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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Migrant integration policies and health inequalities in Europe

Authors: Margherita Giannoni, Luisa Franzini, Giuliano Masiero

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

Research on socio-economic determinants of migrant health inequalities has produced a large body of evidence. There is lack of evidence on the influence of structural factors on lives of fragile groups, frequently exposed to health inequalities. The role of poor socio-economic status and country level structural factors, such as migrant integration policies, in explaining migrant health inequalities is unclear. The objective of this paper is to examine the role of migrant socio-economic status and the impact of migrant integration policies on health inequalities during the recent economic crisis in Europe.

Methods

Using the 2012 wave of Eurostat EU-SILC data for a set of 23 European countries, we estimate multilevel mixed-effects ordered logit models for self-assessed poor health (SAH) and self-reported limiting long-standing illnesses (LLS), and multilevel mixed-effects logit models for self-reported chronic illness (SC). We estimate two-level models with individuals nested within countries, allowing for both individual socio-economic determinants of health and country-level characteristics (healthy life years expectancy, proportion of health care expenditure over the GDP, and problems in migrant integration policies, derived from the Migrant Integration Policy Index (MIPEX).

Results

Being a non-European citizen or born outside Europe does not increase the odds of reporting poor health conditions, in accordance with the “healthy migrant effect”. However, the country context in terms of problems in migrant integration policies influences negatively all of the three measures of health (self-reported health status, limiting long-standing illnesses, and self-reported chronic illness) in foreign people living in European countries, and partially offsets the “healthy migrant effect”.

Conclusions

Policies for migrant integration can reduce migrant health disparities.
Appendix
Available only for authorised users
Footnotes
1
We excluded Iceland from the analysis, because no MIPEX data were available for this country. Moreover, observations for Poland and Norway were excluded from the initial sample due to the presence of several missing data on citizenship. Similarly, Cyprus, Czech republic and Slovenia were excluded from the analysis because of data limitations.
 
2
In this case, we used the interaction term between the migrant status and a set of categorical variables for low education, low income (lowest tertile of individual income), marital status (not married, single or separated, widow), and employment status (unemployed, self-employed, housework). We also estimated models including the six separate dimensions of the MIPEX index (Table 3). This allows for the estimation of the contribution of migrant integration policies in specific areas, namely the acquisition of nationality, political participation, labor market mobility, anti discrimination, long-term residence, and family reunion. However, the MIPEX domains were highly correlated and the estimated odds were all significant and very close to one. Therefore, this specification did not seem to convey any clear message useful for policy purposes. We decided not to report these results in the paper.
 
3
Details on marginal effects calculated using the Delta method are available upon request.
 
4
The graphs shown are the scatter plot output from Stata v.13 routine mlt2scatter for the probability of reporting poor health status. This has been used together with the routine mlt2stage in order to produce two-stage plots of the estimated country-level regression coefficients of the individual lower-level variable for migrant status over the country higher-level variable measuring problems in integration policies.
 
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Metadata
Title
Migrant integration policies and health inequalities in Europe
Authors
Margherita Giannoni
Luisa Franzini
Giuliano Masiero
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3095-9

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