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1.4.2009 | Von:

Explaining The Relationship Between Migration and Health

Migration as a health transition

The populations of poorer and richer countries are exposed to different factors that affect their health during their lifetime. Global differences in hygiene conditions or nutrition are examples of this. Anyone who migrates across national and also economic boundaries has, for this reason alone, a different risk of chronic disease than the non-migrant population in the country of immigration. This results in apparent paradoxes with regard to chronic disease among migrants.

To resolve these paradoxes it is possible to interpret migration from poorer countries to richer ones as a "health transition". The expression "health transition" is normally understood to mean the transition within a society from high mortality, primarily caused by infectious diseases as well as maternal and infant mortality, to a lower mortality, primarily caused by non-communicable, chronic diseases. [12] The health transition is made up of many components, of which the following are relevant here:
  • therapeutic components, i.e. better prevention and treatment options for things like infectious diseases
  • risk factor components, e.g. protection from disease due to the provision of clean drinking water, and also from new risks caused by things like smoking, poor nutrition and a lack of exercise.
A health transition towards chronic disease is proceeding worldwide but at different speeds. Many of the – poorer – countries of migrant origin are still at an earlier stage compared with rich, developed countries such as Germany. If people migrate from a poor country to Germany, the rate at which they acquire new diseases and the rate of death change, occurring at different speeds depending on the type of disease:[13]
  • The mortality of migrants from treatable infectious diseases and also maternal mortality (still high in many countries of origin) falls rapidly towards the level of the population of the country of immigration – in accordance with the "therapeutic" components of the health transition.
  • New diseases and mortality among migrants from ischaemic heart disease (heart attack), the most common cause of death in Germany, remain initially on a low level, e.g. that of a country of origin in southern Europe. This is attributable to the mostly long latency period between the escalation of the risk factors and the occurrence of disease. First-generation immigrants can therefore still have a lower risk of heart attack and mortality than the population of the country of immigration many years after migration.
With increasing length of residence – or in subsequent generations that grow up in the country of immigration – migrants adjust to the "Western" lifestyle. With time, this increases their risk of a heart attack [14] – in accordance with the "risk factor" components of health transition. This can take decades. For certain ethnic groups, however, this aspect of the health transition goes hand in hand with an especially rapid change in disease risks. One example of this is migrants from South Asia to England and Scotland. Probably due to increased insulin resistance, with a "Western" lifestyle and nutrition (high fat, high calorie nutrition, lack of exercise) their risk of a heart attack increases within years, surpassing the risk of the population of both the country of origin and the destination country. [15] There is debate as to whether people of Turkish origin also have an increased risk of heart attack in Germany if they adjust to the "Western" way of life. The reason could be a genetic polymorphism associated with low "protective" cholesterol (HDL cholesterol). [16]

The increased risk of new, lifestyle-related diseases is in addition to the increased risks to migrants of other chronic diseases listed above. Examples include stomach cancer and stroke. These occur in large numbers in people who have spent their childhood in poverty and poor hygiene conditions. [17] These risks of disease that they bring with them are a negative side of the health transition migrants go through. Migrants from poorer countries therefore find themselves at a different stage on the health transition continuum than the majority population. This does not give rise to fundamentally different chronic diseases; rather, they occur in a different distribution pattern.

Fußnoten

12.
See Omran (1971); Feachem et al. (1992).
13.
See Razum and Twardella (2002).
14.
See Anand et al. (2000); Benfante (1992).
15.
See Khunti (2004); Bhopal et al. (1999).
16.
See Hergenc et al. (1999); Mahley et al. (1995).
17.
See Leon and Davey Smith (2000).

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