Presentada en el II Congreso Iberoamericano de Epidemiología y Salud Pública, 3 de septiembre de 2015

1. POLÍTICAS DE INTEGRACIÓN Y SALUD
DE INMIGRANTES EN EUROPA: TRES
ESTUDIOS COMPARATIVOS
Davide Malmusi, Umar Ikram, Laia Palència,
Anton Kunst, Carme Borrell
Congreso Ibero-Americano de Epidemiología y Salud Pública 2015
Mesa Subprograma Inmigración y Salud CIBERESP
Los autores declaran que no existen conflictos de interés.

2. Antecedentes
El efecto en salud de las políticas
de control de fronteras es hoy en
día más que evidente (>5,000
muertos en el mundo en 20141,
>25,000 en camino hacia Europa
desde el año 20002)
Las políticas de integración/exclusión de las personas inmigradas
que ya se encuentran en el país de destino pueden tener efectos
sobre la salud al influir sobre las condiciones materiales de vida y el
contexto psicosocial. Existen muy pocos estudios al respecto.3
1 IOM. The Missing Migrants Project. 2 The Migrants Files.
3 Omar Martinez et al. Evaluating the impact of immigration policies… J Immigr Minor Health 2013

3. Objetivo general
Analizar la asociación entre los modelos de políticas de integración
del país y las desigualdades en salud entre población autóctona e
inmigrante en Europa.
Subestudios
1. Autovaloración de la salud
2. Mortalidad
3. Síntomas depresivos
4. Discriminación y su asociación con salud (Borrell et al. IJERPH 2015)

4. ¿Cómo clasificamos los modelos
de políticas de integración?
A pesar de existir clasificaciones sistemáticas de las políticas
actuales, preferimos un análisis tipológico / de modelos por
considerar que el efecto sobre la salud actual de la población
inmigrada se ha acumulado a lo largo del tiempo.
En literatura se han descrito tradicionalmente tres modelos en
Europa: multicultural, asimilacionista, exclusionista.1,2 Sin embargo
muy pocos países se han clasificado de manera consistente en uno
de estos modelos,1-3 por lo que finalmente utilizamos una
aproximación cuantitativa basada en un análisis de clases latentes
del Migrant Integration Policy Index 2007.
1 Stephen Castles. How Nation-States respond to immigration… New Community 1995
2 Steven Weldon. The institutional context of tolerance for ethnic… Am J Pol Sci 2006
3 Hans Mahnig et al. Country-specific or convergent? A typology… J Int Migr Integr 2000

5. MIPEX 2007 Latent Class Analysis. Bart Meuleman 2009 (Dissertation)
Inclusive
(multicultural)
Exclusionist
Political integration
(assimilationist)
¿Cómo clasificamos los modelos
de políticas de integración?

6. Inclusive (Multicultural)
Exclusionist
Political integration (Assimilationist)
MIPEX 2007 Latent Class Analysis. Bart Meuleman 2009 (Dissertation)
¿Cómo clasificamos los modelos
de políticas de integración?

7. European Union Statistics on Income and Living Conditions 2011
cross-sectional database. 14 countries
Health outcomes: Self-rated health (very good, good / fair, bad,
very bad), Limiting longstanding illness, Activity limitation because of
health problems
Immigrant status: born in country of residence (N=177,300) /
born outside the EU with 10+ years of residence (N=7,088)
Study 1. Self-rated health

8. Countries included by integration regime
Inclusive (Multicultural)
Exclusionist
Political integration (Assimilationist)
Immigrants’ self-rated health by integration policy model
Excluded countries:
No data in the 2013 release
of 2011 data: EL, IE.
Not classified in the
typology: BG, CY, HR, RO.
<0.5% immigrants: HU, CZ,
SK, PL, LT.
Not separating EU and non-
EU immigrants: DE, EE, LV,
SI, MT.

9. Poor self-rated health. Immigrants versus natives
Prevalence ratio with 95%CI (Poisson regression with robust standard error)
UK IT ES NL BE PT SE NO FI FR CH LU AT DK UK IT ES NL BE PT SE NO FI FR CH LU AT DK
Results
Immigrants’ self-rated health by integration policy model
Self-rated health inequality between natives and immigrants
is larger in exclusionist countries (partly but not fully
explained by socioeconomic differences)

10. Study 2. Mortality
MEHO project mortality database. 3 countries:
Netherlands (inclusive) 1996-2006 open cohort
France (assimilation) 2005-07 mortality register / census data
Denmark (exclusionist) 1992-2001 open cohort
Health outcome: Age-standardised mortality rate
Immigrant status: born in country of residence (229 millions
person-years) / born in Turkey (3 millions p-y) / born in Morocco
(4 millions p-y) aged 20-69 years

11. Results
Immigrants’ mortality by integration policy model
Immigrants had higher mortality rates than the local-born population in
Denmark and lower in France.
Age-adjusted Mortality Rate Ratio. Immigrants versus natives
Poisson regression coefficient with 95%CI

12. Social, economic and political determinants of inequalities by
immigrant status in depressive symptoms in Europe
Davide Malmusi, Laia Palència, Umar Ikram, Anton Kunst, Carme Borrell
Manuscript in preparation
European Social Survey 2012. 17 countries
Health outcome: Depressive symptoms (CES-D scale, 8 items
each ranging 0 to 3), self-rated health
Immigrant status: born in country of residence excluding
“second generations” (N=28,333) / born abroad excluding IMF
advanced economies (N=2,019)
Study 3. Depressive symptoms

13. Countries included
Political integration (Assimilationist)
Exclusionist
Inclusive (Multicultural)
Immigrants’ mental health by integration policy model
Excluded countries:
No ESS 2012 data
Not classified in the
typology
<1% immigrants

14. Immigrants
experience more
depressive
symptoms no
matter the regime.
The gap is mainly
explained by
income(adequacy)
but the degree of
explanation varies
by policy regime
and gender.
Results
Immigrants’ mental health by integration policy model
Depressive symptoms. Immigrants versus natives
Linear regression beta coefficient with 95%CI

15. Immigrants
experience more
depressive
symptoms no
matter the regime.
The gap is mainly
explained by
income(adequacy)
but the degree of
explanation varies
by policy regime
and gender.
Results
Immigrants’ mental health by integration policy model
Depressive symptoms. Immigrants versus natives
Linear regression beta coefficient with 95%CI

16. Limitations
Heterogeneity of results between countries in the same cluster
Mixing together all non-EU (or poor countries) migrants of
different origins and reasons for migration
Different data collection methods in the mortality study
Adequate cross-country samples of migrants with similar
background
“Natural experiments” around policy changes
Qualitative studies to uncover HOW policies get under the skin
Future studies…?

17. Conclusions
A pesar de los problemas de comparabilidad de
algunos datos, es sorprendentemente consistente la
asociación entre los modelos de políticas de
integración y las desigualdades en salud relacionadas
con el origen en Europa, siendo estas mayores en los
países “excluyentes”.
Políticas inclusivas hacia la población inmigrante
pueden repercutir positivamente en su salud,
mientras que giros más restrictivos pueden suponer
un riesgo para la misma.

18. sophie-project.eu
slideshare.net/sophieproject
@dmalmusi
@sophieproject
dmalmusi@aspb.cat
Thank you!
Gràcies!
Grazie!
Photos: Roberto Brancolini, Roberto Malaguti