Overview of the health impact of migration

1. The Health Experiences of Migrants in the UK

2. The Health Experiences of Migrants in the UK
Assumptions
Evidence
Questions

3. Some migrants have poorer health than people born in the UK

4. Some migrants have poorer health than people born in the UK
African Caribbean Migrants
Twice as likely to suffer from Asthma (Netuveli et al., 2005)
2.4 - 14.6 times higher Incidence of Schizophrenia (Bhugra and Jones, 2001)
Three times as likely to die from liver cancer (Haworth et al., 1999)

5. Some migrants have poorer health than people born in the UK
African Caribbean Migrants
Twice as likely to suffer from Asthma (Netuveli et al., 2005)
2.4 - 14.6 times higher Incidence of Schizophrenia (Bhugra and Jones, 2001)
Three times as likely to die from liver cancer (Haworth et al., 1999)
East African Migrants have a tenfold excess of deaths from liver
cancer (SMR 1014) (Landman and Cruickshank, 2001)

6. Infant Mortality
Davey-Smith et al., 2000, Critical Public Health, 10, 375-408

7. Infant Mortality
11.000
10.1
7.333
5.8
3.667
0
UK Born Mothers Pakistan Born Mothers
Rate per 100,000
Davey-Smith et al., 2000, Critical Public Health, 10, 375-408

8. Standardised Mortality Ratios (SMR) for Male and Female African-Caribbean Migrants,
20-64 years (England and Wales 1991-1993)
Males Females
Source: Davey-Smith et al., 2000, Critical Public Health, 10, 375-408

9. Standardised Mortality Ratios (SMR) for Male and Female African-Caribbean Migrants,
20-64 years (England and Wales 1991-1993)
Males Females
200
178
169
150
121
104 100 103
100 89
60 59 59
49
50
32
0
All Causes IHD Stroke Lung Cancer Accident Suicide
Source: Davey-Smith et al., 2000, Critical Public Health, 10, 375-408

10. Standardised Mortality Ratios (SMR) for Indian Born
Males, 20-64 years (England and Wales 1991-1993)
Source: Davey-Smith et al., 2000, Critical Public Health, 10, 375-408

11. Standardised Mortality Ratios (SMR) for Indian Born
Males, 20-64 years (England and Wales 1991-1993)
148
150
140
125
106 109
100 97
75
50 43
25
0
All Causes IHD Stroke Lung Cancer Accident Suicide
Source: Davey-Smith et al., 2000, Critical Public Health, 10, 375-408

12. Poor health may be a consequence of migration

13. Poor health may be a consequence of migration
Migrants have been found to
develop higher rates of mental
illness than those who remain at
home (Louden, 1995)

14. Poor health may be a consequence of migration
Migrants have been found to
develop higher rates of mental
illness than those who remain at
home (Louden, 1995)
Despite originating from areas of
the world with low rates of
asthma South Asians are three
times as likely to be admitted to
hospital for Asthma (Netuveli et al., 2005)

15. Poor health may be a consequence of migration
Migrants have been found to
develop higher rates of mental
illness than those who remain at
home (Louden, 1995)
Despite originating from areas of
the world with low rates of
asthma South Asians are three
times as likely to be admitted to
hospital for Asthma (Netuveli et al., 2005)

16. Poor health may be a consequence of migration
Migrants have been found to
develop higher rates of mental
illness than those who remain at
home (Louden, 1995)
Despite originating from areas of
the world with low rates of
asthma South Asians are three
times as likely to be admitted to
hospital for Asthma (Netuveli et al., 2005)

17. TB Infection in the UK: Rate per 100,000 pop.
UK All Born Abroad Recent Entrant +3yr Entrant
Source: Rose, A. et al. 2001 Thorax, 56, 173-179

18. TB Infection in the UK: Rate per 100,000 pop.
UK All Born Abroad Recent Entrant +3yr Entrant
150
118.0
120
90
73.6
60
40.9
30
4.8
0
TB Infection
Source: Rose, A. et al. 2001 Thorax, 56, 173-179

19. Standardised Mortality Ratios (SMR) for Irish Migrants
by Sex, aged 20-64 years (England and Wales 1991-1993)
Males Females
Source: Davey-Smith et al., 2000, Critical Public Health, 10, 375-408

20. Standardised Mortality Ratios (SMR) for Irish Migrants
by Sex, aged 20-64 years (England and Wales 1991-1993)
Males Females
189
190.0
157 160
143 144
142.5 135 135
129 130
121 118
115
95.0
47.5
0
All Causes IHD Stroke Lung Cancer Accident Suicide
Source: Davey-Smith et al., 2000, Critical Public Health, 10, 375-408

21. Standardised Mortality Ratios (SMR) for Scottish Migrants
by Sex, aged 20-64 years (England and Wales 1991-1993)
Males Females
Source: Davey-Smith et al., 2000, Critical Public Health, 10, 375-408

22. Standardised Mortality Ratios (SMR) for Scottish Migrants
by Sex, aged 20-64 years (England and Wales 1991-1993)
Males Females
210 201
177
168 164
146 149 153
129 127 127 131
126 117
111
84
42
0
All Causes IHD Stroke Lung Cancer Accident Suicide
Source: Davey-Smith et al., 2000, Critical Public Health, 10, 375-408

23. Migration and Vulnerability
Source: Bhugra, D. & Jones, P. 2001, Adv. in Psych. Treatment, 7, 216-223.

24. Personal
Factors
Migration and Vulnerability Relational
Factors
Age
Gender
Reason Economic
Preparation Social
Personality Pre Migration Educational
Separation
The process Education
Support Migration Expectations
Alone/Group Language
Social Support networks Achievement
Cultural identity Racism
Self esteem Post Migration Ethnic Density
Self concept Social isolation
Unemployment
Source: Bhugra, D. & Jones, P. 2001, Adv. in Psych. Treatment, 7, 216-223.

25. Psychological Distress

26. Psychological Distress
Refugees may be more likely than other migrant
groups to suffer psychological stress. (Leavey et al.,
2004)

27. Psychological Distress
Refugees may be more likely than other migrant
groups to suffer psychological stress. (Leavey et al.,
2004)
Older migrants and refugees more likely to suffer
post migration stress (Silveira and Allebeck, 2001)

28. Psychological Distress
Refugees may be more likely than other migrant
groups to suffer psychological stress. (Leavey et al.,
2004)
Older migrants and refugees more likely to suffer
post migration stress (Silveira and Allebeck, 2001)
Migrant children are more likely to have
psychological support needs than UK born
children (Leavey et al., 2004)

29. Psychological Distress
Refugees may be more likely than other migrant
groups to suffer psychological stress. (Leavey et al.,
2004)
Older migrants and refugees more likely to suffer
post migration stress (Silveira and Allebeck, 2001)
Migrant children are more likely to have
psychological support needs than UK born
children (Leavey et al., 2004)
Most common psychological problems for refugee
children:
Post Traumatic Stress Disorder
Anxiety
Depression
(Fazel and Stein, 2005)

30. Culture Shock
Osberg 1960 cited in Bhugra and Oyedeji 2004

31. Culture Shock
A stress reaction arising from
uncertainty of important physical and
psychological rewards
Osberg 1960 cited in Bhugra and Oyedeji 2004

32. Culture Shock
A stress reaction arising from
A transitional experience essential
uncertainty of important physical and Social Strain
for self development and growth
psychological rewards
Feelings of Impotence
Role Expectation Confusion
Rejection by Host Culture
Sense of Loss or Deprivation
Surprise, Anxiety, Indignation
Osberg 1960 cited in Bhugra and Oyedeji 2004

33. Experiencing Culture Shock
Language is a significant barrier
to psychological well being for
migrant children (Leavey et al., 2004)
My New Home Channel 4 TV, 15 June 2006

34. Cultural Conflict
(Bhugra and Oyedeji, 2004)

35. Cultural Conflict
Children and Subsequent
Generations
Expectations v Achievements
Alienation and Isolation From
Majority and Minority Culture
Sense of Cultural Tension
(Bhugra and Oyedeji, 2004)

36. Post Migration Experiences

37. Post Migration Experiences
Ethnic density is significant in the genesis and maintenance of
some types of psychological distress (Bhugra and Jones, 2001)

38. Post Migration Experiences
Ethnic density is significant in the genesis and maintenance of
some types of psychological distress (Bhugra and Jones, 2001)
Second generation Irish more likely to die before reaching 44
(SMR 147 males 153 Females) (Davey-Smith et al., 2000)

39. Post Migration Experiences
Ethnic density is significant in the genesis and maintenance of
some types of psychological distress (Bhugra and Jones, 2001)
Second generation Irish more likely to die before reaching 44
(SMR 147 males 153 Females) (Davey-Smith et al., 2000)
Mortality in men of patrileneal Irish descent in Scotland (19th
century migrants) is elevated for overall mortality, CHD
accidental and violent death. (Abbotts et al., 2001)

40. Post Migration Experiences
Ethnic density is significant in the genesis and maintenance of
some types of psychological distress (Bhugra and Jones, 2001)
Second generation Irish more likely to die before reaching 44
(SMR 147 males 153 Females) (Davey-Smith et al., 2000)
Mortality in men of patrileneal Irish descent in Scotland (19th
century migrants) is elevated for overall mortality, CHD
accidental and violent death. (Abbotts et al., 2001)
UK Born African Carribean men have higher smoking rates than
UK born White males (Abbotts et al., 2004)

41. Purpose of the Research
To enrich understanding of the impact of migration on health
and well being in the North West
To facilitate the empowerment of individuals, groups and the
migrant community
To help participants (and services) deal with factors that
influence their health and that of their community

42. Research Methods
Participatory ethnographic case study using documentary analysis,
interviews, narrative workshops- e.g. construction of visual narratives,
photo elicitation, story telling.
17

43. Research Methods
Participatory ethnographic case study using documentary analysis,
interviews, narrative workshops- e.g. construction of visual narratives,
photo elicitation, story telling.
17

44. Participatory
Narratives
Collaborative Construction and Analysis of
Migration and Health Narratives
18

45. Knowledge and Capacity Building

46. Knowledge and Capacity Building
Make positive use of knowledge & community resources

47. Knowledge and Capacity Building
Make positive use of knowledge & community resources
Allows for learning about research methods

48. Knowledge and Capacity Building
Make positive use of knowledge & community resources
Allows for learning about research methods
Allows for flexibility and change in methods and focus

49. Knowledge and Capacity Building
Make positive use of knowledge & community resources
Allows for learning about research methods
Allows for flexibility and change in methods and focus
Enable expression and valuing of personal and collective
experiences

50. Participatory Research
Services
Communities

51. Participatory Research
Services
Research
Communities

52. Participatory Research
Services
Research
Research
Education
Communities

53. Participatory Research
Services
Research
Research
Education
Action
Education
Communities

54. Participatory Research
Services
Research
Perceived Needs
Research
Education
Action
Education
Communities

55. Participatory Research
Services
Research
Perceived Needs
Actual Needs
Research
Education
Action
Education
Communities

56. Participatory Research
Services
Research
Align Knowledge and Resources
Perceived Needs
Actual Needs
Research
Education
Action
Education
Communities