Health effects of migration – secondary publication

The proportion of citizens with an ethnic minority background in Denmark is rising and considerations about how to adapt health care services to the needs of this part of the population are becoming increasingly relevant. To do this, knowledge is needed about the factors influencing the health of these population groups. Migration is one of these factors. The process of migration influences the somatic and mental health of migrants and is described in this article. Ethnicity, social position and aspects related to communication also influence migrants’ health; however, we do not discuss these factors [1]. DEFINITION Migration is a process of social change during which a person moves from one cultural setting to another in order to settle for a longer period of time or permanently [2]. People may migrate from rural to urban areas, between neighbouring countries or over longer distances; migration therefore covers a broad variety of processes [3]. The migration process includes conditions in the country of origin, during the journey, and in the recipient country. Migrants can be defined in various ways, e.g., as internally displaced, asylum seekers, refugees, or immigrants [4]. It is difficult to distinguish between forced and voluntary migration; the reasons for migration often include both elements [4, 5]. Reasons for migration can be divided into push factors (driving the individual out of the country of origin) and pull factors (attracting the individual towards the recipient country). Push factors include war, poverty, hunger etc., while pull factors include employment opportunities and political and religious freedom [1, 6]. These factors affect both the nature of the migration and the migrants’ health [3]. There are large differences in both the reasons for migrating and the conditions related to the migration. Migrants constitute a very diverse group with different ethnic and socioeconomic backgrounds and disease patterns in the countries of origin etc. Thus, migrants’ health is influenced by a broad range of factors [2, 4-6]. MORBIDITY AMONG MIGRANTS Knowledge about the health status of migrants is often limited due to lack of data. This is because migrants are often excluded from surveys. There may be several reasons for this, including insufficient knowledge of the language, lack of professional interpreters, and greater costs when conducting surveys and interviews among migrants. In addition, there are difficulties in engaging migrants in these surveys. This may be due to the migrants’ feelings of less trust and to their contact with the surrounding society and its institutions, with fewer and less positive experiences related to encounters with official institutions in the country of origin and the recipient country. However, existing data show greater morbidity among migrants, especially concerning mental health problems, depression, posttraumatic stress syndrome, psychosomatic complaints and anxiety; certain chronic diseases, such as diabetes; and infectious diseases, such as tuberculosis and hepatitis B [3, 4, 6, 7]. There is a lack of consistency in the findings on migrant health. Some studies show that the morbidity patterns among migrants are not markedly different from the background population in the recipient country; other studies indicate a lower prevalence of certain diseases among migrants compared to the background populations in the recipient countries, e.g., depression [2, 3, 8]. Morbidity patterns among migrants will approach those among the background population in the recipient country in the course of time. Morbidity due to infectious diseases common among citizens in the countries of origin will decrease upon arrival in the recipient country. In contrast, negative as well as positive changes in migrants’ exposure to risk factors for lifestyle related diseases will occur over a longer period of time [4]. For example, a study of changes after migration found an increase in cardiovascular morbidity among Japanese migrants to the US due to a gradual change of exposure to different risk factors [9]. HOW DOES MIGRATION INFLUENCE MORBIDITY? The migration process may imply a number of stressors and strains that influence migrants’ morbidity in several ways (Figure 1). IS IT MAINLY THE HEALTHY PEOPLE WHO MIGRATE? There is often a selection in the people who migrate, as migrants are often healthier and younger than the majority in their countries of origin [2-4]. This is called the healthy migrant effect. The effect may fade out over time because migrants are exposed to risk factors in the recipient country. However, some migrants, especially refugees, may migrate because of a need for protection or treatment. This is the case for many quota refugees selected from refugee camps who often have chronic diseases or disabilities. HEALTH RISKS DURING MIGRATION Migrants may be exposed to health risks before, during and after leaving their countries of origin. Before and during the journey, migrants may experience wars, torture, imprisonment, loss of relatives, long stays in refugee camps, socioeconomic hardship etc. Some of the risks experienced after arriving in the recipient country include imprisonment, long-lasting asylum seeking processes, language barriers, lack of knowledge about health services in the new social context, discrimination and marginalization [10]. Additionally, long periods in refugee camps in the recipient country may cause existential insecurity, leading to stress reactions with negative health impacts [4]. These impacts may happen directly through a higher stress response resulting in, for example, higher blood pressure, or Figure 1. The influence of the migration process on migrants' morbidity. Conditions during the journey from the country of origin to the recipient country Conditions in the country of origin Conditions in the recipient country The migration process