Immigrants have been identified as a vulnerable population, but there is heterogeneity in the degree to which they are vulnerable to inadequate health care. Here we examine the factors that affect ...immigrants' vulnerability, including socioeconomic background; immigration status; limited English proficiency; federal, state, and local policies on access to publicly funded health care; residential location; and stigma and marginalization. We find that, overall, immigrants have lower rates of health insurance, use less health care, and receive lower quality of care than U.S.-born populations; however, there are differences among subgroups. We conclude with policy options for addressing immigrants' vulnerabilities.
Access to emergency and critical care has been established during the recent migratory waves in European countries of entry. However, as far as chronic health conditions are concerned, barriers in ...access to healthcare providers may vary across different health systems 1. According to US data, kidney transplantation is cost-effective compared to chronic and emergency dialysis in various settings including immigrants 2. Medicaid-covered immigrants who underwent renal transplantation had very favourable outcomes, mainly owing to their young age, providing a strong argument for broader access to transplantation programs 3. Nevertheless, in the USA almost 2.5% of organ donation comes from immigrants, whereas less than 1% of organs goes to them, a fact that constitutes per se a social inequity 4.
With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global ...migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency.
In response to these issues, the UCL-
Lancet
Commission on Migration and Health was convened to articulate evidence-based approaches to inform public discourse and policy. The Commission undertook analyses and consulted widely, with diverse international evidence and expertise spanning sociology, politics, public health science, law, humanitarianism, and anthropology. The result of this work is a report that aims to be a call to action for civil society, health leaders, academics, and policy makers to maximise the benefits and reduce the costs of migration on health locally and globally. The outputs of our work relate to five overarching goals that we thread throughout the report.
First, we provide the latest evidence on migration and health outcomes. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health. Migrants generally contribute more to the wealth of host societies than they cost. Our Article shows that international migrants in HICs have, on average, lower mortality than the host country population. However, increased morbidity was found for some conditions and among certain subgroups of migrants, (eg, increased rates of mental illness in victims of trafficking and people fleeing conflict) and in populations left behind in the location of origin. Currently, in 2018, the full range of migrants’ health needs are difficult to assess because of poor quality data. We know very little, for example, about the health of undocumented migrants, people with disabilities, or lesbian, gay, bisexual, transsexual, or intersex (LGBTI) individuals who migrate or who are unable to move.
Second, we examine multisector determinants of health and consider the implication of the current sector-siloed approaches. The health of people who migrate depends greatly on structural and political factors that determine the impetus for migration, the conditions of their journey, and their destination. Discrimination, gender inequalities, and exclusion from health and social services repeatedly emerge as negative health influences for migrants that require cross-sector responses.
Third, we critically review key challenges to healthy migration. Population mobility provides economic, social, and cultural dividends for those who migrate and their host communities. Furthermore, the right to the highest attainable standard of health, regardless of location or migration status, is enshrined in numerous human rights instruments. However, national sovereignty concerns overshadow these benefits and legal norms. Attention to migration focuses largely on security concerns. When there is conjoining of the words health and migration, it is either focused on small subsets of society and policy, or negatively construed. International agreements, such as the UN Global Compact for Migration and the UN Global Compact on Refugees, represent an opportunity to ensure that international solidarity, unity of intent, and our shared humanity triumphs over nationalist and exclusionary policies, leading to concrete actions to protect the health of migrants.
Fourth, we examine equity in access to health and health services and offer evidence-based solutions to improve the health of migrants. Migrants should be explicitly included in universal health coverage commitments. Ultimately, the cost of failing to be health-inclusive could be more expensive to national economies, health security, and global health than the modest investments required.
Finally, we look ahead to outline how our evidence can contribute to synergistic and equitable health, social, and economic policies, and feasible strategies to inform and inspire action by migrants, policy makers, and civil society. We conclude that migration should be treated as a central feature of 21st century health and development. Commitments to the health of migrating populations should be considered across all Sustainable Development Goals (SDGs) and in the implementation of the Global Compact for Migration and Global Compact on Refugees. This Commission offers recommendations that view population mobility as an asset to global health by showing the meaning and reality of good health for all. We present four key messages that provide a focus for future action.
BACKGROUND/OBJECTIVES
Among older adults, intergenerational support can help to improve well‐being. This study examines the correlation between intergenerational relationships and the subjective ...well‐being among older Chinese immigrants in the United States.
DESIGN
Hierarchical multiple regression analyses were applied to test the association between intergenerational relationships and self‐rated well‐being. The mediating effects of sense of control and the moderation effects of support from friends were also tested.
SAMPLE
A cross‐sectional sample of 2717 older Chinese immigrants, aged 60 years and older, with children and grandchildren was drawn from the Population Study of Chinese Elderly.
MEASUREMENTS
Study measures included four items concerning intergenerational relationships: the Pearlin Mastery Scale, two items on seeking support from friends, and single items measuring self‐rated health status and quality of life.
RESULTS
Only the feeling of closeness with children was positively linked with subjective well‐being, while coresidence and frequency of talking were not. Support from friends moderated the association with self‐rated health status, while sense of control partially mediated the association between feeling of closeness and both self‐rated health status and quality of life.
CONCLUSION
A stronger sense of closeness with children correlates to self‐rated health status and quality of life among older Chinese immigrants. The effects of sociocultural changes affecting Chinese American families, and potential implications for older adults' health, could be addressed through strategies to develop emotional closeness with their families and to support sense of control and well‐being among older Chinese adults. J Am Geriatr Soc 67:S557–S563, 2019.
Although widely reported among Latino populations, contradictory evidence exists regarding the generalizability of the immigrant paradox, i.e., that foreign nativity protects against psychiatric ...disorders. The authors examined whether this paradox applies to all Latino groups by comparing estimates of lifetime psychiatric disorders among immigrant Latino subjects, U.S-born Latino subjects, and non-Latino white subjects.
The authors combined and examined data from the National Latino and Asian American Study and the National Comorbidity Survey Replication, two of the largest nationally representative samples of psychiatric information.
In the aggregate, risk of most psychiatric disorders was lower for Latino subjects than for non-Latino white subjects. Consistent with the immigrant paradox, U.S.-born Latino subjects reported higher rates for most psychiatric disorders than Latino immigrants. However, rates varied when data were stratified by nativity and disorder and adjusted for demographic and socioeconomic differences across groups. The immigrant paradox consistently held for Mexican subjects across mood, anxiety, and substance disorders, while it was only evident among Cuban and other Latino subjects for substance disorders. No differences were found in lifetime prevalence rates between migrant and U.S.-born Puerto Rican subjects.
Caution should be exercised in generalizing the immigrant paradox to all Latino groups and for all psychiatric disorders. Aggregating Latino subjects into a single group masks significant variability in lifetime risk of psychiatric disorders, with some subgroups, such as Puerto Rican subjects, suffering from psychiatric disorders at rates comparable to non-Latino white subjects. Our findings thus suggest that immigrants benefit from a protective context in their country of origin, possibly inoculating them against risk for substance disorders, particularly if they emigrated to the United States as adults.
To describe the proportion of women with improving or worsening symptoms of fatigue at 1, 3, 6, and 12 months after birth; to model the trajectory of fatigue across the first year after birth and ...identify baseline predictors (e.g., immigrant status) and time-varying predictors; and to describe the degree to which fatigue interferes with activities of daily living across the first year after birth among a cohort of Chinese immigrant and Chinese Canadian-born women.
Prospective cohort study.
Toronto, Ontario, Canada.
Chinese women who were recent immigrants (n = 244), nonrecent immigrants (n = 247), or Canadian born (n = 100).
Women completed surveys at 1, 3, 6, and 12 months after birth. We measured fatigue with the use of the Multidimensional Assessment of Fatigue scale. Fatigue predictor variables were classified as baseline (e.g., immigrant status) or time varying (e.g., depression). We used latent growth curve modeling to examine fatigue trajectories and identify predictors over time.
Fatigue followed a nonlinear pattern: it improved from 1 to 6 months after birth and then worsened from 6 to 12 months after birth. Depression, anxiety, infant sleep characteristics, and breastfeeding problems, but not immigrant status, significantly increased risk for fatigue. Several daily activities were significantly influenced by fatigue, particularly early in the postpartum period as well as later, which showed a U-shaped relationship between fatigue and activities of daily living.
Fatigue is common and persistent across the postpartum period. Modifiable risk factors related to mental health, infant sleep, and breastfeeding difficulties suggest that preventive strategies for maternal fatigue warrant further investigation.
To understand Chinese immigrants' experiences with mental illness stigma and mental health disparities, we integrate frameworks of ‘structural vulnerability’ and ‘moral experience’ to identify how ...interaction between structural discrimination and cultural engagements might shape stigma. Fifty Chinese immigrants, including 64% Fuzhounese immigrants who experienced particularly harsh socio-economical deprivation, from two Chinese bilingual psychiatric inpatient units in New York City were interviewed from 2006 to 2010 about their experiences of mental illness stigma. Interview questions were derived from 4 stigma measures, covering various life domains. Participants were asked to elaborate their rating of measure items, and thus provided open-ended, narrative data. Analysis of the narrative data followed a deductive approach, guided by frameworks of structural discrimination and “what matters most” – a cultural mechanism signifying meaningful participation in the community. After identifying initial coding classifications, analysis focused on the interface between the two main concepts. Results indicated that experiences with mental illness stigma were contingent on the degree to which immigrants were able to participate in work to achieve “what mattered most” in their cultural context, i.e., accumulation of financial resources. Structural vulnerability – being situated in an inferior position when facing structural discrimination – made access to affordable mental health services challenging. As such, structural discrimination increased healthcare spending and interfered with financial accumulation, often resulting in future treatment nonadherence and enforcing mental health disparities. Study participants' internalizing their structurally-vulnerable position further led to a depreciated sense of self, resulting in a reduced capacity to advocate for healthcare system changes. Paradoxically, the multi-layered structural marginalization experienced by Chinese immigrants with mental illness allowed those who maintained capacity to work to retain social status even while holding a mental illness status. Mental health providers may prioritize work participation to shift service users' positions within the hierarchy of structural vulnerability.
•Integrates structural vulnerability and moral experience frameworks in the study of health disparities.•Identifies how structural mechanisms shape local experiences of stigma.•Identifies interpersonal engagements among Chinese immigrants in the United States that shape and protect against stigma.•Informs interventions to enhance work and lower structural vulnerability for Chinese immigrants.
Cultural brokers can help clinicians meet needs of immigrant patients. This article considers loneliness as an endemic experience of immigrants in the United States and discusses how cultural ...brokerage practices can reduce the ill health effects of loneliness by helping clinicians contextualize their interactions with immigrant patients and by helping immigrants navigate the health care system and build social connections.
Objective
To conduct a systematic review and meta‐analysis of the existing evidence on the association between age at migration and the risk of psychotic disorders.
Methods
Observational studies were ...eligible for inclusion if they presented data on the association between age at migration and the risk of psychotic disorders among first‐generation migrant groups. We used two random effects meta‐analyses to pool effect estimates for each stratum of age at migration relative to (i) a native‐born reference category and (ii) the youngest age stratum (0 to 2 years).
Results
Ten studies met inclusion criteria, and five were included in the meta‐analysis. The risk of psychotic disorder among people who migrate prior to age 18 is nearly twice as high as the native‐born population, with no evidence of effect modification by age strata. People who migrate during early adulthood (19 to 29 years) have a similar risk of psychotic disorder as the native‐born population (IRR = 0.93, 95% CI = 0.60, 1.44) and a lower risk relative to those who migrate during infancy (0 to 2 years) (IRR = 0.58, 95% CI = 0.33, 1.04).
Conclusions
Migrant status is one of few well‐established risk factors for psychotic disorder, yet we have limited understanding of the underlying etiology. The findings of this review advance our understanding of this association and identify high‐risk groups to target for intervention.
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