The Migrant Health and Wellbeing Survey (Maamu) - Results

The Migrant Health and Wellbeing
Survey (Maamu)
Results

Aims of the survey
• to describe health and wellbeing, and the use of services
in migrant populations
• based on the survey, a monitoring system is developed
to plan and evaluate actions
• to promote integration and employment of migrants
• to promote health and wellbeing of migrants and their
families
2The Migrant Health and Wellbeing Survey (Maamu)

3
• The survey was coordinated by the National Institute for Health
and Welfare, in collaboration with
– The Ministry of Social Affairs and Health
– The Finnish Institute of Occupational Health
– The Family Federation
– Municipalities
– Statistics Finland
• Funded by
– The European Social Fund
– The Social Insurance Institution of Finland
– The Finnish Work Environment Fund
– The National Institute for Health and Welfare
– Municipalities
The Migrant Health and Wellbeing Survey (Maamu)

Sample and participants
• Random sample from the Population Register
• 3 000 persons, 1 000 persons / ethnic group
• 6 cities: Helsinki, Espoo, Vantaa, Turku, Tampere, Vaasa
• Selection criteria
– Age 18–64-years
– country of birth: Somalia, Iraq/Iran, Russia/Soviet Union
– mother tongue: Kurdish, Russian/Finnish
– minimum one year residence in Finland
• Comparable information for the Finnish overall population from the
Health 2011 Survey (same age frame and same cities)

Why these target groups?
• All among the largest migrant populations in Finland
• Potentially vulnerable groups
• To include both refugees and people who have other
reasons for migration
• To cover different areas of origin (country of birth)

Implementation
• Planning and preparation started in 2008
– Including expert groups, focus groups and consultations with
migrant organizations and health care professionals with the
selected ethnic origins
• Pilot stage August-October 2010
• Data collection between December 2010 and May 2012.
• Basic results published in November 2012: Castaneda
AE, Rask S, Koponen P, Mölsä M, Koskinen S (eds.)
Migrant health and wellbeing. A study on persons of
Russian, Somali and Kurdish origin in Finland. THL
Report 61/2012.

7
• The study consisted of
– an computer-assisted structured interview (60-90
minutes)
– a health examination (45-60 minutes)
– a short-interview for those refusing or not able to
participate in the longer interview (15-20 minutes)
• Conducted by bilingual fieldwork personnel
recruited and trained by THL
– Fieldwork coordinators for each team (3)
– Interviewers (13)
– Nurses (6)
– Students and other assistants (14)

Content of interviews:
• Background information
• Health status and chronic conditions
• Health behavior
• Experiences of discrimination and violence
• Health services
• Oral health
• Living conditions
• Social wellbeing
• Work

Content of health examinations:
• blood pressure and pulse
• height and weight, waist and hip circumference
• oral health
• fingertip blood sample to measure haemoglobin (anemia)
• functional capacity: self reported and tested (hand grip strength,
balance test, chair stand)
• Depression and anxiety (HSCL-25) and other symptoms (e.g. pain
and allergy)
• blood samples (e.g. fasting glucose, blood lipids, liver function tests
and inflammatory markers, vitamin D)
• Questions on HIV-awareness
• HIV, hepatitis and syphilis tests (with specific consent)

Participation
10
Russian Somali Kurdish
N % N % N %
Participation, at least one part 702 70,2 512 51,2 632 63,2
Health examination + full interview 466 46,6 317 31,7 480 48,0
Health examination + short interview 1 0,1 42 4,2 26 2,6
Only interview 79 7,9 34 3,4 28 2,8
Only health examination 1 0,1 19 1,9 14 1,4
Only short interview 155 15,5 101 10,1 81 8,1
Refused / no show / no appointment 201 20,1 299 29,9 226 22,6
Not contacted 84 8,4 144 14,4 134 13,4
Wrong address 22 2,2 38 3,8 54 5,4
Tried home visit 5 times 62 6,2 106 10,6 80 8,0
Moved / abroad 13 1,3 45 4,5 8 0,8
Total 1000 100 1000 100 1000 100

Socio-demographic factors and
living conditions

Migration background
• Average migration age was 24–25 years.
• Those with Somali background had moved to Finland at
younger age than other groups and they had lived
longest in Finland.
• Mean time lived in Finland was over 10 years in all study
groups.

0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
90 %
100 %
Russian
men
Russian
women
Somali
men
Somali
women
Kurdish
men
Kurdish
women
Other
Remigrant
Work-based immigrant,
his or her spouse or
children
Family-reunification
Aslum seeker or
refugee
Residence permit, by gender (%)

Basic education, by gender (%)
14
0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
90 %
100 %
Russian
men
Russian
women
Somali
men
Somali
women
Kurdish
men
Kurdish
women
Finnish
men
Finnish
women
High school
Elemanetary school
No education

0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
90 %
100 %
Russian
men
Russian
women
Somalian
men
Somalian
women
Kurdish
men
Kurdish
women
Finnish
men
Finnish
women
Retired or other
Unemployed
Work at
home/housewife
Student
Employed
The main activity, by gender (%)

0%
10%
20%
30%
40%
50%
60%
70%
Men
Women
Experienced financial difficulties, by gender (%)

Self-rated health and long-term
illnesses

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Russian Somali Kurdish Finnish
Men
Women
Self-rated health good or rather good, by gender (%)

0%
5%
10%
15%
20%
25%
30%
Men
Women
Prevalence of constant pain and aches, by gender (%)

Chronic disease risk factors

Body Mass Index (BMI), by gender (%)
21
0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
90 %
100 %
Russian
men
Russian
women
Somali
men
Somali
women
Kurdish
men
Kurdish
women
Finnish
men
Finnish
women
BMI ≥ 30
BMI 25-29,99
BMI < 25

0%
5%
10%
15%
20%
25%
30%
35%
40%
Men
Women
Prevalence of high blood pressure (systolic ≥ 140 or diastolic
≥ 90 mmHg and/or use of medication for high BP), by gender (%)

Lipids
• Total cholesterol levels were significantly lower among
those of Somali and Kurdish background compared to
the total population.
• Lipid levels of those with Russian background were very
close to the levels of total population.
• HDL cholesterol levels were lower in all groups (except
Russian men) than in the total population.

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men
Women
Prevalence of low levels of vitamin D (< 50 nmol/l), by
gender (%)

Infectious diseases

• Infectious diseases were rarely screened upon arrival to Finland,
except among those who were refugees or asylum seekers.
• Over 95 % of those who participated to the health examination
agreed to be tested for HIV, hepatitis and syfilis.
• Less than half of the participants had contacted health care
professionals before visiting their country of origin (e.g. to be
vaccinated)
• Infectious diseases were relatively uncommon; the most common
was hepatitis B, no HIV infections were found
• The prevalence of infectious diseases reflected their prevalence in
the country of origin.
• Awareness of HIV was low especially among those with Somali
and Kurdish background.

0%
10%
20%
30%
40%
50%
60%
Men
Women
Correct answers to all five HIV awareness questions
(UNGASS), by gender (%)

Oral health

Oral health
• In all migrant groups the perceived oral health status
was worse than in the total population.
• 34-54 % of the participants reported having had tooth
pain or other problems in teeth or dentures during the
past 12 months, this was most common among women
with Somali origin.
• Those with Russian and Somali background reported
that they were brushing thier teeth at least twice a day
as often than those in the total population. A third of
those of Kurdish background reported brushing their
teeth less often than recommended.

Reproductive health

Number of lifetime abortions among women aged 18–
54 years (%)
31
0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
90 %
100 %
3 or more
1-2
None

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Somali Kurdish
Circumcision
Problems related to
circumcision
Prevalence of female circumcisions and problems
related to the circumcision (% of female participants)

Mental health

0%
10%
20%
30%
40%
50%
60%
Men
Women
Prevalence of severe depression and anxiety
symptoms over the last 7 days, by gender (%)

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Russian Somali Kurdi
Men
Women
Prevalence of trauma experiences in the country of
origin, by gender (%).

0%
5%
10%
15%
20%
25%
Men
Women
Health service use due to mental health problems
over last 12 months, by gender (%).

Lifestyle factors

0%
5%
10%
15%
20%
25%
30%
35%
40%
Men
Women
Prevalence of daily smoking, by gender (%)

Alcohol and substance use
• Nearly 40 % of those with Russian background aged
18–29 years had used cannabis.
• Compared to other groups there were less of those not
using any alcohol at all and more of those using at least
six doses of alcohol at one occasion among participants
of Russian origin .
• Using any alcohol was rare among those with Somali
background.

Eating habits and physical exercise
• Those with Somali background used fresh vegetables,
fruits and berries less often than other groups.
• Men and women with Somali background and women of
Kurdish background reported working strenuously less
often than those in the total population.

0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Men
Women
Fitness training for several hours per week, by gender
(%)

Functional and working capacity

0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Men
Women
Having difficulties or being unable to climb up the
stairs (several floors without rest), by gender (%)

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men
Women
Standing balance test performed successfully (for 60
seconds), by gender (%)

Understands spoken Finnish or Swedish not at all or
poorly, by gender (%)
45
0%
5%
10%
15%
20%
25%
30%
35%
40%
Men
Women

46
Unable to use internet, by gender (%)
0%
5%
10%
15%
20%
25%
30%
35%
40%
Men
Women

Work ability, by gender (%)
47
0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
90 %
100 %
Russian
men
Russian
women
Somali
men
Somali
women
Kurdish
men
Kurdish
women
Finnish
men
Finnish
men
Fully unable to
work
To some extent
unable to work
Fully able to
work

Social wellbeing

49
Quality of life good or very good, by gender (%)
0%
20%
40%
60%
80%
100%
120%
Men
Women

Experiencing own life very or a lot meaningful, by
gender (%)
50
0%
20%
40%
60%
80%
100%
120%
Men
Women

Having at least one good Finnish friend, by gender (%)
51
0%
10%
20%
30%
40%
50%
60%
70%
80%
Men
Women

Experiences on discrimination
and violence

Experiences of discrimination in everyday life in
Finland
0% 5% 10% 15% 20% 25% 30% 35% 40%
threatening/harassing
name-calling
disrespectful treatment
unpolite treatment
Russian
Somalian
Kurdish

0%
2%
4%
6%
8%
10%
12%
14%
16%
Men
Women
Experienced violence over the last 12 months, by
gender (%)

Health care services

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Health check-up Eye examination
Health check-up or eyesight examination over last 5
years (%).
56
• Also women had
participated in cancer
screening less often
compared to the total
population

Outpatient and primary care visits during
the past 12 months
• Compared to the total population
– Those with Somali- and Kurdish background reported more visits
to municipal health centers
– Those with Kurdish background reported more visits to hospital
outpatient clinics
– All migrant groups reported less visits to occupational health care
and private clinics
• Women reported more physician consultations than men in all
other groups except those with Kurdish background
• Visiting physicians outside Finland was common among
women with Russian background (22 % of these women
reported visits to physicians outside Finland during the past
12 months)

0%
10%
20%
30%
40%
50%
60%
70%
80%
Men
Women
Reported need for dental health services, by gender
(%)

0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Need for continuous care
Unmet need for care
Reported need for continuous care by a physician and
those not receiving the care they expected (%)

Satisfaction with latest physician visit
• Those with Russian background were most critical and those
with Somali background most satisfied with the care they had
received
• The participants were least satisfied with getting information
on their own health (54-81 % reported getting enough
information) and with possibilities to take part in decisions
about their care (50-77 % reported being able to take part).
• 54-75 % thought that the care they had received had helped
them

Conclusions

Achievements and challenges
• New information on health, wellbeing and integration
• Strengths among the migrant groups
• Good perceived heath
• Good quality of life and trust in the services
• Many issues improved by longer stay in Finland
• Worries among the migrant groups
• Mental health
• Experiences of discrimination
• Restrictions in functional capacity
• Overweight and obesity with Somali and Kurdish women
• Low vitamin D levels

Conclusions to developing heath care
• Culture sensitive, participatory approaches to health
promotion are needed, activating migrants is essential
• Goals need to be set to prevent obesity and to promote
physical activity, especially among women with Somali
and Kurdish background
• Development of family planning and actions to promote
reproductive health are needed especially among
women with Russian and Somali background
• Work against female circumcision is needed also in
Kurdish communities, not only the Somali communities.

Health promotion: information and
support in collaboration
• Migrant groups need more information on health and
health services
• Health in all policies: services and organizations (also
non governmental) in the fields of e.g. sports and
physical activity, education, housing, as well as those
who organize activities to support migrant integration
need to work together
• Support to health promoting choices and integration of
migrants at individual, family and community levels by
removing obstacles
– in cultural, educational, practical and economical factors
• Focus on health disparities

Conclusions about services
• Migrants’ insufficient knowledge about health services
• Professionals’ insufficient knowledge about migrants;
their culture and specific needs
65
• Understanding differences between migrant groups and
between individuals (e.g. culture and life experiences)
manifesting in differences in seeking health services
and in expressing personal problems and needs

Conclusions about mental health
services
• Prevalence of depression and anxiety symptoms vs. use
of mental health care services
– Unmet need for mental health care
• Challenges to mental health care:
– Stigmatization
– Self-refection, giving conceptualizing symptoms
– Culture specific characteristics taken into account both in
identifying symptoms and in therapy  Training
professionals
– Complicated care system  Easier access to care
– Limited language skills  Challenges to develop
interpreting services

Development of migrant health care
• Migrant specific services, e.g.
– Consulting team for migrants’ psychiatric care, specific hours for
migrant women in sports centers and swimming halls
• Universal services, e.g.
– Child health care: focus to coping among migrant parents, mental
health issues and promoting migrant women’s health (especially
mental wellbeing among parents of Kurdish origin, prevention of
obesity among women of Somali origin)
– Primary health care services: education for staff members to
encounters with migrant patients and more use of interpreters
when needed

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