10th Summer Institute on
Migration and Global Health
June 22-25, 2015
Oakland, California, USA
An Overview of
Global Migration and Health
•••••
Summer Institute
•••••
June 22, 2015
Marc Schenker M.D., M.P.H.
mbschenker@ucdavis.edu
University of California at Davis
Outline
Overview of global migration
Migration demographics and economics
Health status and care for immigrants
Occupational health of migrant, vulnerable
workers
Future directions
1. Migration has always been
and will continue to be a natural
phenomena for living species.
One seventh of the global
human population is migrant.
Gray Whale
Migration
Major Migration Flows (2000’s)
2. The major causes of global
migration are likely to increase
in the future.
 Natural disasters
Biologic, geophysical,
climate-related
(hydrologic, meteorological)
Indonesia, 12/26/2004
Haiti, 1/13/2010
Philippines, 11/9/2013
Dhaka, Bangladesh
Mexico:
Migration to
Cope with
Drought and
Disaster
Too Much Water
Not Enough Water
Extreme Events
Mexico: Migration to Cope with Drought and Disaster
Experts predict 50 million
environmental refugees by 2020,
200 million by 2050
2. The major causes of global
migration are likely to increase
in the future.
 Environmental Change
 Political Change (refugees)
The UN High Commissioner for Refugees
estimates there were 40 million refugees
and IDP worldwide in 2012
UN Estimates 60 Million Refugees
Worldwide – June 18, 2015
The major causes of global
migration are likely to increase
in the future.
 Environmental Change
 Political Change (refugees)
 Demographic and Economic
Disparities
Farmworker in
Oaxaca earns
(U.S.) $1.50/hr
1 hr Calif =
1 day Mexico
Same farmworker
in California earns
$10/hr
Global Migration
•232 million people live outside their country of birth (46 million
in the U.S.)
•750 million internal migrants
• Demographics will make increased migration inevitable
•In 2016 there will be 87 entrants in workforce for 100
retirees.
• Only immigrants can make up this gap
• 342 candidates for every 100 jobs in developing
countries.
Changing U.S. Immigrant Sources
1890 – 14.6% born
abroad, mostly W & N
Europe
1930 – 11.5% born
abroad, most
common Italy,
Poland, Russia
2000 – Latin America
and Asia
Ellis Island, 1902
Pew
Center
Global Migration Money Flow
• World Bank estimates $542 billion sent in
remittances annually
• 3.8 times the combined global foreign aid
budgets
• 60 countries receive > $1 billion
• 22 countries remittances are > 10% of GDP
• Western Union has 5x the locations of McDonalds,
Starbucks, Burger King and Wal-Mart combined!
3. Migration can have negative
impacts on health in the origin,
transit and destination locations





Mental health
Chronic diseases
Occupational health
Infectious disease
………etc
4. Social protections in health
are reduced for the majority of
immigrants
 Less workplace protection
 Less preventive (public) health care
 Migrants have less financial
resources
 Migrants may be excluded from
health care access (e.g. ACA)
Mexican Immigrant Adults Lack Connection
to Health Care Facilities, California
20.9%
14.7%
9.2%
46.2%
66.3%
79.4%
14.7%
9.0%
42.4%
14.5%
39.6%
Recent Mexican
Immigrants
31.1%
Longer-stay
Mexican
immigrants
Mexican American U.S.-Born Whites
Doctor's office or health center
Clinic
None
Mexican immigrant adults have highest levels of
no medical visits in the past two years, U.S.
Mexican immigrant adults have the
lowest levels of emergency room visits
16.7%
15.5%
11.9%
7.1%
Recent Mexican
Immigrants
Longer-stayed Mexican
immigrants
Mexican-Americans
U.S.-Born Whites
Adults age 18 and over with no
dental visit in past year
62.4%
46.1%
34.3%
Recent Mexican
migrants
26.8%
Long-stay migrants Mexican- Americans U.S. Born whites
(10+ years)
Mexican immigrant adults have the highest
use of health or dental services - in Mexico
12.9%
10.6%
8.1%
Low income
Other
10.5%
5.3%
0.9%
Recent Mexican
Immigrants
Longer-stayed
Mexican
immigrants
MexicanAmericans
0.7% 0.2%
U.S.-Born Whites
Health Among Hispanics in the United
States — 2009–2013
“Hispanics had better health outcomes than whites
for most analyzed health factors, despite facing
worse socioeconomic barriers, but they had much
higher death rates from diabetes, chronic liver
disease/cirrhosis, and homicide, and a higher
prevalence of obesity. There were substantial
differences among Hispanics by origin, nativity, and
sex.”
MMWR, May 8, 2015
Active and Passive Smoking by
Years in U.S., Mexican Women
Social Determinants of Health
among Latino Immigrants
•
•
•
•
•
•
•
•
•
•
Health care access
Poverty
Education
Employment
Language
Violence/safety
Discrimination
Fear of authorities (for undocumented)
Access to healthy foods
Housing and environment
Health Care for
immigrants………It Depends on
Your Visa!
Mexican Immigrants have High Levels
of Poverty
United States, all adults
Source: SSA, Inmigrantes Mexicanos y Centroamericanos en Estados Unidos, 2006
http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196 and U.S Census, CPS 2006
Immigration and Occupation
Postville, Iowa
May 12, 2008
Employed Latinos in U.S. by
Industry, 2010 (%)
Source: Bureau Labor Statistics, Household Data Annual Averages
Fatality Rate and % of Fatalities to
Foreign Born Workers in the U.S.
Occupation and Industry Injury and
Fatality Rates, ACS
Variable
Industry Injury
Rate*
Occupational
Injury Rate*
Industry Fatality
Rate+
Occupational
Fatality Rate+
*per 10,000 workers
+per 100,000 workers
Natives
Immigrants
140.5
148.7
108.8
139.7
4.7
6.5
5.9
7.5
Orrenius. Demography. 46:535, 2009
Why do some immigrants have
worse occupational health
outcomes than natives?




Work in more hazardous industries and jobs
Different perceptions or knowledge of job risks
Lower level of education, social capital, English
ability
They have few alternatives
 Precarious job (= Undocumented status)
-- Unwilling to complain
-- Risk taking
Poor Self-Rated Health in Female Workers by
Employment Contract Type, ITSAL (Spain)
40
%
Poor
Health
35
Spanish-Born
30
Foreign-Born (New)
25
Foreign-Born
(Established)
20
15
10
5
0
Permanent
Temporary
None
Employment Contract Type
Sousa, Int J Pub Hlth, 2010
Domestic Workers
Health issues of female foreign
domestic workers: a systematic review

32 research papers or reports, 1990 – 2012
 Most in Middle East or SE Asia





Work hours 14 – 18/day
No rest days or hours common
>50% report underpayment
Sub-standard living conditions
Other abuses: restricted mobility, food
deprivation, etc.
Malhotra, Arambepola et al. IJOEH, 2013
New Operational
Frameworks are Needed
 Monitor and study migrant worker health
 Health systems sensitive to migrant
worker status
 Equal health and safety protection and
enforcement for all workers
 Multinational approaches for immigrant
workers
Social campaigns to improve work
conditions in overseas factories
“Every ethnic minority, in
seeking in its own
freedom, helped
strengthen the fabric of
liberty in American life.
Similarly, every aspect of
the American economy
has profited from the
contributions of
immigrants.”
John F. Kennedy
A Nation of Immigrants (1958)
Migration and Health: A
Research Methods
Handbook
Editors:
Schenker
Castañeda
Rodriguez-Lainz
UC Press
www.ucpress.edu
2014
Thank you!
mbschenker@ucdavis.edu
@migranthealth
www.ucghi.universityofcalifornia.edu/
http://mahrc.ucdavis.edu/