Evolution of migrants' health in times of economic crisis in Spain: evidence from health surveys in the general population

and in vulnerable groups

Davide Malmusi @dmalmusi, Mercè Gotsens, Ana M Novoa

Immigration and economic growth in SpainChanging pattern in the last decade

Spanish National Health SurveysN foreign 650* 3605 3022 .

2000 2002 2004 2006 2008 2010 2012-4

-2

0

2

4

6

8

10

Foreign-born residents (millions) GDP growth rate (%)

2011:Non-EU foreignersat-risk-of-povertyrate: 49%

Objective of the presentation

• To describe the health status of immigrants from less advanced economies before and during the crisis according to different information sources• National Health Survey• Caritas Barcelona users’ survey on housing and health• “Immigration, work and health” project (ITSAL) follow

up cohort

• CIBERESP Immigration and health program

• Aim: To analyse the health status, health determinants and healthcare use of immigrants in Spain– according to sex, birthplace,

length of residence, social class– compared to the Spanish

population,– in 2006 and 2012.

Spanish National Health Survey (SNHS) 2006-2012

SNHS 06-12. Methods

Cross-sectional survey of the non-institutionalised population

Multistage sampling with representation by Autonomous Community

Face-to-face interviews at home

Valid sample completing the adult questionnaire (aged 15 or over): 2006, n=29.478; 2012, n=21.007

Age-standardised proportions were calculated by survey year, sex and:

1. birthplace: Spain, high-income countries, low-income countries

2. Low-income countries divided by continents

3. Low-income countries by years of residence in Spain

4. Spain and low-income countries by social class

SNHS 06-12. ResultsSample size by birthplace

ResultsSocial determinants of health

% employment status, men% manual social class, women

PRB = Países de renta baja (Low-Income countries). PRA = Países de renta alta (High-Income countries)

ResultsGeneral health and chronic conditions

% fair/poor self-rated health, men

ResultsGeneral health and chronic conditions

% fair/poor self-rated health, women

ResultsMental health

% poor mental health (Goldberg GHQ-12 score >2), men

ResultsMental health

% poor mental health (Goldberg GHQ-12 score >2), men

Also rise of anxiolytics and antidepressants in “PRB” men

ResultsMental health

% poor mental health (Goldberg GHQ-12 score >2), men

ResultsMental health

% poor mental health (Goldberg GHQ-12 score >2), women

SNHS 06-12. Strenghts and limitations

• Wide range of health aspects covered• Standardised procedures. Repetition over time• Comparison with Spanish population

• Sample size• Sample composition. Are responders a representative sample of

the immigrant population?

• Baseline survey of a quasiexperimental study to evaluate health effects of Caritas rehousing program, part of the SOPHIE project

• Published as part of annual Caritas Barcelona report

• Aim: to describe the health status and determinants of Caritas users with housing problems, compared with Barcelona general population

Caritas Barcelona users with housing problems, 2012 survey

Rehoused (Caritas social renting programme)

Waiting list

Families/people attended by Caritas living in substandard

housing*

Baseline survey

(Sept-Dec 2012)

Follow-up survey (1 year after)

*Inadequate housing habitability conditions or overcrowding

Caritas 2012. MethodsStudy population

Rehoused (Caritas social renting programme)

Waiting list

Families/people attended by Caritas living in substandard

housing*

n=175

n=145

*Inadequate housing habitability conditions or overcrowding

Follow-up survey (1 year after)

Baseline survey

(Sept-Dec 2012)

Caritas 2012. MethodsStudy population

… or attended by Caritas Housing Mediation Service

(HMS) (unable to afford rent/mortgage)

Families/people attended by Caritas living in substandard

housing*

n=175 – 164 foreign-born

n=145 – 84 foreign-born

*Inadequate housing habitability conditions or overcrowding

Baseline survey

(Sept-Dec 2012)

Caritas 2012. MethodsStudy population

… or attended by Caritas Housing Mediation Service

(HMS) (unable to afford rent/mortgage)

• 3 questionnaires(1) Dwelling questionnaire (household composition, housing type and conditions, housing costs, housing and neighbourhood satisfaction)(2) Resident questionnaire (demographic and socio-economic characteristics, and health status of the person interviewed)(3) Child questionnaire (sociodemographic and health information of one randomly selected child 4-14 years old; reported by mother/father) N=177

• Performed at Cáritas by a trained interviewer• Answered by the household head or partner (randomly

selected)

Caritas 2012. MethodsData collection

• Barcelona Health Survey 2011Adults and childrenFor comparable indicators (same question)Prevalences directly standardised by age (reference: Caritas sample)Comparison groups:- Whole population- Manual social class (IV-V)- Immigrants from low-income countries

Caritas 2012. MethodsComparison with Barcelona population

• Substandard Housing: 74% women. HMS: 50% women• 89% manual social class• 77% immigrants

– 58% Latin America; 17% North Africa; 12% Sub-saharian Africa– undocumented: 44% of substandard housing sample, 2% HMS

• 53% unemployed. Most employed have no contract• 78% food insecurity

Caritas 2012. ResultsSociodemographic characteristics

• 88% overburden of housing costs (>30% income)• 59% SH, 78% HMS think they’ll lose their house in two years• 54% SH, 44% HMS hot/cold temperature is a problem• 58% SH, 44% HMS rats/cockroaches/similar (5% Barcelona)

Caritas 2012. Housing conditions

22,1

3,2 4,7

56,6

0

20

40

60

80

100

Subst Housing HMS BCN BCN SC IV and V

%

Overcrowding

• Much worse health status than overall Barcelona population

Caritas 2012. ResultsHealth status

62,2

75,0

11,5 12,1

66,972,6

15,2 17,4

0

20

40

60

80

100

Subst housing HMS BCN BCN SC IV and V

%

Men Women

Poor mental health (GHQ>2)

24,4

45,8

11,2 12,8

53,1

60,3

15,320,5

0

20

40

60

80

100

Subst housing HMS BCN BCN SC IV and V

%

Men Women

Fair/poor health status

BCN migrants: 15% men, 18% womenBCN migrants: 16% men, 18% women

• Much worse health status than overall Barcelona population – also for children

Caritas 2012. ResultsHealth status

Poor mental health (anormal SDQ)

BCN migrants’ children: 8%

Repeat otitis

Caritas 2012. Press coverage

PRESS CONFERENCE (18th Des)• Presentation of the report “Home, house and health. Housing action and prevention”

– Annual evaluation of Caritas’s activity– Description of baseline analysis results

Other studies: ITSAL (quanti)

Other studies: ITSAL (quanti)

Other studies: ITSAL (quali)

Fri 13.30h, Session A12, Room A6

Abstracts book page 120

Other studies: ITSAL (quali)

Fri 13.30h, Session A12, Room A6

Abstracts book page 120

Conclusions

• General population surveys show a substantially stable pattern in migrants’ health, with worsening mental health in men as sentinel event

• Specific migrant cohorts recruited in community settings show a much

• The health-damaging consequences of economic precariousness are especially evident among the most vulnerable migrants and their children, often underrepresented in general population surveys.

Reports available at:www.sophie-project.eu/pdf/ens_inmi.pdf

www.sophie-project.eu/pdf/salut_habitatge.pdf

Evolution of migrants' health in times of economic crisis in Spain: evidence from health surveys in the general population

and in vulnerable groups

Davide Malmusi @dmalmusi, Mercè Gotsens, Ana M Novoa