Social Determinants of Migrant Health

Bellagio Conference

We are at an unprecedented moment in history in terms of the health of populations around the world….Moving forward effectively as a field will benefit from a focus on the changing needs of global health, and on how changing conditions, globally, should define the next generation of public health leadership so as to best accomplish global health goals…Migration is one of the topics of paramount importance in the future.

Fried, L, Piot, P, Frenk, J, Flahault, A and Parker, R, Global Public Health, July 30, 2012.

Introduction

In October, 2014, a group of researchers working on migrant health convened at the Bellagio Center of the Rockefeller Foundation for a conference, “Social Determinants of Migrant Health.” The conference reflected the integration of social determinants of health – socioeconomic and structural factors – into immigrant health research and policy. It used a cross-national framework to consider issues of place, migration and health. In addition to public health, the conference drew upon the fields of economics, sociology of immigration, and social epidemiology, and incorporated three theoretical frameworks: the life-course framework from social epidemiology, the ‘push-pull’ factor theories from geography and economics, and transnational theory from sociology. It built upon recent academic literature, including a Social Sciences and Medicine (SSM) supplement on immigration and health, to formulate areas where more research is needed and to recommend potentially fruitful program interventions and policy changes. The cluster of articles in the SSM supplement addressed migration and health, linking North America with Latino immigrants, Asian and South Asian immigrants, African and Afro-Caribbean immigrants, and Arab immigrants.  Conference participants conducted additional research linking the migration to Europe of Arab, Turks and other populations, and to the Middle East of immigrants from Africa.

Background, Vision and Goal of Proposed Conference

Migration between countries is at higher levels than ever before. The movement of people across national boundaries influences economic development, labor and population health, as noted in by WHO in 2010 and by the OECD in 2012.  Studies of immigrant health have steadily increased as have efforts to develop appropriate policies to address immigration. It is increasingly recognized that health and social policies within and between countries can influence the health of immigrants, their families, and population health patterns.

The goal of this conference is to discuss an integrative conceptual framework for understanding immigrant health from a cross-national perspective, drawing on literature from the aforementioned academic research disciplines. It will also address knowledge gaps critical for understanding the social determinants of immigrant health and inform interventions and policy opportunities to preserve or prolong the health advantage among first-generation immigrants, improve their health and the health of their offspring and the communities affected by world migration. It will facilitate a more complex understanding of variations in mental and physical health among immigrant groups by exploring social, political, and economic factors in countries of origin and in receiving nations.

The health of immigrants and their families is typically related to both conditions in the sending countries and the receiving countries. Cross-national research broadens our understanding of observed variations in mental and physical health among immigrant groups by exploring social, political, and economic factors in countries of origin and in nations receiving large shares of immigrants. Considering an array of related conditions in several places over time leads to a fuller, more precise understanding about how we might enhance and improve the health of immigrants, their children, and the communities affected by world migration.

The health of non-immigrants is primarily influenced by the societies they live in, while the health of immigrants is embedded in the cultures of both the sending and receiving countries.  Social determinants of health in sending countries affect immigrant health before migration, after migration, and across the lifecourse.  Push and pull factors, such as wage differentials and political conditions, stimulate migration but also may be considered as social determinants of migrant health.

Gender is an additional significant factor influencing migration. Also, immigrants are a self-selected group, another determinant of migrant health.These factors operate through the lifecourse to affect immigrant health outcomes; factors such as childhood health and well being, age at migration, and exposure to disease, risk and stress, are determinants of migrant health.

In the receiving country, factors such as economic opportunity for upward mobility, racial/ethnic discrimination, healthcare and health insurance policies and other immigration policies, as well as attitudes of the native population toward new immigrants, all have the potential to affect health and well being of immigrants.

The lifecourse perspective focuses on critical developmental periods, accumulation of risk, and social trajectories.  Social epidemiologists applied this model to examine the influence of childhood health and socioeconomic status on adult health. Research on immigrant health should consider health and status before and after migration, with age at migration a potentially significant determinant.

Unfavorable conditions in one place, such as low wages, political instability or violence, and favorable conditions in another location, such as more employment and higher wages, act to mobilize individuals to migrate. In economics, these push and pull factors are seen to influence migration decisions, as well as being likely to produce favorable health selection, that is, the migration of healthier or more resilient individuals.

The sociology of immigration has long examined assimilation of immigrants, while transnationalism, the struggle of immigrants to become integrated in the host country while also maintaining ties with the communities of origin, has been less intensively examined. Using this lens can help illuminate costs and benefits of migration for immigrants, their children, and their sending and receiving communities.

Research on the socioeconomic patterning of health also illuminates the effort to understand immigrant health. Despite a disadvantaged socioeconomic profile, certain immigrant groups in some circumstances have better than expected health outcomes. The SSM supplement papers examine some of the complex findings regarding health outcomes in various immigrant groups, and where those are better, the same or worse than might have been anticipated.

Looking at the flow the other way, from receiving countries to sending countries, one study of 98 developing countries found that health aid and remittances contributed to reducing infant and child mortality. (Chauvet, 2008) Thus, decreasing remittances with economic slowdowns in receiving countries may adversely affect population health in sending countries.

Drawn from the work of Dolores Acevedo-Garcia and the special supplement to Social Science and Medicine.

Conference Impact

Progress in immigrant health research and in enlightened policies toward immigration in sending and receiving countries is linked to improved understanding of population health patterns in sending and receiving countries. Conceptually, methodologically and analytically, cross-national immigrant health research needs to be better integrated into social epidemiological research.  At the same time, it offers conceptual and empirical insights and analytic opportunities to advance social epidemiological research and health and social policies. Such integration will contribute to our knowledge of population health and to the health of immigrants, their children, and the communities affected by world migration. (Acevedo-Garcia et.al., Social Science and Medicine, in press)

Conference Outputs

Conference proceedings and recommendations on actionable future research and policy will be published and disseminated. Dissemination channels include the KConnection e-newsletter, the Kaiser Permanente Burch Minority Leadership Development Program and the Culture of Health Equity website (www.cultureofhealthequity.org), and the Place, Migration and Health website (www.placemigrationandhealth.org) and listserv.

The thrust of this conference reflects the Rockefeller Foundation’s core value of promoting global health and the well-being of humanity throughout the world.

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