Evolution of migrants' health in times of
economic crisis in Spain: evidence from
health surveys in the general population...
Immigration and economic growth in Spain
Changing pattern in the last decade
Spanish National Health Surveys
N foreign 650...
Objective of the presentation
• To describe the health status of immigrants from less
advanced economies before and during...
• CIBERESP Immigration and health
program
• Aim: To analyse the health status,
health determinants and
healthcare use of i...
SNHS 06-12. Methods
Cross-sectional survey of the non-institutionalised population
Multistage sampling with representation...
SNHS 06-12. Results
Sample size by birthplace
Results
Social determinants of health
% employment status, men% manual social class, women
PRB = Países de renta baja (Low...
Results
General health and chronic conditions
% fair/poor self-rated health, men
Results
General health and chronic conditions
% fair/poor self-rated health, women
Results
Mental health
% poor mental health (Goldberg GHQ-12 score >2), men
Results
Mental health
% poor mental health (Goldberg GHQ-12 score >2), men
Also rise of anxiolytics and antidepressants in...
Results
Mental health
% poor mental health (Goldberg GHQ-12 score >2), men
Results
Mental health
% poor mental health (Goldberg GHQ-12 score >2), women
SNHS 06-12. Strenghts and limitations
• Wide range of health aspects covered
• Standardised procedures. Repetition over ti...
• Baseline survey of a
quasiexperimental study to
evaluate health effects of
Caritas rehousing program, part
of the SOPHIE...
Rehoused (Caritas social
renting programme)
Waiting list
Families/people attended
by Caritas living in
substandard housing...
Rehoused (Caritas social
renting programme)
Waiting list
Families/people attended
by Caritas living in
substandard housing...
Families/people attended
by Caritas living in
substandard housing*
n=175 – 164 foreign-born
n=145 – 84 foreign-born
*Inade...
• 3 questionnaires
(1) Dwelling questionnaire (household composition, housing type and
conditions, housing costs, housing ...
• Barcelona Health Survey 2011
Adults and children
For comparable indicators (same question)
Prevalences directly standard...
• Substandard Housing: 74% women. HMS: 50% women
• 89% manual social class
• 77% immigrants
– 58% Latin America; 17% North...
• 88% overburden of housing costs (>30% income)
• 59% SH, 78% HMS think they’ll lose their house in two years
• 54% SH, 44...
• Much worse health status than overall Barcelona population
Caritas 2012. Results
Health status
62,2
75,0
11,5 12,1
66,9
...
• Much worse health status than overall Barcelona population
– also for children
Caritas 2012. Results
Health status
28,9
...
Caritas 2012. Press coverage
PRESS CONFERENCE (18th Des)
• Presentation of the report “Home, house and health. Housing act...
Other studies: ITSAL (quanti)
Other studies: ITSAL (quanti)
Other studies: ITSAL (quali)
Fri 13.30h, Session A12, Room A6
Abstracts book page 120
Other studies: ITSAL (quali)
Fri 13.30h, Session A12, Room A6
Abstracts book page 120
Conclusions
• General population surveys show a substantially stable pattern
in migrants’ health, with worsening mental he...
Reports available at:
www.sophie-project.eu/pdf/ens_inmi.pdf
www.sophie-project.eu/pdf/salut_habitatge.pdf
Evolution of migrants' health in times of
economic crisis in Spain: evidence from
health surveys in the general population...
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Evolution of migrants' health in times of economic crisis in Spain: evidence from health surveys in the general population and in vulnerable groups

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"Evolution of migrants' health in times of economic crisis in Spain: evidence from health surveys in the general population and in vulnerable groups", by Davide Malmusi, Mercè Gotsens and Ana M Novoa.

Presented at the 5th European Conference on Migrant and Ethnic Minority Health. Granada, 2014 April 11.

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Evolution of migrants' health in times of economic crisis in Spain: evidence from health surveys in the general population and in vulnerable groups

  1. 1. Evolution of migrants' health in times of economic crisis in Spain: evidence from health surveys in the general population and in vulnerable groups Davide Malmusi @dmalmusi, Mercè Gotsens, Ana M Novoa
  2. 2. Immigration and economic growth in Spain Changing pattern in the last decade Spanish National Health Surveys N foreign 650* 3605 3022 . -4 -2 0 2 4 6 8 10 2000 2002 2004 2006 2008 2010 2012 Foreign-born residents (millions) GDP growth rate (%) 2011: Non-EU foreigners at-risk-of-poverty rate: 49%
  3. 3. Objective of the presentation • To describe the health status of immigrants from less advanced economies before and during the crisis according to different information sources • National Health Survey • Caritas Barcelona users’ survey on housing and health • “Immigration, work and health” project (ITSAL) follow up cohort
  4. 4. • CIBERESP Immigration and health program • Aim: To analyse the health status, health determinants and healthcare use of immigrants in Spain – according to sex, birthplace, length of residence, social class – compared to the Spanish population, – in 2006 and 2012. Spanish National Health Survey (SNHS) 2006-2012
  5. 5. SNHS 06-12. Methods Cross-sectional survey of the non-institutionalised population Multistage sampling with representation by Autonomous Community Face-to-face interviews at home Valid sample completing the adult questionnaire (aged 15 or over): 2006, n=29.478; 2012, n=21.007 Age-standardised proportions were calculated by survey year, sex and: 1. birthplace: Spain, high-income countries, low-income countries 2. Low-income countries divided by continents 3. Low-income countries by years of residence in Spain 4. Spain and low-income countries by social class
  6. 6. SNHS 06-12. Results Sample size by birthplace
  7. 7. Results Social determinants of health % employment status, men% manual social class, women PRB = Países de renta baja (Low-Income countries). PRA = Países de renta alta (High-Income countries)
  8. 8. Results General health and chronic conditions % fair/poor self-rated health, men
  9. 9. Results General health and chronic conditions % fair/poor self-rated health, women
  10. 10. Results Mental health % poor mental health (Goldberg GHQ-12 score >2), men
  11. 11. Results Mental health % poor mental health (Goldberg GHQ-12 score >2), men Also rise of anxiolytics and antidepressants in “PRB” men
  12. 12. Results Mental health % poor mental health (Goldberg GHQ-12 score >2), men
  13. 13. Results Mental health % poor mental health (Goldberg GHQ-12 score >2), women
  14. 14. SNHS 06-12. Strenghts and limitations • Wide range of health aspects covered • Standardised procedures. Repetition over time • Comparison with Spanish population • Sample size • Sample composition. Are responders a representative sample of the immigrant population?
  15. 15. • Baseline survey of a quasiexperimental study to evaluate health effects of Caritas rehousing program, part of the SOPHIE project • Published as part of annual Caritas Barcelona report • Aim: to describe the health status and determinants of Caritas users with housing problems, compared with Barcelona general population Caritas Barcelona users with housing problems, 2012 survey
  16. 16. Rehoused (Caritas social renting programme) Waiting list Families/people attended by Caritas living in substandard housing* Baseline survey (Sept-Dec 2012) Follow-up survey (1 year after) *Inadequate housing habitability conditions or overcrowding Caritas 2012. Methods Study population
  17. 17. Rehoused (Caritas social renting programme) Waiting list Families/people attended by Caritas living in substandard housing* n=175 n=145 *Inadequate housing habitability conditions or overcrowding Follow-up survey (1 year after) Baseline survey (Sept-Dec 2012) Caritas 2012. Methods Study population … or attended by Caritas Housing Mediation Service (HMS) (unable to afford rent/mortgage)
  18. 18. Families/people attended by Caritas living in substandard housing* n=175 – 164 foreign-born n=145 – 84 foreign-born *Inadequate housing habitability conditions or overcrowding Baseline survey (Sept-Dec 2012) Caritas 2012. Methods Study population … or attended by Caritas Housing Mediation Service (HMS) (unable to afford rent/mortgage)
  19. 19. • 3 questionnaires (1) Dwelling questionnaire (household composition, housing type and conditions, housing costs, housing and neighbourhood satisfaction) (2) Resident questionnaire (demographic and socio-economic characteristics, and health status of the person interviewed) (3) Child questionnaire (sociodemographic and health information of one randomly selected child 4-14 years old; reported by mother/father) N=177 • Performed at Cáritas by a trained interviewer • Answered by the household head or partner (randomly selected) Caritas 2012. Methods Data collection
  20. 20. • Barcelona Health Survey 2011 Adults and children For comparable indicators (same question) Prevalences directly standardised by age (reference: Caritas sample) Comparison groups: - Whole population - Manual social class (IV-V) - Immigrants from low-income countries Caritas 2012. Methods Comparison with Barcelona population
  21. 21. • Substandard Housing: 74% women. HMS: 50% women • 89% manual social class • 77% immigrants – 58% Latin America; 17% North Africa; 12% Sub-saharian Africa – undocumented: 44% of substandard housing sample, 2% HMS • 53% unemployed. Most employed have no contract • 78% food insecurity Caritas 2012. Results Sociodemographic characteristics
  22. 22. • 88% overburden of housing costs (>30% income) • 59% SH, 78% HMS think they’ll lose their house in two years • 54% SH, 44% HMS hot/cold temperature is a problem • 58% SH, 44% HMS rats/cockroaches/similar (5% Barcelona) Caritas 2012. Housing conditions 22,1 3,2 4,7 56,6 0 20 40 60 80 100 Subst Housing HMS BCN BCN SC IV and V % Overcrowding
  23. 23. • Much worse health status than overall Barcelona population Caritas 2012. Results Health status 62,2 75,0 11,5 12,1 66,9 72,6 15,2 17,4 0 20 40 60 80 100 Subst housing HMS BCN BCN SC IV and V % Men Women Poor mental health (GHQ>2) 24,4 45,8 11,2 12,8 53,1 60,3 15,3 20,5 0 20 40 60 80 100 Subst housing HMS BCN BCN SC IV and V % Men Women Fair/poor health status BCN migrants: 15% men, 18% womenBCN migrants: 16% men, 18% women
  24. 24. • Much worse health status than overall Barcelona population – also for children Caritas 2012. Results Health status 28,9 38,9 3,6 62,3 65,8 8,5 0 20 40 60 80 100 Subst housing HMS BCN % Boys Girls Poor mental health (anormal SDQ) BCN migrants’ children: 8% 20,5 19,0 3,6 31,9 19,5 1,6 0 20 40 60 80 100 Subst housing HMS BCN % Boys Girls Repeat otitis
  25. 25. Caritas 2012. Press coverage PRESS CONFERENCE (18th Des) • Presentation of the report “Home, house and health. Housing action and prevention” – Annual evaluation of Caritas’s activity – Description of baseline analysis results
  26. 26. Other studies: ITSAL (quanti)
  27. 27. Other studies: ITSAL (quanti)
  28. 28. Other studies: ITSAL (quali) Fri 13.30h, Session A12, Room A6 Abstracts book page 120
  29. 29. Other studies: ITSAL (quali) Fri 13.30h, Session A12, Room A6 Abstracts book page 120
  30. 30. Conclusions • General population surveys show a substantially stable pattern in migrants’ health, with worsening mental health in men as sentinel event • Specific migrant cohorts recruited in community settings show a much • The health-damaging consequences of economic precariousness are especially evident among the most vulnerable migrants and their children, often underrepresented in general population surveys.
  31. 31. Reports available at: www.sophie-project.eu/pdf/ens_inmi.pdf www.sophie-project.eu/pdf/salut_habitatge.pdf
  32. 32. Evolution of migrants' health in times of economic crisis in Spain: evidence from health surveys in the general population and in vulnerable groups Davide Malmusi @dmalmusi, Mercè Gotsens, Ana M Novoa

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