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Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (22 May 2022) | Viewed by 34165

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Special Issue Editors

Prof. Dr. Kayvan Bozorgmehr

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Guest Editor

Deptartment of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
Interests: health services research; social epidemiology; health of forced migrants; global public health; health policy and systems research

Dr. Miriam Orcutt

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Guest Editor

Institute of Global Health, University College London, London WC1E 6BT, UK
Interests: global public health; forced migration and health; public policy & governance; health systems and medical-humanitarian response research

Dr. Santino Severoni

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Guest Editor

Migration Health Programme, World Health Organization, DK-2100 Copenhagen, Denmark
Interests: migrant health; refugee health; health systems; health policy

Dr. Dominik Zenner

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Guest Editor

Centre for Global Public Health, Institute of Population Health Sciences, Queen Mary University London, London E1 4NS, UK
Interests: infectious disease epidemiology; migrant health; refugee health; health information systems

Special Issue Information

Dear Colleagues,

Human migration and mobility are shaping contemporary societies in an increasingly interconnected world. However, health systems have not kept pace with the demands and needs raised by a world on the move. As such, health needs, health risks, and broader determinants of health for increasing numbers of international migrants, asylum seekers, and refugees often go unnoticed and unresponded to. The Covid-19 pandemic has made these gaps and inequities painfully visible. Health monitoring can be defined as ‘regular collection of data on relevant components of health and its determinants in the population or in samples thereof, aimed at informing the public health policy process’ (EUPHA). It requires strong health information systems that are well equipped to collect reliable data from health and other societal sectors for quality assurance, disaggregated data analysis, and timely dissemination by converting the data into relevant information for health-related decision-making. Yet, health monitoring, and the health information systems where data are derived, struggle to keep up with the diversity and mobility of societies, especially in relation to migrants, asylum seekers, and refugees, and with the multiple legal, socio-economic, political, and environmental conditions in which they live.

Recent scholarship has identified major research gaps in advancing knowledge, policy, and practice of health monitoring in order to improve health care provision among migrants, asylum seekers, and refugees. These relate to:

cross-border harmonisation of definitions of migrants, asylum seekers, and refugees in health information systems;
cross-border compatibility and inter-operability of data;
international cooperation and governance of data management;
advocacy and action in response to health monitoring and data (whether health interventions or health response);
development and implementation of diversity-sensitive and multi-lingual health surveys;
data linkage methods and strategies to enhance health information systems;
access to and integration of migrants, refugees, and asylum seekers in health monitoring policies;
systems and strategies to improve health data in detention and reception and transit contexts, which pose challenges in terms of access, data collection, and monitoring;
linkage to broader global health agendas such as the Sustainable Development Goals, Universal Health Coverage, and related reporting and monitoring systems;
ethical and legal challenges; and
capacity building and human resources for effective health monitoring and health responses.

We are very excited about editing a Special Issue on Health Monitoring among Migrants, Asylum Seekers, and Refugees for Evidence-Informed Health Care Policy, Practice, and Action, and cordially invite the submission of high-quality papers that address any of the topics above. Papers that combine a high academic standard coupled with a focus on policy or practice and the implementation of solutions, strategies, and approaches to improve monitoring of health and health care among migrants, asylum seekers, and refugees are particularly welcome. We would also particularly welcome submissions that highlight how health information and monitoring have been used to improve health responses and/or health policy. We invite the submission of quantitative research, qualitative research, rigorous literature reviews, policy analysis, and implementation research

Prof. Dr. Kayvan Bozorgmehr
Dr. Miriam Orcutt
Dr. Santino Severoni
Dr. Dominik Zenner
Guest Editors

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

health monitoring
health information system
health interventions
health response
migration
asylum seeker
refugee
data collection
reporting
survey methods
public health ethics
equity
sustainable development goals
universal health coverage
global health

Published Papers (10 papers)

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12 pages, 1506 KiB

Open AccessArticle

Trends and Changes in Socio-Economic Inequality in Self-Rated Health among Migrants and Non-Migrants: Repeated Cross-Sectional Analysis of National Survey Data in Germany, 1995–2017

by Elisa Wulkotte and Kayvan Bozorgmehr

Int. J. Environ. Res. Public Health 2022, 19(14), 8304; https://doi.org/10.3390/ijerph19148304 - 7 Jul 2022

Cited by 3 | Viewed by 1506

Abstract

Socio-economic inequalities in health may change over time, and monitoring such change is relevant to inform adequate policy responses. We aimed to quantify socio-economic inequalities in health among people with direct, indirect and without migration background in Germany and to assess temporal trends and changes between 1995 and 2017. Using nationally representative survey data from the Socio-Economic Panel (SOEP), we quantified absolute and relative socio-economic inequalities in self-reported general health by calculating the slope (SII) and relative index of inequality (RII) with 95% confidence intervals (CI) among each group and year (1995–2017) in a repeated cross-sectional design. Temporal trends were assessed using a GLM regression over the SII and RII, respectively. The total sample size comprised 492,489 observations, including 108,842 (22.23%) among people with migration background. About 31% of the population with and 15% of the population without migration background had a low socio-economic status. Socio-economic inequalities in health persisted in the group with migration background (1995 to 2017), while inequalities in the non-migrant population increased (SII:

β_{T r e n d}

= 0.04, p < 0.01) and were on a higher level. The highest socio-economic inequalities in health were found among those with direct migration background (

β_{S I I, m i n}

= −0.23, p< 0.01;

β_{S I I, m a x}

= −0.33, p < 0.01). The results show that the magnitude and temporal dynamics of inequalities differ among populations with direct, indirect and without migration background. Monitoring systems can capture and investigate these inequalities if migrant populations are adequately integrated into the respective systems. Full article

(This article belongs to the Special Issue Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action)

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17 pages, 746 KiB

Open AccessArticle

From Research into Practice: Converting Epidemiological Data into Relevant Information for Planning of Regional Health Services for Refugees in Germany

by Maren Hintermeier, Andreas W. Gold, Stella Erdmann, Clara Perplies, Kayvan Bozorgmehr and Louise Biddle

Int. J. Environ. Res. Public Health 2022, 19(13), 8049; https://doi.org/10.3390/ijerph19138049 - 30 Jun 2022

Cited by 1 | Viewed by 3307

Abstract

Health data of refugees and asylum seekers (ASR) is not routinely collected in Germany. Based on health data of ASR collected in 2018 in regional accommodation centres, we developed a dashboard to estimate regional burden of disease in Baden-Wuerttemberg, Germany. We aimed to find out how scientific data can support actors involved in healthcare planning for ASR in Germany and, within this scope, to explore how healthcare planning is conducted in this context. We conducted 12 qualitative semi-structured interviews including a usability test for a health data dashboard with regional decision-makers. Results showed that healthcare planning processes for ASR in Germany involve a complex set of actors in both long- and short-term decision-making. Data gained from representative surveys can support long-term decision-making and thus support the resilience of the health system, but it must balance the need for simple data presentation with transparent communication of potentially complex methods. Full article

(This article belongs to the Special Issue Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action)

20 pages, 1205 KiB

Open AccessArticle

Resilient or Vulnerable? Effects of the COVID-19 Crisis on the Mental Health of Refugees in Germany

by Laura Goßner, Yuliya Kosyakova and Marie-Christine Laible

Int. J. Environ. Res. Public Health 2022, 19(12), 7409; https://doi.org/10.3390/ijerph19127409 - 16 Jun 2022

Cited by 1 | Viewed by 2815

Abstract

Even though the COVID-19 pandemic had consequences for the whole society, like during most crises, some population groups tended to be disproportionally affected. We rely on the most recent data from the IAB-BAMF-SOEP Survey of Refugees to explore the resilience or vulnerability of refugees in the face of the pandemic. As the 2020 wave of the survey was in the field when the second nationwide lockdown started in December, we are able to apply a regression discontinuity design to analyze how refugees in Germany are coping with these measures. Our results reveal a negative effect of the lockdown on refugees’ life satisfaction. Male refugees and those with a weaker support system face stronger negative outcomes than their counterparts. Since mental health is an important prerequisite for all forms of integration, understanding the related psychological needs in times of crisis can be highly important for policymakers and other stakeholders. Full article

(This article belongs to the Special Issue Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action)

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11 pages, 307 KiB

Open AccessArticle

Sociodemographic Characteristics and Inadequate Usual Sources of Healthcare in a National Sample of US Refugees

by Kyle J. Baumann and Tilahun Adera

Int. J. Environ. Res. Public Health 2022, 19(12), 7234; https://doi.org/10.3390/ijerph19127234 - 13 Jun 2022

Cited by 2 | Viewed by 1266

Abstract

Introduction: Refugees resettled into the United States (US) face challenges in accessing adequate healthcare. Knowledge of demographic and social characteristics related to healthcare access among refugees is scarce. This study examines potential sociodemographic predictors of inadequate usual sources of care (USCs)—one key component of healthcare access—within the US refugee population. Methods: The 2016 Annual Survey of Refugees (ASR) involving 4037 refugees resettled into the US served as the data source for this study. Inadequate USC was defined as a USC that was neither a private healthcare provider nor a health clinic. We used multiple binary logistic regression methods to identify sociodemographic predictors of inadequate USCs. In addition, we used multinomial logistic regression to further assess predictors of inadequate USCs with a particular focus on severely deficit USCs (i.e., emergency department dependence and USC absence). Results: Refugees with interrupted healthcare coverage were more likely to have an inadequate USC. Refugees who were young (age 10–19), resettled into the western region of the US, and highly educated were less likely to have an inadequate USC. Refugees with an education level higher than secondary had a significantly lower likelihood of having a severely deficient USC, while refugees with interrupted healthcare were more than twice as likely to have a severely deficient USC. Conclusions: Considering these results alongside our previous healthcare coverage findings provides a more comprehensive understanding of sociodemographic predictors of poor healthcare access among refugees resettled into the US. This improved understanding has the potential to assist early refugee contacts toward more effective healthcare resource allocation and aid policymakers attempting to improve programs linked to refugee healthcare access. Full article

(This article belongs to the Special Issue Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action)

18 pages, 677 KiB

Open AccessArticle

Results and Strategies for a Diversity-Oriented Public Health Monitoring in Germany

by Carmen Koschollek, Katja Kajikhina, Susanne Bartig, Marie-Luise Zeisler, Patrick Schmich, Antje Gößwald, Alexander Rommel, Thomas Ziese and Claudia Hövener

Int. J. Environ. Res. Public Health 2022, 19(2), 798; https://doi.org/10.3390/ijerph19020798 - 12 Jan 2022

Cited by 7 | Viewed by 2624

Abstract

Germany is a country of immigration; 27% of the population are people with a migration background (PMB). As other countries, Germany faces difficulties in adequately including hard-to-survey populations like PMB into national public health monitoring. The IMIRA project was initiated to develop strategies to adequately include PMB into public health monitoring and to represent diversity in public health reporting. Here, we aim to synthesize the lessons learned for diversity-oriented public health monitoring and reporting in Germany. We also aim to derive recommendations for further research on migration and health. We conducted two feasibility studies (interview and examination surveys) to improve the inclusion of PMB. Study materials were developed in focus groups with PMB. A systematic review investigated the usability of the concept of acculturation. A scoping review was conducted on discrimination as a health determinant. Furthermore, core indicators were defined for public health reporting on PMB. The translated questionnaires were well accepted among the different migrant groups. Home visits increased the participation of hard-to-survey populations. In examination surveys, multilingual explanation videos and video-interpretation services were effective. Instead of using the concept of acculturation, we derived several dimensions to capture the effects of migration status on health, which were more differentiated. We also developed an instrument to measure subjectively perceived discrimination. For future public health reporting, a set of 25 core indicators was defined to report on the health of PMB. A diversity-oriented public health monitoring should include the following: (1) multilingual, diversity-sensitive materials, and tools; (2) different modes of administration; (3) diversity-sensitive concepts; (4) increase the participation of PMB; and (5) continuous public health reporting, including constant reflection and development of concepts and methods. Full article

(This article belongs to the Special Issue Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action)

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11 pages, 2433 KiB

Open AccessArticle

Equity of Social Health Insurance Coverage for Migrants in Thailand: A Concentration Index Analysis

by Peeraya Piancharoen, Hathairat Kosiyaporn and Rapeepong Suphanchaimat

Int. J. Environ. Res. Public Health 2022, 19(1), 64; https://doi.org/10.3390/ijerph19010064 - 22 Dec 2021

Viewed by 2033

Abstract

Thailand is attempting to implement an effective health insurance scheme to cover all migrant workers in the country. One of the remarkable policies is the Social Security Scheme (SSS). This study aims to assess the equity of SSS coverage among migrant workers in Thailand, sorted by types of businesses (agriculture, services and industrial sectors) and Gross Provincial Product (GPP) per capita. A secondary data analysis on time series cross-sectional data was employed. The dataset comprised: (1) the number of migrant insurees under the SSS; (2) the volume of migrant insurees in formal and informal sectors; and (3) provincial economic level and provincial population by years from 2015–2018. Descriptive statistics, Spearman’s rank correlation, and concentration index analysis on the ratio of SSS insurees to all migrants ranked by GPP per capita and business types from 2015–2018 were performed. Results showed that the ratio of SSS insurees to all migrants increased from 38.5% to 58.9%. Spearman’s correlation found a positive relationship between the SSS coverage and GPP per capita and business types in 2018. The statistical significance (p < 0.001) was found only in the industrial sector (r_s = 0.346). Significant CIs were found in SSS coverage in the industrial sector in 2016 (CI = 0.147, p < 0.001), and SSS coverage in the industrial sector in 2017 (CI = 0.137, p < 0.001). In conclusion, the trend of CIs displayed a movement towards zero for all business types. This implied that the distribution of migrants in SSS shifted toward the equitable distribution across provinces in Thailand. A possible explanation was a major change in Thai politics in 2014 and a change in employment legislation for migrants in 2017. To expand the insurance coverage, the government should use the CI as a guide to consider specific provinces or target specific economic sectors as a priority to expedite the insurance enrolment for migrants. Full article

(This article belongs to the Special Issue Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action)

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14 pages, 2037 KiB

Open AccessArticle

Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK

by Neha Pathak, Claire X. Zhang, Yamina Boukari, Rachel Burns, Rohini Mathur, Arturo Gonzalez-Izquierdo, Spiros Denaxas, Pam Sonnenberg, Andrew Hayward and Robert W. Aldridge

Int. J. Environ. Res. Public Health 2021, 18(24), 13304; https://doi.org/10.3390/ijerph182413304 - 17 Dec 2021

Cited by 4 | Viewed by 2563

Abstract

International migrants comprised 14% of the UK’s population in 2020; however, their health is rarely studied at a population level using primary care electronic health records due to difficulties in their identification. We developed a migration phenotype using country of birth, visa status, non-English main/first language and non-UK-origin codes and applied it to the Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country-of-birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997 to 2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified: 178,749 (1.11%) had foreign-country-of-birth or visa -status codes, 216,731 (1.35%) non-English-main/first-language codes, and 8288 (0.05%) non-UK-origin codes. The cohort was similarly distributed versus ONS data by sex and region of birth. Migration recording improved over time and younger migrants were better represented than those aged ≥50. The validated phenotype identified a large migrant cohort for use in migration health research in CPRD GOLD to inform healthcare policy and practice. The under-recording of migration status in earlier years and older ages necessitates cautious interpretation of future studies in these groups. Full article

(This article belongs to the Special Issue Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action)

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13 pages, 1773 KiB

Open AccessArticle

Geographical Access to Child and Family Healthcare Services and Hospitals for Africa-Born Migrants and Refugees in NSW, Australia; A Spatial Study

by Carolyne Njue, Nick Nicholas, Hamish Robertson and Angela Dawson

Int. J. Environ. Res. Public Health 2021, 18(24), 13205; https://doi.org/10.3390/ijerph182413205 - 15 Dec 2021

Cited by 2 | Viewed by 2627

Abstract

Background: African-born migrants and refugees arriving from fragile states and countries with political and economic challenges have unique health needs requiring tailored healthcare services and support. However, there is little investigation into the distribution of this population and their spatial access to healthcare in Australia. This paper reports on research that aimed to map the spatial distribution of Africa-born migrants from low and lower-middle-income countries (LLMICs) and refugees in New South Wales (NSW) and access to universal child and family health (CFH) services and hospitals. Methods: We analysed the Australian Bureau of Statistics 2016 Census data and Department of Social Services 2018 Settlement data. Using a Geographic Information System mapping software (Caliper Corporation. Newton, MA, USA), we applied data visualisation techniques to map the distribution of Africa-born migrants and refugees relative to CFH services and their travel distance to the nearest service. Results: Results indicate a spatial distribution of 51,709 migrants from LLMICs in Africa and 13,661 refugees from Africa live in NSW, with more than 70% of the total population residing in Sydney. The Africa-born migrant and refugee population in Sydney appear to be well served by CFH services and hospitals. However, there is a marked disparity between local government areas. For example, the local government areas of Blacktown and Canterbury-Bankstown, where the largest number of Africa-born migrants and refugees reside, have more uneven and widely dispersed services than those in Sydney’s inner suburbs. Conclusion: The place of residence and travel distance to services may present barriers to access to essential CFH services and hospitals for Africa-born refugees and migrants. Future analysis into spatial-access disadvantages is needed to identify how access to health services can be improved for refugees and migrants. Full article

(This article belongs to the Special Issue Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action)

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14 pages, 714 KiB

Open AccessArticle

Childbirths and the Prevalence of Potential Risk Factors for Adverse Perinatal Outcomes among Asylum Seekers in The Netherlands: A Five-Year Cross-Sectional Study

by Julia B. Tankink, Anouk E. H. Verschuuren, Ineke R. Postma, Peggy J. A. van der Lans, Johanna P. de Graaf, Jelle Stekelenburg and Annelies W. Mesman

Int. J. Environ. Res. Public Health 2021, 18(24), 12933; https://doi.org/10.3390/ijerph182412933 - 8 Dec 2021

Cited by 2 | Viewed by 3779

Abstract

This five-year cross-sectional study mapped the prevalence of several known risk factors for adverse perinatal outcomes in asylum-seeking women in The Netherlands. Characteristics of 2831 registered childbirths among residents of asylum seekers centers (ASCs) in The Netherlands from 2016 to 2020 were included. Results showed a high general and teenage birthrate (2.15 and 6.77 times higher compared to the Dutch, respectively). Most mothers were pregnant upon arrival, and the number of births was highest in the second month of stay in ASCs. Another peak in births between 9 and 12 months after arrival suggested that many women became pregnant shortly after arrival in The Netherlands. Furthermore, 69.5 percent of all asylum-seeking women were relocated between ASCs at least once during pregnancy, which compromises continuity of care. The high prevalence of these risk factors in our study population might explain the increased rate of adverse pregnancy outcomes in asylum seekers compared to native women found in earlier studies. Incorporating migration-related indicators in perinatal health registration is key to support future interventions, policies, and research. Ultimately, our findings call for tailored and timely reproductive and perinatal healthcare for refugee women who simultaneously face the challenges of resettlement and pregnancy. Full article

(This article belongs to the Special Issue Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action)

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22 pages, 1753 KiB

Open AccessSystematic Review

LGBTQI + Migrants: A Systematic Review and Conceptual Framework of Health, Safety and Wellbeing during Migration

by Vanessa Yarwood, Francesco Checchi, Karen Lau and Cathy Zimmerman

Int. J. Environ. Res. Public Health 2022, 19(2), 869; https://doi.org/10.3390/ijerph19020869 - 13 Jan 2022

Cited by 23 | Viewed by 10033

Abstract

The health and safety of LGBTQI+ migrants or migrants who are of diverse sexual orientation, gender identity or expression (SOGIE) remains an under-studied area, particularly for the period during transit from their place of origin to destination. This systematic review aims to describe the literature on the health risks and consequences among SOGIE migrants during transit and examine their access and use of services. Six peer-reviewed databases and websites of nine large migration organisations were searched to identify the literature on forced migrants and sexual and gender minorities. Twenty English-language studies from 2000–2021 were included and analysed drawing on a conceptual framework. Studies emerged from six regions and the majority of research participants identified as gay men. In general, quality appraisal demonstrated studies as either medium or high quality. Findings suggested five common themes associated with SOGIE health and well-being, including: daily exposure to discrimination, harassment and violence; coping, social support and resilience; access to services; mental health; and physical and sexual health. Depression, anxiety and post-traumatic stress disorder (PTSD) were prevalent amongst SOGIE migrants, particularly when associated with detention or camp environments, and were exacerbated by social isolation. Barriers to accessing healthcare were identified and specific sexual health services were often found lacking, especially for trans persons. Unsurprisingly, during transit, SOGIE migrants are very likely to experience the double marginalisation of their migrant or minority status and their gender identity. Results indicate that services for SOGIE migrants need to tailor service access and support approaches to respond to the particular health and protection needs of SOGIE individuals in each setting. Full article

(This article belongs to the Special Issue Health Monitoring among Migrants, Asylum Seekers and Refugees for Evidence-Informed Health Care Policy, Practice and Action)

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