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Ziersch A, Walsh M, Due C. Housing and health for people from refugee and asylum-seeking backgrounds: findings from an Australian qualitative longitudinal study. BMC Public Health 2024; 24:1138. [PMID: 38654272 DOI: 10.1186/s12889-024-18616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND For people from asylum-seeking and refugee backgrounds, housing and the re-establishment of home are key social determinants of health. Research highlights the inequities faced by asylum seekers and refugees in the housing markets of high-income resettlement countries, resulting in their overrepresentation in precarious housing. There is also emerging evidence of the relationship between housing and health for this population relating to lack of affordability, insecurity of tenure, and poor suitability (physical and social). The mechanisms by which housing impacts health for this group within these housing contexts, is however, understudied - especially overtime. This qualitative longitudinal study aimed to address this gap. METHODS Semi-structured interviews were conducted with 25 people from asylum-seeking and refugee backgrounds in South Australia, recruited through a community survey. Thematic analysis of interview data across three time points over three years identified four material and psychosocial mechanisms through which housing contributed to health outcomes via psychological and physical stressors - physical environment; stability; safety; and social connections, support and services. The study also identified additional health promoting resources, particularly elements of ontological security. The dynamics of these indirect and direct mechanisms were further illuminated by considering the impact of international, national and local contexts and a range of intersecting social factors including gender, country/culture of origin, family circumstances, immigration status, language skills, income, and health status. CONCLUSIONS Rebuilding a sense of home and ontological security is a key resettlement priority and crucial for wellbeing. More comprehensive strategies to facilitate this for refugees and asylum seekers are required.
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Affiliation(s)
- Anna Ziersch
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia.
| | - Moira Walsh
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia
| | - Clemence Due
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia
- School of Psychology; University of Adelaide, Adelaide, Australia
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Biddle L, Bozorgmehr K. Effect of area-level socioeconomic deprivation on mental and physical health: A longitudinal natural experiment among refugees in Germany. SSM Popul Health 2024; 25:101596. [PMID: 38304416 PMCID: PMC10832457 DOI: 10.1016/j.ssmph.2023.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/18/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024] Open
Abstract
Existing studies on contextual health effects struggle to account for compositional bias, limiting causal interpretation. We use refugee dispersal in Germany as a natural experiment to study the effect of area-level socioeconomic deprivation on mental and physical health, while considering the potential mediating role of neighbourhood characteristics. Refugees subject to dispersal (n = 1466) are selected from a nation-wide longitudinal refugee study (IAB-SOEP-BAMF Panel; 2016-2018). Multi-level linear regression models, adjusted for age, sex, education, country of origin, federal state, asylum status and length of residence in Germany, are fitted to the change in mental and physical health subscales of the SF-12 depending on quintiles (Q1 - Q5) of commune-level socioeconomic deprivation (German Index of Socioeconomic Deprivation, GISD). This is followed by sensitivity analyses and mediation analyses for housing, social cohesion, proportion of non-citizens in the neighbourhood, access to green space, population density and primary care physician density. Residency in districts with moderate-high deprivation (Q4) has a negative impact on physical health (coef.: -2.2, 95%CI: -4.1;-0.2) compared to lowest deprivation (Q1). Moderate-high deprivation (Q4) has a positive impact on mental health, but the effect is statistically insignificant (coef.: 1.6, 95%CI: -0.7; 3.9). Comparisons with other deprivation quintiles are statistically insignificant. Sensitivity analyses confirm results of the final models, while no mediating factors show a substantial impact on the observed relationship. The results point to gaps in health and social service provision for refugees living in the most deprived regions, but further research is required to understand the precise mechanisms behind the observed relationships. Further research using longer timeframes and larger sample sizes are required to confirm results.
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Affiliation(s)
- Louise Biddle
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Bielefeld, Germany
- German Socio-Economic Panel, German Institute for Economic Research (DIW Berlin), Mohrenstraße 58, 10117, Berlin, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Bielefeld, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Mohsenpour A, Biddle L, Bozorgmehr K. 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. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001755. [PMID: 38150435 PMCID: PMC10752521 DOI: 10.1371/journal.pgph.0001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/21/2023] [Indexed: 12/29/2023]
Abstract
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.
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Affiliation(s)
- Amir Mohsenpour
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
- Department for Psychiatry, Psychotherapy and Psychosomatic Medicine, Vitos Kurhessen, Kassel, Germany
| | - Louise Biddle
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
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Akbulut N, Razum O. [Othering in the context of migration: how Others emerge from social categories]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1109-1116. [PMID: 37721566 PMCID: PMC10539436 DOI: 10.1007/s00103-023-03763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
'Migrants' and 'refugees' are often categorized as Other, in a process called Othering. Using the example of forced migration, we develop a definition of Othering to make it useful for the analysis of health inequalities. We consider Othering as a social process that constructs and classifies differences in such a way that certain groups become socially visible as essential Others. On one hand, the process of Othering operates through a discursive practice that constructs differences, thereby transforming individuals into visible Others. On the other hand, it is based on a power asymmetry that enables the categorization of people, thereby marking them as different.Othering is not solely based on negative attitudes of individuals or groups. Rather, Othering is the result of a broad and historically evolved system of beliefs that gain credibility through power relations. Thus, we understand Othering as a powerful process that goes substantially beyond concepts of discrimination based on mere categorization processes. The concept of Othering stands out from other concepts of inequality by including the epistemic level as a key factor for inequality. Othering not only produces the Other epistemologically, but at the same time establishes a discursive legitimation for the unequal treatment of the Other.Drawing upon our understanding of Othering, we present practice-related findings on the consequences of Othering for the healthcare of 'migrants' and 'refugees'.
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Affiliation(s)
- Nurcan Akbulut
- AG Epidemiologie & International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland.
| | - Oliver Razum
- AG Epidemiologie & International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
- Forschungszentrum gesellschaftlicher Zusammenhalt (FGZ), Standort Bielefeld, Bielefeld, Deutschland
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Mohsenpour A, Dudek V, Bozorgmehr K, Biddle L, Razum O, Sauzet O. Type of Refugee Accommodation and Health of Residents: A Cross-Sectional, Population-Based Cluster Analysis in South-West Germany. Int J Public Health 2023; 68:1605786. [PMID: 37736387 PMCID: PMC10509756 DOI: 10.3389/ijph.2023.1605786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Objectives: Few studies have assessed whether refugees' health is associated with accommodation characteristics. We aimed to devise a typology of refugee accommodation based on variables on the accommodation and its physical context before assessing its association with health in multivariate analyses. Methods: We performed a cluster analysis based on a hierarchal, agglomerative clustering algorithm using Euclidean Distance and Ward's method. We analysed accommodation clusters based on number of inhabitants, degree of housing deterioration, urbanity of location (urban/rural distinction), and remoteness (walking distance to shops, medical or administrative services). In total, we analysed health and accommodation data of 412 refugees and asylum seekers from 58 different accommodation facilities in the federal state of Baden-Württemberg in the south-west of Germany. Results: Accommodations with a moderate occupation, lowest levels of deterioration, and a central urban location showed the best health outcomes in terms of subjective general health status, depression, and generalized anxiety disorder (GAD). Associations were strongest for GAD and weakest for depression. Conclusion: Our findings inform policymakers on layout and location of refugee collective accommodation centres.
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Affiliation(s)
- Amir Mohsenpour
- Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Verena Dudek
- Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kayvan Bozorgmehr
- Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arkaden, Heidelberg, Germany
| | - Louise Biddle
- Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Odile Sauzet
- Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Data Analysis Group, Department of Business Administration and Economics, Bielefeld University, Bielefeld, Germany
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Murphy A, Bartovic J, Bogdanov S, Bozorgmehr K, Gheorgita S, Habicht T, Richardson E, Azzopardi-Muscat N, McKee M. Meeting the long-term health needs of Ukrainian refugees. Public Health 2023; 220:96-98. [PMID: 37290174 DOI: 10.1016/j.puhe.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/31/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Since Russia's full-scale invasion of Ukraine on 24 February 2022, millions of people have fled the country. Most people have gone to the neighbouring countries of Poland, Slovakia, Hungary, Romania, and Moldova. This vulnerable population has significant healthcare needs. Among the most challenging to address will be chronic non-communicable diseases (NCDs), including mental disorders, as these require long-term, continuous care and access to medicines. Host country health systems are faced with the challenge of ensuring accessible and affordable care for NCDs and mental disorders to this population. Our objectives were to review host country health system experiences and identify priorities for research to inform sustainable health system responses to the health care needs of refugees from Ukraine. STUDY DESIGN In-person conference workshop. METHODS A workshop on this subject was held in November 2022 at the European Public Health Conference in Berlin. RESULTS The workshop included participants from academia and non-governmental organisations, health practitioners, and World Health Organisation regional and country offices. This short communication reports the main conclusions from the workshop. CONCLUSION Addressing the challenges and research priorities identified will require international solidarity and co-operation.
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Affiliation(s)
- A Murphy
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - J Bartovic
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - S Bogdanov
- Centre for Mental Health and Psychosocial Support, The National University of Kyiv Mohyla, Kyiv, Ukraine
| | - K Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - S Gheorgita
- World Health Organization Moldova Country Office, Chișinău, Republic of Moldova
| | - T Habicht
- World Health Organization Barcelona Office for Health Systems Financing, Barcelona, Spain
| | - E Richardson
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; World Health Organization European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - N Azzopardi-Muscat
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - M McKee
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Brake TM, Dudek V, Sauzet O, Razum O. Psychosocial Attributes of Housing and Their Relationship With Health Among Refugee and Asylum-Seeking Populations in High-Income Countries: Systematic Review. Public Health Rev 2023; 44:1605602. [PMID: 37213704 PMCID: PMC10193459 DOI: 10.3389/phrs.2023.1605602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Objectives: Housing as a social determinant of health should provide not only shelter, but also a feeling of home. We explored psychosocial pathways creating a sense of home and influencing the relationship between housing and health among asylum seekers and refugees (ASR) in high-income countries. Methods: We performed a systematic review. To be included, studies had to be peer-reviewed, published between 1995 and 2022, and focus on housing and health of ASR in high-income countries. We conducted a narrative synthesis. Results: 32 studies met the inclusion criteria. The psychosocial attributes influencing health most often identified were control, followed by expressing status, satisfaction, and demand. Most attributes overlap with material/physical attributes and have an impact on ASR's mental health. They are closely interconnected with each other. Conclusion: Psychosocial attributes of housing play an essential role in the health of ASR; they are closely associated with material/physical attributes. Therefore, future research on housing and health of ASR should routinely study psychosocial attributes, but always in association with physical ones. The connections between these attributes are complex and need to be further explored. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021239495.
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