological dimensions of health to actualize its full potential as a central public health measure.

Integration of migrant and refugee data in health information systems in Europe: advancing evidence, policy and practice

Coverage of migrant and refugee data is incomplete and of insufficient quality in European health information systems. This is not because we lack the knowledge or technology. Rather, it is due to various political factors at local, national and European levels, which hinder the implementation of existing knowledge and guidelines. This reflects the low political priority given to the topic, and also complex governance challenges associated with migration and displacement. We review recent evidence, guidelines, and policies to propose four approaches that will advance science, policy, and practice. First, we call for strategies that ensure that data is collected, analyzed and disseminated systematically. Second, we propose methods to safeguard privacy while combining data from multiple sources. Third, we set out how to enable survey methods that take account of the groups' diversity. Fourth, we emphasize the need to engage migrants and refugees in decisions about their own health data. Based on these approaches, we propose a change management approach that narrows the gap between knowledge and action to create healthcare policies and practices that are truly inclusive of migrants and refugees. We thereby offer an agenda that will better serve public health needs, including those of migrants and refugees and advance equity in European health systems.

Funding

No specific funding received.

Context, health and migration: a systematic review of natural experiments

Background

Migration health research pays little attention to the places into which people migrate. Studies on health effects of contextual factors are often limited because of the ability of individuals to self-select their environment, but natural experiments may allow for the causal effect of contexts to be examined. The objective was to synthesise the evidence on contextual health effects from natural experiments among migrant groups.

Methods

We performed a systematic review of natural experiments among migrant populations in PubMed/MEDLINE, The Cochrane Library, Web of Science, CINAHL and Google Scholar for literature published until 13 October 2022. 5870 articles were screened in duplicate using the following inclusion criteria: quantitative natural experiment design, migrant population, context factor as treatment variable and health or healthcare outcome variable. Synthesis without meta-analysis was performed following quality appraisal using the EPHPP tool for quantitative studies and data extraction (PROSPERO: CRD42020169236).

Findings

The 46 included articles provide evidence for negative effects of neighbourhood disadvantage on physical health and mortality, while finding mixed effects on mental health. Articles comparing migrants with those that stayed behind demonstrate detrimental effects of migration and adverse post-migratory contexts on physical health and mortality, while demonstrating favourable effects for mental and child health. Natural experiments of policy environments 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 complement observational studies and provide robust evidence to advocate for more inclusive migration, health and social policies as well as neighbourhood improvement programmes. In order to strengthen the methodological approach, future research utilising natural experiments should be more explicit in the mechanisms underlying the experiment and provide details on potential causal mechanisms for the observed effects.

Funding

German Science Foundation (FOR: 2928/GZ: BO5233/1-1).

Politicians' views on societal responsibility and possibility to promote newly arrived migrants' health in Sweden

Newly arrived migrants in Sweden risk facing ill health. Politicians at the local and regional levels are involved in many decisions regarding the social determinants of health. The aim of this study was to explore politicians' views on different societal actors' responsibility and possibility to promote newly arrived migrants' health. Data were collected through online questionnaires completed by 667 politicians from municipality and regional councils in northern Sweden. Bivariate analysis was performed using the Wilcoxon signed-rank test. Multivariate analyses were performed using cluster analysis and binary logistic regression analysis. The results show that politicians generally rate societal actors' responsibility and possibility to promote the general population's health higher than newly arrived migrants' health. Moreover, they consider societal actors' responsibility to be greater than their possibility to promote health. Factors significantly contributing to politicians' high ratings of societal responsibility and possibility are attitude (odds ratio [OR] = 2.156, 95% confidence interval [CI]: 1.306-3.558), specific knowledge of newly arrived migrants' health status (OR = 1.528, 95% CI: 1.005-2.323), personal interest in public health (OR = 2.452, 95% CI: 1.460-4.119), being a municipality politician (OR = 1.659, 95% CI: 1.031-2.670) and being female (OR = 1.934, 95% CI: 1.333-2.806). This study shows that politicians generally rate societal responsibility and possibility to promote newly arrived migrants' health rather high. Personal characteristics are important for politicians' high or low ratings of responsibility and possibility, suggesting insufficient structural support for politicians in health promotion.

Migration and health research: past, present, and future

Global migration continues to rise at unprecedented rates. Migrants are an extremely heterogeneous group and face diverse health needs related to infectious diseases, sexual and reproductive health, non-communicable diseases, and healthcare access across the whole lifespan. In this editorial, we set the context and invite contributions for a collection on 'Migration and health' at BMC Public Health.

Migration integration policies as social determinants of health for highly educated immigrants in the United States

Highly educated immigrants are part of the growing population of immigrants who are impacted by the increasingly hostile migration policies in the U.S. This qualitative study used a phenomenological approach and inductive reasoning to explore the possible impacts of migration integration policies as social determinants of health among this group. Data was collected through 31 semi-structured interviewees with highly educated immigrants who had an intention and interest to stay in the U.S. at the time of the interview. Data were analyzed using reflexive thematic analysis and four main themes emerged: (1) a life overshadowed by silent worries, (2) living through uncertainties and forced decisions as the result of migration integration policies, (3) complexities and challenges of living on a work visa, and (4) shared recommendations by interviewees. Documented narratives as part of this study suggest high rates of stress and anxiety as well as negative mental and physical health outcomes among the participants. Results also suggest high levels of internalized vulnerabilities. Participants shared that migration policies can be enhanced in the U.S. to support highly educated immigrants' growth by creating a better and more transparent communication system, replacing random review processes for applications with systematic procedures, creating expedited pathways to citizenship based on merit, and granting access to work as a basic human right.

Misuse of Pregabalin: a qualitative study from a patient's perspective

INTRODUCTION

The misuse of Pregabalin has been the subject of growing concern for several years. The effects sought are multiple and it is rarely taken as a single drug. It is most frequently used together with opioids, which may increase the risk of fatal overdose. In response to this emerging phenomenon, we seek to better understand the situation of misuse in Belgium and identify the people involved in it.

METHODOLOGY

A qualitative study using semi-structured interviews with 20 participants who misuse Pregabalin was conducted throughout the French-speaking region of Belgium between August 2021 and January 2022. Recruitment mostly took place in addictions centers, shelters for migrants and homeless persons and primary care centers. We then conducted a thematic analysis with the help of Nvivo software.

RESULTS

A profile emerged, of young male users, immigrants, mainly first generation immigrants coming from North Africa. They had in common a challenging or even traumatic migration pathway and precarious living conditions in Belgian territory. Most of them had no stable income. They saw Pregabalin as enabling them to cope with their daily situation. All had psychiatric and/or somatic comorbidities for which they had apparently not recieved adequate medical care. This seemed to lead many of them to use Pregabalin as self-medication, for anxiety-depressive disorders and chronic pain, and it was sometimes initiated in their home country. Pregabalin was never used alone.

CONCLUSION

This study has highlighted a rare and insufficient documented profile of Pregabalin misuse: self-medication among a group of first generation immigrants, most of whom have no previous history of opioid-related disorders. Measures should be taken to improve access to health and social care for this population, considering all their biopsychosocial vulnerabilities.

Impact of legal status regularization on undocumented migrants’ self-reported and mental health in Switzerland

Undocumented migrants face cumulative difficulties like precarious living and working conditions or exclusion from health services that might negatively influence their health. Little is known about the evolution of undocumented migrants' self-reported health (SRH) and mental health after they get documented. This study aims to observe the effect of legal status regularization on SRH and mental health in a cohort of migrants undergoing regularization in Geneva, Switzerland. We evaluate SRH with the first item of the Short Form Survey (SF12) and depression as a proxy of mental health with the PHQ-9 questionnaire over four years among 387 undocumented and newly documented migrants. Using hybrid linear models, our data show that regularization has no direct effect on SRH, but has direct positive effects on mental health in a longitudinal perspective, even when controlling for competing factors. The arrival of the pandemic did not alter these effects. Migrants tend to evaluate their subjective health status more positively than the prevalence of screened depression shows. Those findings point towards better targeted policies that could reduce the burden of depression among undocumented migrants.

Assessing the Effect of Increased Deportations on Mexican Migrants’ Remittances and Savings Brought Home

Beginning in the 1990s and intensifying after the events of September 11, deportations in the United States increased to record levels under President Obama and continued at high levels under President Trump. Although a growing literature addresses how migrants respond to the shifting context of reception, empirical evidence on how migrants’ remitting and saving behavior changed as a result of immigration enforcement remains limited. Using detailed individual-level data from the Mexican Migration Project (MMP, N = 6787) for the years 1970–2019, this study examines how deportations relate to Mexican migrants’ joint decisions to remit and/or save, and how this relationship differs by documentation status. Results from multinomial logistic regressions reveal that rising deportations are associated with an increase in the transnational economic engagement of undocumented migrants. This is largely due to an increase in remittances; savings brought back decrease with rising deportations, likely because keeping savings in the United States is riskier than sending money back directly. Among documented migrants, the remitting and saving behavior does not appear to change as deportations rise. Analyzing these behaviors together is important to gain a more complete understanding of migrants’ transnational economic ties and links to the country of destination.

Making an economic argument for investment in global mental health: The case of conflict-affected refugees and displaced people

Mental health expenditure accounts for just 2.1% of total domestic governmental health expenditure per capita. There is an economic, as well as moral, imperative to invest more in mental health given the long-term adverse impacts of mental disorders. This paper focuses on how economic evidence can be used to support the case for action on global mental health, focusing on refugees and people displaced due to conflict. Refugees present almost unique challenges as some policy makers may be reluctant to divert scarce resources away from the domestic population to these population groups. A rapid systematic scoping review was also undertaken to identify economic evaluations of mental health-related interventions for refugees and displaced people and to look at how this evidence base can be strengthened. Only 11 economic evaluations focused on the mental health of refugees, asylum seekers and other displaced people were identified. All but two of these intervention studies potentially could be cost-effective, but only five studies reported cost per quality-adjusted life year gained, a metric allowing the economic case for investment in refugee mental health to be compared with any other health-focused intervention. There is a need for more consistent collection of data on quality of life and the longer-term impacts of intervention. The perspective adopted in economic evaluations may also need broadening to include intersectoral benefits beyond health, as well as identifying complementary benefits to host communities. More use can be also made of modelling, drawing on existing evidence on the effectiveness and resource requirements of interventions delivered in comparable settings to expand the current evidence base. The budgetary impact of any proposed strategy should be considered; modelling could also be used to look at how implementation might be adapted to contain costs and take account of local contextual factors.

Local political climate and spill-over effects on refugee and migrant health: a conceptual framework and call to advance the evidence

The health of refugees and migrants is determined by a wide range of factors. Among these, the local political climate in the postmigration phase is an important determinant which operates at interpersonal and institutional levels. We present a conceptual framework to advance theory, measurement and empirical evidence related to the small-area factors which shape and determine the local political climate, as these may translate into variations in health outcomes among refugees, migrants and other marginalised population groups. Using the example of Germany, we present evidence of small-area variation in factors defining political climates, and present and discuss potential pathways from local political climates to health outcomes. We show that anti-immigrant and antirefugee violence is a Europe-wide phenomenon and elaborate how resilience of individuals, communities, and the health system may function as moderator of the effects of the local political climate on health outcomes. Building on a pragmatic review of international evidence on spill-over effects identified in other racialised groups, we present a conceptual framework which incorporates direct effects as well as 'spill-over' effects on mental health with the aim to spark further academic discussion and guide empirical analysis on the topic. After presenting and discussing methodological challenges, we call for collective efforts to build coalitions between social sciences, conflict and violence studies, political science, data science, social psychologists and epidemiology to advance theory, measurement, and analysis of health effects of local political climates.

Health Care Organization in Poland in Light of the Refugee Crisis Related to the Military Conflict in Ukraine

BACKGROUND

Poland is witnessing a migration crisis caused by the ongoing military conflict in Ukraine. In addition to housing and necessities, 1.8 million Ukrainians that had taken refuge in Poland must have access to medical care. We aim to propose a strategy for implementing the changes in the Polish health care system in response to the Ukrainian refugee crisis.

METHODS

A literature review on organizational changes in the functioning of health care systems during the migration crises worldwide in recent years and brainstorming in order to develop a strategy for implementing changes in the Polish health care system in response to the Ukrainian refugee crisis.

RESULTS

The proposed strategy for implementing the changes in the Polish health care system is based on building health care resilience and adaptation to different crises. The operational objectives of organization-related activities are: (1) preparation of medical facilities to provide help for refugees, (2) development and implementation of the communication system, (3) implementation of available digital solutions, (4) organization of the diagnostic and medical services, (5) and implementation of changes in the management of medical facilities.

CONCLUSIONS

Urgent reorganization is required to respond to an unavoidable increase in the demand for health care services.

Potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people: A conceptual framework and lines of enquiry for research and policy

Mental health is inextricably linked to both poverty and future life chances such as education, skills, labour market attachment and social function. Poverty can lead to poorer mental health, which reduces opportunities and increases the risk of lifetime poverty. Cash transfer programmes are one of the most common strategies to reduce poverty and now reach substantial proportions of populations living in low- and middle-income countries. Because of their rapid expansion in response to the COVID-19 pandemic, they have recently gained even more importance. Recently, there have been suggestions that these cash transfers might improve youth mental health, disrupting the cycle of disadvantage at a critical period of life. Here, we present a conceptual framework describing potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people. Furthermore, we explore how theories from behavioural economics and cognitive psychology could be used to more specifically target these mechanisms and optimise the impact of cash transfers on youth mental health and life chances. Based on this, we identify several lines of enquiry and action for future research and policy.

Knowledge of legal rights as a factor of refugee and asylum seekers' health status: a qualitative study

OBJECTIVES

To examine health behaviours of refugees and asylum seekers, in relation to their knowledge of public benefits and legal rights.

DESIGN

Qualitative study, utilising an open-ended, semi-structured interview guide to ensure information-rich data collection. Thematic content was analysed using qualitative research software.

SETTING

Participants were drawn from the Weill Cornell Center for Human Rights (WCCHR) in New York City, a single-center, human rights clinic with a globally representative patient population. All interviews were conducted at the Weill Cornell Medicine Clinical and Translational Science Center, a multidisciplinary space within an urban academic medical center.

PARTICIPANTS

Twenty-four refugees and asylum seekers currently living in the greater New York City area. Eligible participants were 18 years of age or older and had previously sought services from the WCCHR. The recruitment rate was 55%.

PRIMARY AND SECONDARY OUTCOME MEASURES

Themes and concepts in participants' health, knowledge, perceptions of and experiences with accessing healthcare and public benefits programmes.

RESULTS

Twenty-four participants represented 18 countries of origin and 11 primary languages. Several impediments to accessing healthcare and public benefits were identified, including pragmatic barriers (such as prohibitive costs or lack of insurance), knowledge gaps and mistrust of healthcare systems.

CONCLUSIONS

There is low health engagement by refugees and asylum seekers, as a result of multiple, complex factors impeding the ability of refugee and asylum seekers to access healthcare and other public benefits for which they are eligible-with resultant detrimental health effects. However, there is an opportunity to utilise novel approaches, such as digital technologies, to communicate relevant information regarding legal rights and public benefits to advance the health of vulnerable individuals such as refugees and asylum seekers.

Prevalence and risk factors of psychological distress among foreign-born population in Finland: A population-based survey comparing nine regions of origin

AIMS

Previous research indicates that foreign-born populations experience more psychological distress than general populations. However, it remains unclear how prevalence varies between regions of origin. The role of socio-demographic and migration-related factors also needs to be further investigated. We aimed to (a) compare the prevalence of psychological distress in foreign-born and general Finnish populations, (b) investigate differences in prevalence between nine regions of origin and (c) examine which socio-demographic and migration-related factors are associated with distress among foreign-born populations.

METHODS

The study used data from the Survey on Well-Being among Foreign Born Population (FinMonik), a population-based survey (n=6312) of foreign-born populations living in Finland collected between 2018 and 2019 by the Finnish Institute for Health and Welfare. Psychological distress was measured using the Mental Health Inventory-5 (MHI-5), with a cut-off point of 52. Logistic regression was used to adjust analyses by age and sex to determine the prevalence of psychological distress and the associated socio-demographic factors.

RESULTS

Psychological distress was more prevalent among those who were foreign born (17.4%) than among the general population (12.9%). Migrants from the Middle East and North Africa had the highest prevalence (29.7%) compared to other regions of origin. Unemployment or economic inactivity, international protection as a reason for migration and beginner-level language proficiency were the main factors increasing the odds for distress among foreign-born populations.

CONCLUSIONS

Foreign-born populations experience more psychological distress than the general population, but prevalence varies between regions of origin. Future efforts should aim at a better understanding of the mental health risk factors and the development of targeted interventions for these subpopulations.

Health service behaviors of migrants: A conceptual framework

Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.

European immigrant health policies, immigrants' health, and immigrants' access to healthcare

OBJECTIVE

Evidence indicates presence of immigrant health disparities in the European Union (EU) and the United States (US). We examined the association between immigrant health policies and the gap in health status, unmet needs and service use between immigrants and citizens, in the EU and US.

METHODS

We used the Migrant Integration Policy Index (MIPEX), European Health Interview Survey, and National Health Interview Survey for 2014. Our independent variables of interest were MIPEX Health strand score and citizenship. Our dependent variables were four measures of health status (self-reported poor health; severely limited in general activities; two or more comorbidities; one or more ambulatory care sensitive conditions) and four measures of health access and utilization (unmet need due to non-financial reasons; could not afford needed health care; one or more primary care visits last year; any hospitalization last year). We conducted linear probability models and presented the marginal effects of each outcome in percentage points.

FINDINGS

We found that immigrant-friendly health policies were significantly associated with better health and less unmet need due to non-financial reasons.

CONCLUSION

Our findings supported the promotion of immigrant-friendly and a 'Health-in-All Policies' (HiAP) approach to preserve the health of immigrants.

How social policies shape the health and well-being of sexual- and gender-minority youth: Pathways of influence, social side effects and implications for life course trajectories

Recent research has documented the harmful health consequences of structural-level stigma that targets sexual and gender minority (SGM) individuals. In the case of sexual and gender minority youth (SGMY), life trajectories are shaped not only by targeted, SGM-focused policies, but also by social policies more broadly which may have unique impacts on SGMY given their social position. However, little work has explored the pathways that connect both targeted and universal social policies and the health and well-being of SGMY. In this study, we conducted 68 qualitative interviews with SGMY in New York City (n = 30) and community stakeholders across the US (n = 38) and used the constant comparative method to identify the pathways through which social policies affect SGMY health and well-being. We propose three pathways that are shaped by specific inter-related social policies in ways that contribute to health inequities among SGMY: 1) access to social inclusion in educational settings; 2) housing-related regulations and subsequent (in)stability; and 3) access to material resources through labor market participation. We also highlight ways that SGMY, and organizations that support them, engage in agency and resistance to promote inclusion and wellbeing. Drawing on ecosocial theory, we demonstrate how policies work across multiple domains and levels to influence cycles of vulnerability and risk for SGMY. We close by discussing the implications of our findings for future research and policy.

Left behind on the path to 90-90-90: understanding and responding to HIV among displaced people

INTRODUCTION

In 2021, the number of people affected by displacement worldwide reached the highest on record, with an estimated 30.5 million refugees and 4.6 million asylum seekers seeking safety across international borders and further 53.2 million people displaced within their countries of origin. Most forcibly displaced persons come from or relocate to lower- and middle-income countries (LMICs) and many of those countries have large HIV epidemics. In this commentary, we describe some of the challenges at the intersection of HIV and displacement vulnerabilities that cannot be easily addressed in resource-limited environments.

DISCUSSION

HIV transmission and prevention and treatment efforts in the context of displacement are affected by myriad behavioural, social and structural factors across different stages of the displacement journey. For example, structural barriers faced by people experiencing displacement in relation to HIV prevention and care include funding constraints and legal framework deficiencies. Such barriers prevent all forced migrants, and particularly those whose sexual identities or practices are stigmatized against, access to prevention and care equal to local residents. Xenophobia, racism and other social factors, as well as individual risky behaviours facilitated by experiences of forced migration, also affect the progress towards 90-90-90 targets in displaced populations. Current evidence suggests increased HIV vulnerability in the period before displacement due to the effect of displacement drivers on medical supplies and infrastructure. During and after displacement, substantial barriers to HIV testing exist, though following resettlement in stable displacement context, HIV incidence and viral suppression are reported to be similar to those of local populations.

CONCLUSIONS

Experiences of often-marginalized displaced populations are diverse and depend on the context of displacement, countries of origin and resettlement, and the nature of the crises that forced these populations to move. To address current gaps in responses to HIV in displacement contexts, research in LMIC, particularly in less stable resettlement settings, needs to be scaled up. Furthermore, displaced populations need to be specifically addressed in national AIDS strategies and HIV surveillance systems. Finally, innovative technologies, such as point-of-care viral load and CD4 testing, need to be developed and introduced in settings facing displacement.

Migration health research in the Nordic countries: Priorities and implications for public health

The past 50 years have witnessed an increase in immigration to the Nordic countries from and beyond neighbouring countries in Europe. Diversity implies variations and differences in health status and health outcomes both within and across populations. Migrant health research has not been prioritized and health policies and practice, especially long-term national plans, often exclude migrants. In this article, we briefly trace the history, the groups, reasons for migration and the road to migrant health research in Norway, Sweden, Finland and Denmark. We discuss the case for data and research including needs, basis for data collection and the methodological challenges. We provide a brief snapshot of migrant health research, identify current gaps and discuss the implications for research. We recommend a regional Nordic strategy to promote intercountry exchange, sharing and learning. Finally, we reflect on the larger picture, implications for policy and practice that could enable societal conditions to reduce avoidable health inequalities.

Apprehension and educational outcomes among Hispanic students in the United States: The impact of Secure Communities

Prior research suggests that disruptive events, such as shocks induced by family instability, neighborhood violence, or relocation, tend to be detrimental for children’s educational outcomes, but findings are heterogeneous depending on the type of event. Limited evidence is available on how shocks resulting from immigration enforcement impact educational outcomes among targeted minority groups. This study contributes to the literature by assessing how a policy implementation in the US–Secure Communities–is related to the school district level achievement of Hispanic students. The Secure Communities program is a national level immigration enforcement policy that was rolled out on a county-by-county basis. The program has increased the risk of deportation and led to rising apprehension and insecurity among undocumented migrants and the wider Hispanic community. Using detailed information on the implementation of Secure Communities, data from the Stanford Education Data Archive, and the Current Population Survey, this study estimates dynamic difference in differences exploiting regional variation in the timing of the policy change to assess its impact on educational outcomes. Results show that the activation of Secure Communities is negatively associated with Hispanic students’ subsequent English language arts achievement, while white and black students’ achievement does not change. Findings further suggest that Hispanic students living in the South, rural areas, and areas with high proportions of likely undocumented migrants are disproportionately impacted by the program’s activation. Whereas, Hispanic students in sanctuary jurisdictions, which reduce the likelihood of deportation, are not impacted. These findings indicate that immigration enforcement can have negative consequences for educational and social inequalities in the United States.

Migrants in Swedish sexual and reproductive health and rights related policies: a critical discourse analysis

BACKGROUND

Previous research has shown that migrants in Sweden are disadvantaged in terms of sexual and reproductive health and rights (SRHR). SRHR policies might play a crucial role in shaping migrants' SRHR outcomes. The purpose of the study was to critically examine: a) how migrants were represented in the discourses embedded within Swedish SRHR-related policies, and b) how migrants' SRHR-related issues were framed and addressed within these discourses.

METHODS

Critical discourse analysis (CDA) was used to analyze a total of 54 policy documents. Following Jäger's approach to CDA, discourse strands and entanglements between different discourse strands were examined.

RESULTS

Our findings consisted of three discourse strands: 1) "Emphasizing vulnerability", 2) "Constructing otherness", and 3) "Prioritizing the structural level or the individual level?". Migrants' representation in Swedish SRHR-related policies is often associated with the concept of vulnerability, a concept that can hold negative connotations such as reinforcing social control, stigma, and disempowerment. Alongside the discourse of vulnerability, the discourse of otherness appears when framing migrants' SRHR in relation to what is defined as honor-related violence and oppression. Furthermore, migrant SRHR issues are occasionally conceptualized as structural issues, as suggested by the human rights-based approach embraced by Swedish SRHR-related policies. Relevant structural factors, namely migration laws and regulations, are omitted when addressing, for example, human trafficking and HIV/AIDS.

CONCLUSIONS

We conclude that the dominant discourses favor depictions of migrants as vulnerable and as the Other. Moreover, despite the prevailing human rights-based discourse, structural factors are not always considered when framing and addressing migrants' SRHR issues. This paper calls for a critical analysis of the concept of vulnerability in relation to migrants' SRHR. It also highlights the importance of avoiding othering and paying attention to the structural factors when addressing migrants' SRHR.

Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis

Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence.

Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence.

Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I² = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I² = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I² = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence.

Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contexts and immigrant populations’ composition seem to be important to predict the level and direction of behavioural change.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO CRD42018108881.

Immigrant-Related Policies and the Health Outcomes of Latinx Adults in the United States: A Systematic Review

BACKGROUND

US federal and subfederal immigrant-related policy activity has increased in recent years. We hypothesize that these policies are structural determinants of health for Latinx communities, operating through access to resources, discriminatory enforcement, and stress.

METHODS

We searched seven databases for quantitative studies, published as of September 2021, examining the association between the presence of federal, state, or local immigrant-related policy(ies), over time or cross-sectionally, and mental or physical health outcomes among immigrant or US-born Latinx adults. We rated studies on methodologic quality.

RESULTS

Eleven studies were included. Policies included federal and state policies. Health outcomes included mental health (seven studies), self-rated health (n = 6), and physical disability (n = 1). Among immigrant, noncitizen, or Spanish-preferring Latinx adults, exclusionary policies were associated with poor self-rated health, physical disability, and poor mental health. Inclusive policies were associated with better health, although null findings were more common than among studies of exclusionary policies. Only three studies separately examined policy effects on US-born or citizen Latinx adults and these findings were often null. All studies received a weak overall study quality rating; among quality domains, studies were strongest in confounding control and weakest in outcome information bias and reporting missing data approaches.

CONCLUSIONS

These results support the hypothesis that immigrant-related policies, especially exclusionary policies, are structural drivers of health for immigrant or noncitizen Latinx adults. However, evidence is scant among US-born or citizen Latinx adults. Studies of policies and physical health outcomes besides disability are lacking, as are results disaggregated by nativity and/or citizenship status.

Self-Rated Health Among Italian Immigrants Living in Norway: A Cross-Sectional Study

Background

Most studies on immigrant health focus on immigrant groups coming from extra-European and/or low-income countries. Little attention is given to self-rated health (SRH) in the context EU/EEA migration. To know more about health among European immigrants can provide new insights related to social determinants of health in the migration context. Using the case of Italian immigrants in Norway, the aim of this study was to (i) examine the levels of SRH among Italian immigrants in Norway as compared with the Norwegian and the Italian population, (ii) examine the extent to which the Italian immigrant perceived that moving to Norway had a positive or negative impact on their SRH; and (iii) identify the most important factors predicting SRH among Italian immigrants in Norway.

Methods

A cross-sectional survey was conducted among adult Italian immigrants in Norway (n = 321). To enhance the sample's representativeness, the original dataset was oversampled to match the proportion of key sociodemographic characteristics of the reference population using the ADASYN method (oversampled n = 531). A one-sample Chi-squared was performed to compare the Italian immigrants' SRH with figures on the Norwegian and Italian populations according to Eurostat statistics. A machine-learning approach was used to identify the most important predictors of SRH among Italian immigrants.

Results

Most of the respondents (69%) rated their SRH as "good" or "very good". This figure was not significantly different with the Norwegian population, nor to the Italians living in Italy. A slight majority (55%) perceived that their health would have been the same if they continued living in Italy, while 23% perceived a negative impact. The machine-learning model selected 17 variables as relevant in predicting SRH. Among these, Age, Food habits, and Years of permanence in Norway were the variables with the highest level of importance, followed by Trust in people, Educational level, and Health literacy.

Conclusions

Italian immigrants in Norway can be considered as part of a "new mobility" of high educated people. SHR is shaped by several interconnected factors. Although this study relates specifically to Italian immigrants, the findings may be extended to other immigrant populations in similar contexts.

What can the UK learn from the impact of migrant populations on national life expectancy?

Improvements in life expectancy at birth in the UK had stalled prior to 2020 and have fallen during the COVID-19 pandemic. The stagnation took place at a time of relatively high net migration, yet we know that migrants to Australia, the USA and some Nordic countries have positively impacted national life expectancy trends, outperforming native-born populations in terms of life expectancy. It is important to ascertain whether migrants have contributed positively to life expectancy in the UK, concealing worsening trends in the UK-born population, or whether relying on national life expectancy calculations alone may have masked excess mortality in migrant populations. We need a better understanding of the role and contribution of migrant populations to national life expectancy trends in the UK.

Acculturation and Cardiovascular Risk Screening among African Immigrants: The African Immigrant Health Study

Acculturation and immigration-related factors may impact preventive, routine cardiovascular risk (CV) screening among African immigrants. We examined the associations between length of stay, percent of life spent in the U.S. (proxy for acculturation), and CV screening. Outcomes were recent screening for hypertension, diabetes, and dyslipidemia. Multivariable logistic regression analyses were used to examine these relationships. Among 437 African immigrants, 60% were males, mean age was 47 years, 61% had lived in the U.S. for ≥10 years, mean length of stay was 15 years, and 81% were employed. Only 67% were insured. In the 12 months prior, 85% had screened for hypertension, 45% for diabetes, and 63% for dyslipidemia. African immigrants with a ≥10-year length of U.S. stay had 2.20 (95%Confidence Intervals: 1.31−3.67), and those with >25% years of life spent in the U.S. had 3.62 (95%CI: 1.96−6.68) higher odds of dyslipidemia screening compared to those with a <10-year length of stay and ≤25% years of life spent in the U.S., respectively. Overall, screening for CV risk higher in African immigrants who have lived longer (≥10 years) in the U.S. Recent African immigrants may experience challenges in accessing healthcare. Health policies targeting recent and uninsured African immigrants may improve access to CV screening services.

Labour market marginalisation in young refugees and their majority peers in Denmark and Sweden: The role of common mental disorders and secondary school completion

Background

Due to the circumstances of their early lives, young refugees are at risk of experiencing adverse labour market and health outcomes. The post-settlement environment is thought to play a decisive role in determining how this vulnerability plays out. This study compared trends in labour market marginalisation in young refugees and their majority peers during early adulthood in two national contexts, Denmark and Sweden, and explored the mediating role of common mental disorders and secondary school completions.

Methods

Using registry data, 13,390/45,687 refugees were included in Denmark/Sweden and 1:5 matched to majority peers. Inequalities in labour market marginalisation were investigated during 2012–2015 in each country using linear probability models and mediation analysis. Country trends were standardised to account for differences in observed population characteristics.

Results

The risk of marginalisation was 2.1–2.3 times higher among young refugees compared with their majority peers, but the risk decreased with age in Sweden and increased in Denmark for refugees. Birth-cohort differences drove the increase in Denmark, while trends were consistent across birth-cohorts in Sweden. Differences in population characteristics did not contribute to country differences. Common mental disorders did not mediate the inequality in either country, but secondary school completions did (77–85% of associations eliminated).

Conclusions

The findings document both the vulnerability of young refugees to labour market marginalisation and the variability in this vulnerability across post-settlement contexts. While the contrast in policy climates in Denmark and Sweden sharpened over time, the risk of marginalisation appeared more similar in younger cohorts, pointing to the importance of factors other than national immigration and integration policies. Institutional efforts to assist young refugees through secondary education are likely to have long-lasting consequences for their socio-economic trajectories.

Perceived health, adversity, and posttraumatic stress disorder in Syrian and Iraqi refugees

BACKGROUND

Exposure to armed conflict and fleeing country of origin for refugees has been associated with poorer psychological health.

METHODS

Within the first month following their arrival in the United States, 152 Syrian and Iraqi refugees were screened in a primary care setting for posttraumatic stress disorder (PTSD), anxiety, and depression and rated their perceived health, and perceived level of adversity of violence, armed conflict/flight. The moderating effects of psychiatric symptoms on the relation between perceived adversity and perceived health were assessed.

RESULTS

Three models based on diagnosis (PTSD, anxiety, and depression) were tested. While significant effects were found on perceived adversity negatively influencing perceived health across diagnoses, slightly different patterns emerged based on diagnosis.

DISCUSSION

Findings suggest that refugees' perception regarding adversity of violence, armed conflict, and flight may contribute to perceived health, with a moderating role of clinically significant symptoms of PTSD, anxiety, and depression.

A vicious cycle of health (IN)equity: Migrant inclusion in light of COVID-19

Objectives

Methods

Results

Conclusions

Social support as a bridge: A rapid realist review of migrant inclusion in the Japanese response to the COVID-19 pandemic

•

Inclusion of migrants in public health policy in Japan is rare.

•

We synthesized the evidence on migrant inclusion during COVID-19.

•

Vulnerability derived from movement restrictions and socioeconomic background.

•

Access to support programs was conceptually equal, yet structurally inequitable.

•

Structural gaps were bridged with social support from host society.

Government policy to address the COVID-19 pandemic has been complex with profound impacts on vulnerable minorities like international migrants. In Japan migrants are an important and growing community but their consideration in health policy is rare. We conducted a rapid realist review about ‘what works’ for the equitable inclusion of migrants during the pandemic as a case study for other public health emergencies. Due to the time-sensitive needs of policy-makers in the ongoing COVID-19 emergency, our evidence search was purposive, yet exploratory and iterative in nature. We assessed academic and gray literature sources, published in either English or Japanese, that examined the policy response to COVID-19 in Japan and its impact on migrants. A panel of external stakeholders was also consulted during the review process. This evidence synthesis suggests that, rather than illness alone, restrictions on movement and socioeconomic background lead to the considerable impact of policy on the well-being of migrants. Many policy responses, while conceptually inclusive and flexible, were often structurally inequitable for migrants. Poor outcomes included confusion about changing virus-related regulations and need for technical assistance to access support. Social support from volunteers and non-profit organizations were consistently left to connect migrants with unmet needs to available services. Using the diverse international community of Japan as an example, we show that, during public health emergencies, social support from civil society remains crucial for bridging structural inequities. For equitable inclusion of migrants, evidence-informed policy will be key for governments to better protect migrants’ right to health and well-being in future emergencies.

Association between migration paths and mental health of new-generation migrants in China: The mediating effect of social integration

BACKGROUND

The new-generation migrants born in 1980 and later are large and vulnerable internal migrants in China. Migration paths and social integration are important factors to explain for their mental health. However, they faced difficulties in social integration varying from migration paths. We aimed to explore the mediating role of social integration between migration paths and the mental health of new-generation migrants.

METHODS

The migration paths included urban-to-urban, urban-to-rural, rural-to-urban and rural-to-rural. Mental health was assessed by the Kessler Screening Scale for Psychological Distress (K6) and the Perceived Stress Scales (PSS-4). Social integration was measured by economic integration, life integration, maintenance of the local culture, acceptance of the host culture and psychological integration. Multiple linear regressions with bootstrapping were used to examine the mediating effect.

RESULTS

A total of 9,830 new-generation migrants were included in this study. The mean age was 26.92 (SD = 4.47) years and the proportion of rural-to-urban migrants was 63.7%. Compared with the new generation of rural-to-rural migrants, rural-to-urban migrants had higher psychological distress (β = 0.305, 95% CI: 0.152-0.458) and perceived stress (β = 0.328, 95% CI: 0.199-0.456). The bootstrapping test found that two dimensions ("life integration" and "acceptance of the host culture") of social integration as a mediator weakened the negative effect of the rural-to-urban migration path on the mental health of new-generation migrants.

CONCLUSION

Rural-to-urban migrants had poorer mental health, and the association was mediated by their poorer social integration. The migration policies developed to enhance social integration could effectively improve the mental health of new-generation migrants.

Medical Facilities for Refugees in Europe: Creating a Consultation for Resettled Syrian Families

The wave of migration that has hit Europe in recent years has led to several changes in the organization of asylum systems and medical care provided to migrants. Previous studies indicate that asylum seekers and refugees face multiple barriers in accessing health care. For that reason, adapted structures are needed. In this context, a family consultation service was implemented in our medical center in Lausanne, Switzerland. It aimed at addressing the unique health care needs of recently resettled families from Syria, which has been the leading source country for refugees since 2014. This intervention, developed through collaboration between the University Center for Primary Care and Public Health (Unisanté) and the Children's Hospital of Lausanne (HEL) involved a multidisciplinary team comprising a pediatrician, a general practitioner and a pediatric nurse. Bringing together a multidisciplinary team optimized care coordination, facilitated communication between care providers and enabled a more global vision of the family system with the aim of enhancing quality of care.

Measuring structural xenophobia: US State immigration policy climates over ten years

There is an increasing need to understand the structural drivers of immigrant health inequities, including xenophobic and racist policies at the state level in the United States. Databases aggregate state policies related to immigration and research using single year indices examines state policy and immigrant health. Yet none of these sources use a theoretically informed social determinants of immigrant health approach to consider state environments longitudinally, include both exclusionary and inclusionary policies, and are relevant to immigrants from any region of the world or ethnic group. Using an established social determinants of immigrant health framework, a measure of structural xenophobia was created using fourteen policies across five domains: access to public health benefits, higher education, labor and employment, driver's licenses and identification, and immigration enforcement over a ten-year period (2009-2019). To create the Immigration Policy Climate (IPC) index, we used data from state legislatures as well as policy databases from foundations, advocacy organizations, and scholarly articles. We identified and coded 714 US state policies across the 50 US States and the District of Columbia from 2009 to 2019. We calculated annual IPC index scores (range: 12 - 12) as a continuous measure (negative scores: exclusionary; positive scores: inclusionary). Results show that the US has an exclusionary immigration policy climate at the state-level (mean IPC score of -2.5). From 2009 to 2019, two-thirds of state-level immigration policies are exclusionary towards immigrants. About 75% of states experienced a 4-point change or less on the IPC index, and no state changed from largely exclusive to largely inclusive. By aggregating comprehensive, detailed data and a measure of state-level immigration policies over time, the IPC index provides population health researchers with rigorous evidence with which to assess structural xenophobia and an opportunity for longitudinal research on health inequities and immigrant health.

COVID-19: Marking the Gaps in Migrant and Refugee Health in Some Massive Migration Areas

The health of migrants and refugees, which has long been a cause for concern, has come under greatly increased pressure in the last decade. Against a background where the world has witnessed the largest numbers of migrants in history, the advent of the COVID-19 pandemic has stretched the capacities of countries and of aid, health and relief organizations, from global to local levels, to meet the human rights and pressing needs of migrants and refugees for access to health care and to public health measures needed to protect them from the pandemic. The overview in this article of the situation in examples of middle-income countries that have hosted mass migration in recent years has drawn on information from summaries presented in an M8 Alliance Expert Meeting, from peer-reviewed literature and from reports from international agencies concerned with the status and health of migrants and refugees. The multi-factor approach developed here draws on perspectives from structural factors (including rights, governance, policies and practices), health determinants (including economic, environmental, social and political, as well as migration itself as a determinant) and the human security framework (defined as "freedom from want and fear and freedom to live in dignity" and incorporating the interactive dimensions of health, food, environmental, economic, personal, community and political security). These integrate as a multi-component 'ecological perspective' to examine the legal status, health rights and access to health care and other services of migrants and refugees, to mark gap areas and to consider the implications for improving health security both for them and for the communities in countries in which they reside or through which they transit.

Internal Migration as a Social Determinant of Occupational Health and WASH Access in Myanmar

Background:

Migration is at an all-time high worldwide, and despite increased focus on international migrants, there is little evidence about internal migrants’ exposures to socioeconomic, occupational, and environmental risk factors in low-and middle-income countries.

Objective:

The aim of this study was to examine differences in occupational health and access to water, sanitation, and hygiene (WASH) between internal migrants and non-migrants.

Methods:

A face-to-face survey (n = 937) was conducted in Mandalay, Myanmar. Bivariate and multivariate analysis included traditional social determinants such as education, income, occupation, gender, age, and location in addition to internal migration status.

Findings:

The majority of internal migrants (23% of the total sample) were labor migrants (67.3%), and while common social determinants (e.g., household income, education, and gender) were not statistically different between migrants and non-migrants, these groups reported different occupational profiles (p < 0.001). Migrants had higher odds of being street vendors (AOR = 2.26; 95% CI 1.33–3.85; p = 0.003) and were less likely to work labor jobs such as in factories or construction (AOR = 0.44; 95% CI 0.19–1.00; p = 0.051) when controlling for age, gender, education, and location. Internal migrants had significantly greater probabilities of experiencing some injuries and illness symptoms, such as cuts, vomiting, coughing, heatstroke, and diarrhea at work (p < 0.001). Compared to non-migrants, migrants’ households were approximately three times more likely (AOR = 3.45; 95% CI 2.17–5.62; p < 0.001) to have an unimproved source of drinking water and twice as likely (AOR = 1.98; 95% CI 1.10–3.58; p < 0.05) to have unimproved sanitation facilities in their homes.

Conclusions:

The results underscore the importance of considering internal migration as an aspect of social determinants analyses, and the need for targeting appropriate WASH interventions to address inequities.