The Relationship Between
Migration and Health
Professor Basanti Majumdar RN, MSc, MEd, MSc(T), PhD
School of Nursing, McMaster University
Faculty of Health Sciences
Introduction
1. Immigrants (focus: legal landed immigrants) in Canada
constitute a diverse and generally healthy population
2. The health problems of arriving and returning populations
will become an increasingly important concern for all
Canadians
Introduction
3. Recent changes in Canada's immigration patterns
have made this country more ethnically diverse than
ever before
4. People migrate from different cultural backgrounds
where their experiences are different from the health
and disease patterns that are common in Canada
(Majumdar et al, 1995; Health Canada; 1998, Ray 2002)
How does the health of
migrants differ systematically
from non-migrants?
Health of Migrants
Assumptions:
When immigrants arrive in Canada, they are a healthy group, (Chen
et al 1994-95). This is assumed to be associated with:
a. Good health - More inclined than those in poor health to
emigrate
b. Employability - Granting permission to immigrate requires a
certain level of health.
c. Screening
- Screening that ensures that they do not suffer
from serious medical conditions
(Immigration Act of Canada)
Illegal and trafficked migrants do not go through this process
Myths
Immigrants
are unhealthy
bring diseases
have low health habits
believes in mysterious health practices
Health of Recent Migrants
Studies Indicate
1. Recent immigrants are healthier than the Canadian-born
population“healthy immigrant effect”
(Fowler N., 1998; Ali J.,2002)
2. Recent immigrants, less likely than the Canadian-born
population to have chronic conditions or disabilities
(Chen at al, 1994-95)
Physical Health
1. Study on physical health of recent immigrants (women) show
that they have healthier lifestyles. They
• Smoked less
• Drank less
• Ate more fruits and vegetables
2. On the other hand, native–born Canadians, in general,
exercise more than immigrants (Chen et al 1994-95, Perez CE 2002)
Chronic Conditions
70%
60%
50%
40%
30%
20%
Incidence of chronic
conditions in general
rose with time since
immigration to Canada
Adjustments were made age, education
and income (Ali J, 2002)
10%
0%
Canadians Recent Immigrants
In general, but focuses mainly on heart disease, diabetes,high blood
pressure, and cancer
Mental Health
Depression in the previous 12 months
(Age 15-75 yrs)
9
8
7
6
5
4
3
2
1
0
Canadians Recent Immigrants
(Ali J, 2002)
Mental Health
Alcohol Dependence in the previous 12 months (indicator of
stress/ poor mental health)
5%
Immigrant Canadians have a
higher percentage of people
from cultures and religions that
forbid alcohol, specially in the
past couple of decades where a
high number of new Canadians
have arrived from Africa and
Asia (Ali J, 2002)
4%
3%
2%
1%
0%
Canadians Recent Immigrants
Mental Health
Recent and Long Term Immigrants
1. Language barriers, immigrants’ higher unemployment rates,
their lower sense of belonging to the local community did not
diminish the gap with respect to depression or alcohol
dependence.
2. Immigrants who had been in Canada the longest had health
outcomes similar to those of their Canadian counterparts
(Ali J, 2002)
Mental Health
Other Studies
• immigrants represent a vulnerable population at risk
with higher rates of depression and alcohol dependence
(Beiser et al 1994)
• Discrepancies may relate to the fact that literatures has
typically focused on specific subsets of individuals (such
as refugees) (Dunn et al 2000, Noh et al 1999)
Mental Health
• It is clear that there are vulnerable sub-groups
among immigrants
Though, recent immigrants, exhibit fewer mental health
problems than the Canadian-born population:
it cannot be assumed that immigrants have better mental
health than the Canadian-born population
(Ali J, 2002)
• Paradigm Shift ( Value/Norm difference in a societal context)
Chronic Conditions
In terms of chronic conditions in general, immigrants and nonimmigrants appear to converge in health status over time
Which shows that recent immigrants in Canada are in better
health than the Canadian born population
( Chen et al 1994-95, Parakulam et al 1992,The Daily,Sept 19,2002; Ali ,J., 2002)
How does the place of origin and
destination factor into the health of
migrants ?
Origin and Destination
The impact of mobility on health risk may be beneficial , neutral, or
unfavorable with respect to the adult population . Example
Movement from a tropical area endemic for malaria to a temperate
region where the disease is not transmitted
(MacPherson DW et al ,2001)
Infectious Diseases
1. Health is directly related to the origin, behavior,
environment and social make up of the population in
question (Gushulak, 2001)
2. The volume of international travel precludes individual
screening of travelers for infections (Gushulak, 2000)
3. Recent major changes in migration health: concern
for re-emergence and growing threat of infectious diseases
Infectious Diseases
4. High speed air travel = the international movement
of individuals within the incubation time of all
virulent infections
5. Migrants come from developing areas with
prevalence of infectious diseases such as tuberculosis,
HIV/AIDS, hepatitis, malaria and parasitic diseases
(Cookson et al 1998)
Infectious Diseases
Migrant children and the newly-born may have risks to
certain diseases that are different from Canadian children.
Examples are:
•
•
•
•
tuberculosis
malaria
intestinal parasites and
hepatitis
(Mortenson J et al, 1989, Gushulak, 1999)
Other Diseases
Children who come from environmental polluted regions
may carry the effects with them (e.g. lead poisoning , arsenic
poisoning in Bangladesh)
Increased risk of ill health due to a combination of dietary and
cultural factors (e.g. low levels of Vitamin D & Iron deficiency
anemia in children of Asian families)
(Lawson M et al 1999, Carey E 1998, Gushulak, 1999)
Specific Diseases
Tuberculosis
Dramatic increase in the proportion of foreign-born cases of TB
has been observed over the past 20 years in Canada.
TB in immigrants and refugees results from reactivation and a
smaller proportion from primary infection just prior to postmigration
(Applied Research and Analysis Directorate- http://www.hc-sc.gc.ca/iacb-dgiac/arad-
draa/english/rmdd/wpapers/immigration03.html)
Tuberculosis
Risk of TB transmission within immigrant communities are
considerable (Carballo et al 1998)
A 5 year Alberta study (1990-1994) – 351 cases of TB diagnosed,
immigrants accounted for 70.6% of these cases. 73.4% were from
Asian countries (Cowie & Sharpe 1998)
Toronto Study- Immigrants account for 92% of TB cases(Applied
Research and Analysis Directorate - http://www.hc-sc.gc.ca/iacb-dgiac/araddraa/english/rmdd/wpapers/immigration03.html)
Determinants of Tuberculosis
Individuals born in countries with a high TB prevalence represent
a high risk group (Brancker 1991, Wobeser et al 2000)
Predisposing causes:
poverty
substandard housing
substance abuse
poor sanitation and malnutrition
contribute to the reactivation of TB in immigrants
(Applied Research and Analysis Directorate- http://www.hc-sc.gc.ca/iacb-dgiac/araddraa/english/rmdd/wpapers/immigration03.html, Kent,1993; McSherry & Conner, 1993)
Barriers to Surveillance and Treatment
stigma
Major barriers to TB surveillance and treatment in Canada:
lack of awareness / accessibility of available services
lack of coordination between health care services
(Applied Research and Analysis Directorate- http://www.hc-sc.gc.ca/iacb-dgiac/araddraa/english/rmdd/wpapers/immigration03.html)
HIV/AIDS
Human Mobility is associated with the risk of HIV infection.
Major barriers to HIV/AIDS surveillance and treatment in Canada:
Stigma and isolation of HIV-positive individuals
Sociocultural behavior and language differences within the immigrant
community
Awareness of the condition, availability and accessibility of the health
care services
(Decostas and Adrien 1997,UNESCO/UNAIDS 2000, Calzavara et al 2000: Tharao et al, 2000)
Controversies Related to Mental Health
Studies have demonstrated negative psychological effects of
migration on mental health. Others have suggested that
immigrants have a mental health advantage over their native-born
counterparts
Suicide rates among 25 immigrant groups in Canada- converged
with those of the Canadians
(Kliewer and Ward 1988; Kliewer, 1991)
For immigrant women, loneliness and depression were a daily
feature and high suicide rate among Asian women were indicated
(Anderson 1987, Kinnon 1999)
Other Diseases
Certain conditions, including
• anemia
• dental caries
• intestinal parasites
• nutritional deficiencies
• immunization irregularities
appear more commonly in newly arrived refugees from
developing countries (Fowler 1998)
What are the impacts of
migration on health?
Impacts of Immigration
Immigrants go through three distinct resettlement stages:
a. initially a period of euphoria
b. followed by a period of disillusionment, during which
depression is common
c. finally, a period of adaptation
(Research and Analysis Directorate - http://www.hc-sc.gc.ca/iacb-dgiac/araddraa/english/rmdd/wpapers/immigration03.html, Thompson 1986, Oberg 1954, Brink 1976,
Thompson and MacDonald 1990)
Impacts of Immigration
Stresses faced by migrants:
• sense of loss
• helplessness
• alienation
• isolation/ segregation
• Language difficulties
• Multiple responsibilities
• Financial and employment stressors
• Lack of acceptance by their host communities
• Culture conflict
• Perceived lack of social support
(Research and Analysis Directorate - http://www.hc-sc.gc.ca/iacb-dgiac/araddraa/english/rmdd/wpapers/immigration03.html, MacKinnon)
Impacts of Immigration
Stresses faced by migrants (cont):
• racism due to color and ethnicity rather than religion
• poverty resulting from academic deskilling
• under-employment and unemployment
• the disruption of social ties
• lack of immediate supportive networks
(Cameron et al 1996, Brice-Baker 1994)
Impacts of Immigration (Children)
• Poor mental health outcomes : associated with
political violence in the country of origin and stress.
Unaccompanied migrant children have higher risks for
behavior and psychosocial problems (Hjern A 1998)
• Intrafamilial conflict and disagreement: Children, may acquire
aspects of the new cultural environment more rapidly than adults
who maintain traditional values (Rakoff 1981, Freire 1985,1991, Gushulak1999)
Impacts of Immigration: Women
Multiple roles they are required to play within the home and the
external society (Meleis, 1991)
“Role overload” as one of the defining stressors in the lives
of immigrant women (MacKinnon and Howard 2000)
Poor pregnancy outcomes of women, due to:
• social exclusion
• being non-white
(Waterstone M et al 2001)
Conclusion
Canada has a long tradition of opening its doors to people
from all over the world.
As regional, international and global factors including
wars and conflicts affect different parts of the world,
patterns and profiles of migrants and mobile populations
has and will continue to change
Conclusion
In summary, raising awareness of health issues related to
migrants among
• Health care providers
• Educational institutions
• Social agencies
• NGO’s & communities
Within the context of
historical
sociocultural & economical factors
geographical backgrounds
of the migrants is essential
Conclusion
Appropriate prevention and control of health conditions
related to migrant population can be achieved by:
• positive awareness
• planning strategies and implementation of educational
interventions and
• ongoing outcome evaluations
of health and social services
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