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

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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. …

"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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  • 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. 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. 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. • 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. 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. SNHS 06-12. Results Sample size by birthplace
  • 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. Results General health and chronic conditions % fair/poor self-rated health, men
  • 9. Results General health and chronic conditions % fair/poor self-rated health, women
  • 10. Results Mental health % poor mental health (Goldberg GHQ-12 score >2), men
  • 11. Results Mental health % poor mental health (Goldberg GHQ-12 score >2), men Also rise of anxiolytics and antidepressants in “PRB” men
  • 12. Results Mental health % poor mental health (Goldberg GHQ-12 score >2), men
  • 13. Results Mental health % poor mental health (Goldberg GHQ-12 score >2), women
  • 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. • 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. 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. 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. 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. • 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. • 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. • 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. • 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. • 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. • 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. 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. Other studies: ITSAL (quanti)
  • 27. Other studies: ITSAL (quanti)
  • 28. Other studies: ITSAL (quali) Fri 13.30h, Session A12, Room A6 Abstracts book page 120
  • 29. Other studies: ITSAL (quali) Fri 13.30h, Session A12, Room A6 Abstracts book page 120
  • 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. Reports available at: www.sophie-project.eu/pdf/ens_inmi.pdf www.sophie-project.eu/pdf/salut_habitatge.pdf
  • 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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