Migration and Health: Overview, Indicators and Determinants

1
Migration and HealthOverview, Indicators and
Determinants

• Alfonso Rodriguez-Lainz, PhD, DVM, MPVM
• Division of Global Migration and Quarantine,
• CDC

2
Outline

• What is migration?
• Who is a migrant?
• What is migrant health?
• Determinants of migrants health after
  resettlement
• Migrant health indicators

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Migration People on the move!
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Migration movement of people

• Across an international border
  (international migration) or within a country
  (internal migration)
• Different durations and patterns
• (e.g., permanent, temporary, cyclical)
• Different causes
• (e.g., economic, forced, family reunification)
• Source J. Weekers (IOM) Global Consultation on
  Migrant and Health, Madrid, Spain (35 March
  2010) adapted from IOM Glossary on Migration
  (2004)

5
Who is a migrant?
6
Who is a migrant?

• No universally accepted definition
• Countries and agencies use their own criteria,
  based and their own legislation and policies
• Definitions are not consistently used
• Popular terms

7
Migration-related terminology
Migrant
Alien
Migrant worker
Farmworker
Minorities
Latino
Immigrant
Foreign born
Ethnic groups
Foreigner
Hispanic
Mobile populations
Illegal
Traveler
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What are the international recommendations?
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International Migrant UN Recommendations (1998
and 2007)

• A person changing his/her country of usual
  residence for at least 12 months

Residence in new country

• Sources
• UN Recommendations on International Migration
  Statistics (1998)
• UN Expert Group Meeting on the use of censuses
  and surveys to measure international migration,
  ESA/STAT/AC.132/1 (2007)

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Some statistics
Source WHO (2010)
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International migrants as a share of the total
world population
Source United Nations Population Division
12
U.S.A 13.5 UK France 11
Note Among countries with at least 1 million
inhabitants
Source United Nations, Department of Economic
and Social Affairs, Population Division (2009).
International Migration, 2009 Wallchart (United
Nations publication, Sales No. E.09.XIII.8).
13
International migrants U.S definitions
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U.S Census Bureau

• Native anyone who is a U.S. citizen at birth.
  Includes
• born in the U.S mainland or territories OR
• born abroad of at least one U.S. citizen parent
• Foreign-born anyone who is not a U.S citizen at
  birth

Source Census Bureau, ACS
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Foreign-born population,2009

• 39.4 million
• 12.7 of
• U.S population
• 11.1 million unauthorized

Peak 14.8 (1890)
Sources American Community Survey, 2008 Martin
M Midgley, June 2010 and Migration Policy
Institute
16
China excluding Hong Kong and Taiwan
Source ACS, 2008
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Hispanic Origin and Race
Source U.S. Census Bureau, 2010 Census
questionnaire
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Race/ethnicity vs. Foreign-born
Source American Community Survey, 2008
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Migration and Health
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Phases of Migration
Transit country
2. Journey
Origin country
1. Pre-departure
4. Return
Destination country
3. Post-arrival
?
Adapted from Gushulak, 2010
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Migration a bridge to global health
ORIGIN COUNTRY
DESTINATIONCOUNTRY

• Disease burden
• Health risks
• Vectors
• Food safety
• Sanitation
• Others
• Health beliefs/behaviors
• Health infrastructure
• Others

• Disease burden
• Health risks
• Vectors
• Food safety
• Sanitation
• Others
• Health beliefs/behaviors
• Health infrastructure
• Others

Migration
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Prevalence gaps among countries
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Migrant Healthbeyond migrants themselves

• Health issues and risks related to migrant
  populations, AND the way in which migration
  affects
• Countries of origin, transit and destination, and
  
• Second and later migrant generations

(Adapted from Roux, 2004 IOM)
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Determinants of migrants health after
resettlement
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The post-arrival Phase

• DESTINATION COUNTRY
• Disease prevalence
• Health risks
• Vectors
• Food safety
• Sanitation
• Others
• Health beliefs/practices
• Access to health care
• Work opportunities
• Housing
• Many others (eg., language)

Individual factors -Biology and genetics
-SES -Health beliefs/behaviors -Pre-existing
health conditions -Migration status

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Individual factorsMigrants vs. U.S-born

• Genetic predispositions
• Natural or acquired immunity
• Younger age distribution
• Exception European
• Different gender distribution

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Individual factors (Cont.) Migrants vs. U.S-born

• Lower education
• Exceptions Africans, Europeans, Asians
• Higher poverty rates
• Exceptions Asians, Europeans
• Limited language proficiency
• Exceptions English-speaking countries

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Individual factors (Cont.) Migrants vs. U.S-born

• Health beliefs/behaviors
• Pre-existent health conditions
• Health conditions prevalent in home country or
  acquired during transit
• Migration (legal) status

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Social determinants of health

• Social/political environment
• (Anti-immigrant) Policies and regulations
• Discrimination gt xenophobia
• Poor housing
• Occupation
• High-risk and low-paid jobs

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Access to health careVulnerabilities

• Different health systems and practices
• Legal limitations on access to care
• Other barriers
• Culture, language, cost
• Limited awareness about available services
• Lack of health insurance
• Disparities in quality of care

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Migrant health a double jeopardy

• Vulnerable minorities
• Low SES
• Income
• Housing
• Occupation
• Culture
• Discrimination
• Others

• Access to health care

• HEALTH
• INEQUITIES

• Migration-specific factors
• Limited legal rights
• Language
• Multinational exposures (origin, transit,
  destination)
• Others

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Migrant health a complex picture

• The health of migrants varies across space, time,
  age, gender, across different countries of origin
  and type of migration
• Caution about making generalizations about the
  health of all migrants
• Mladovsky, 2005 Ingleby 2009

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Migrant Health Indicators
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The state of migrant health research

• still in its infancy (Ingleby, 2009)
• The information is voluminous, but sparse for
  many issues and sometimes contradictory
  (Cunningham, 2008)

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Migration and Health Research challenges

• Limitations of available data
• No migration-related data
• Small sample sizes
• Linguistic culturally inappropriate data
  collection methodologies and instruments
• Characteristics of migrant populations
• Diversity
• Mobility
• Rarity
• Hidden

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Broad migrant health patterns

• Positive health indicators
• Negative health indicators
• Worsening of health with longer residence in the
  U.S

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Positive health indicators New immigrants
health capital

• Especially for recently arrived immigrants
• Even after adjusting for age and other variables
  
• Healthy migrant paradox

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Positive health indicators for migrants vs.
native population

• Lower mortality rate
• Higher life expectancy
• Lower incidence and mortality due to some cancers
  (e.g, breast, colon and prostate cancer)
• Perinatal health outcomes (e.g,, low birth
  weight)
• Less tobacco use and substance abuse
• Lower prevalence of CVD and obesity

Cunningham S.A et al. Health of foreign-born
people in the United States a review. Health
Place. 2008
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Infant mortality rates, by mothers place of
birth and race/ethnicity of mother, U.S, 2006

• Source Mathews TJ, et al. Infant mortality
  statistics from the 2006 period linked
  birth/infant death data set. National vital
  statistics reports vol 57 no 2. Hyattsville, MD
  National Center for Health Statistics. 2010

41
Past month
Source SAMHSA, Office of Applied Studies,
National Survey on Drug Use and Health, 1999-2001
42
Negative health indicators for migrants vs.
native population

• Access to care and quality of care
• Preventive health services
• Immunization coverage (especially adults)
• Lower health literacy
• Infectious diseases (eg., TB, hepatitis B,
  HIV/AIDS)
• Higher incidence and mortality due to some
  cancers (eg., cervical, liver)
• Occupational, transportation and home injuries

43
Current Population Survey March Supplement, 2009
Source Kaiser Family Foundation Immigrants
Health Coverage and Health Reform Key Questions
and Answers (December, 2009)
44

• Source 2007 California Health Interview Survey

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Percentage of women 30 years and older with a
mammogram within previous 2 yrs, California, 2007
Source 2007 California Health Interview Survey
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Particularly vulnerable migrants

• Victims of human trafficking
• Refugees and asylum seekers
• Unauthorized migrants
• Labor migrants in high risk occupations
• Indigenous
• Detained and deported migrants

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Worsening of Health With Longer Residence
Diabetes prevalence for foreign-born
(by length or residence) vs. U.S-born
Adjusted for age, sex, poverty, income ratio,
BMI, smoking status, alcohol drinking status,
marital status, survey year, region of birth
migrants)

• Source Oza-Frank et al. Diabetes prevalence by
  length of residence among U.S immigrants. J Imm
  Minority Health (2009)

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• Thank you! Gracias!
• Alfonso Rodriguez-Lainz
• jqi3_at_cdc.gov

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References

• Gushulak BD, Weekers J, MacPherson DW. Migrants
  in a globalized world health threats risks and
  challenges an evidence-based framework. Emerging
  Health threats Journal 2009, 2e10
  http//www.eht-forum.org/ehtj/journal/v2/pdf/ehtj0
  9010a.pdf
• Davis AA, Basten A, Frattini C. Migration A
  Social Determinant of the Health of Migrants.
  International Organization of Migration, 2009
  http//www.migrant-health-europe.org/files/FINAL2
  0DRAFT20IOM.pdf
• International Migration, Health and Human Rights.
  WHO, 2003 http//www.who.int/hhr/activities/en/int
  l_migration_hhr.pdf
• Kandula NR, et al. Assuring the health of
  immigrants what the leading health indicators
  tell us. Annual review of public health.
  200425357-76.
• Gushulak BD and MacPherson DW. The basic
  principles of migration health Population
  mobility and gaps in disease prevalence. Emerg
  Themes Epidemiol. 2006 3 3
• IOM, Seminar on Health and Migration, Geneva 2004
  http//www.iom.int/en/know/idm/smh_200406.shtml
• Migration and health a review of the
  international literature (2003), Available at
  http//www.msoc-mrc.gla.ac.uk/
  Publications/pub/PDFs/Occasional-Papers/OP012.pdf
  
• McPherson DW, Gushulack BD, Mcdonald L. 2007.
  Health and foreign policy influences of
  migration and population mobility. Bullletin of
  the World Health Organization, 85(3)200-206

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References

• Cunningham SA. et al. Health of foreign-born
  people in the United States a review. Health
  Place. 2008 Dec14(4)623-35.
• Carballo M et al.. Migration and health in the
  European Union. Trop Med Int Health. 1998
  Dec3(12)936-44.
• Mladovsky P. Migration and Health in the EU.
  European Commission. 2007
• Beiser M. The health of immigrants and refugees
  in Canada . Revue Canadienne de Sante Publique,
  96, Suppl. 2S30S44. 2005
• Ingleby, D. European Research on Migration and
  Health. International Organization for Migration,
  Background Paper, 2009
• WHO. Health of migrants- Report by the
  Secretariat. A61/12 (April, 2008)
• WHO. Health of migrants the way forward (2010)