The Health Status of Migrants - Selected Empirical Results | Zuwanderung, Flucht und Asyl: Aktuelle Themen | bpb.de

For many diseases this results in a different frequency distribution than in the non-migrant majority population. A current focus report offered by the Federal Health Monitoring information system offers differentiated information in this regard. The health situation of migrants in Germany presented below is based on selected examples from this report. Age differences in the demographic structure have been adjusted where applicable; data sources derived from the report are shown in brackets. Publications with additional data are also quoted in individual cases.

The health report clearly indicates the distinctly heterogeneous situation among people with a migration background as regards their health. There are also certain results regarding their state of health that are not so easily explained. The following section discusses possible explanatory models to support the interpretation of the empirical findings.

Infectious diseases

Many migrants originate from poorer countries or were in an unfavourable socio-economic position in their country of origin. For this reason, infectious diseases common in their country of origin may be more prevalent amongst them than amongst the population in the country to which they are migrating. At the time of immigration, therefore, communicable diseases in migrants reflect the epidemiological situation in the country of origin. Taking the example of HIV, immigrants from so-called high-prevalence countries, predominantly sub-Saharan African countries, have a higher incidence of HIV than the majority population in Germany. Over the course of time, the incidence of newly diagnosed cases and the prevalence of infectious diseases will increasingly be determined by the living conditions in the host country and access to medical care. With 24.4 new cases of tuberculosis per 100,000 inhabitants and year, the incidence among foreign citizens is five times greater than among Germans. Cases also occur at a significantly younger age (the median age of migrant tuberculosis patients is 34 years, compared to 56 years for non-migrants). On the one hand, this is attributable to migrants who have been resident for a short time and who bring the disease with them from their countries of origin. On the other hand, migrants with a low socio-economic status, similar to Germans in the same position, have an increased risk of tuberculosis.

Maternal mortality

The term maternal mortality refers to cases of death associated with pregnancy, childbirth and postpartum complications. Maternal mortality is calculated on the basis of the number of maternal deaths for every 100,000 live births. Since maternal deaths are essentially avoidable, maternal mortality is a sensitive indicator of inequalities with regard to access to and the use of health services. Until the mid-1990s, maternal mortality among foreign women was about 1.5 times greater than among German women. Since then, the figures, which show an overall decline, have become similar. Maternal mortality among Turkish women in Germany is substantially lower than that in Turkey, their country of origin, evidently a consequence of differences in access to and the quality of obstetric services.

Child health

The health of children is determined in particular by the lifestyle of their family, their socio-economic status, and also in part by genetic factors. The fact that the characteristics of these determinants vary from one population group to another results in variations in the incidence of certain diseases and risk factors. Access to and making use of health services and preventive measures can likewise play a major role.Thus, for example, according to the results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) the uptake of vaccinations against diphtheria and tetanus for children aged between 11 and 17 with a migration background is lower than that for children with no migration background. According to the KiGGS results, participation in early detection examinations for children is also lower for children with a migration background. Thus 14% of children with a migration background did not take advantage of the standard early detection examinations (in German, the so-called U3 to U6) compared with 2% of children with no migration background.

Growing up in less favourable hygiene conditions may be associated with a lower prevalence of allergies. Certainly, children below 18 with a migration background are less often affected by allergies than children with no migration background (27.4% v. 40.4%).

The issue of child obesity is attracting increasing attention. Nutrition and physical activity influence the prevalence of obesity. Migrants from poorer countries benefit on the one hand from the adequate and secure provision of food in Germany. On the other hand, malnutrition and a lack of exercise lead to the development of obesity in people with a migration background just as they do in Germans. According to KiGGS statistics, children with a migration background aged 3-17 are more often overweight than children of the same age from the non-migrant majority population (19.5% v. 14.1%).

Risk factors for cardio-vascular diseases

The frequency of cardio-vascular diseases, in particular of coronary heart disease and heart attacks, is determined by the prevalence of risk factors such as obesity and smoking; these, in turn, are influenced in migrants by customs in their country of origin, adaptation processes in the host country and by psychosocial stress. Corresponding differences may be found in the available empirical data. Thus the average Body Mass Index (BMI) of foreign women at 24.5 kg/m2 may indeed be only minimally different than that of German women (24.8 kg/m2), yet a significantly larger percentage of foreign women aged 65 and above are obese compared to German women (BMI>= 30 kg/m2; 28.1% v. 17.6% in 2005). In all age groups, a larger percentage of foreign men than German men smoke (36.3% v. 27.1% in 2005).

Due to the somewhat higher prevalence of risk factors among migrants, it would be reasonable to expect increased incidence of heart attacks; to date, however, there is no empirical evidence to bear this out. Possible explanations lie in protective factors (e.g. in nutrition), a comparably smaller numbers of cigarettes consumed over a lifetime, and data distortion.

Cancer

The incidence of many cancers depends at least partly on nutrition, smoking and other lifestyle factors, and in the case of cervical cancer additionally on the frequency of (sexually transmitted) infection with the human papilloma virus (HPV). In the case of breast cancer and cervical cancer, participation in preventive examinations also plays a role. Cancer mortality is additionally influenced by opportunities to access or use health services. In view of the large range of factors associated with the onset of cancer, differences between population groups are not easy to interpret.

Descriptive studies of Turkish and ethnic German migrants from the former USSR show a slightly lower cancer risk overall compared with the German population; over time, and with increasing periods of residence in Germany, this risk increases. For particular types of cancer, such as stomach cancer, there is a slightly increased risk among migrants. This is explained by less favourable hygiene conditions during childhood. Such conditions promote the transmission of the stomach bacteria helicobacter pylori, which may cause stomach cancer later in life. For breast cancer, by contrast, there is a lower incidence and mortality rate among Turkish and ethnic German migrant women than among non-migrant German women.

Death rates due to lung cancer are lower among Turkish citizens than among Germans, but have increased significantly since observations began in the 1980s. Among male ethnic German migrants, lung cancer mortality is already higher than that of the German population in general. This is in accordance with the consideration expressed above that not only the percentage of smokers in the population plays a role, but also the number of cigarettes smoked in the past (which in turn depends on the economic development of the country of origin, since the smoker incurs costs through smoking).

Health in the workplace

Indicators such as accident, illness and severe disablement rates can provide insights into the situation at work. Comparisons of the frequency of workplace accidents between migrants and the non-migrant majority population, for example, show that migrants more often carry out physical labour with a greater risk of accidents. It would therefore be more meaningful to make comparisons within a given occupation.

Overall, the number of accidents in Germany is decreasing. German and non-German males demonstrate similar (and declining) accident rates. Accidents in the workplace, including those resulting in death, however, are about 1.5 times more common among Turkish citizens than among German citizens, possibly due to the former more often carrying out dangerous physical work and having received inadequate safety instruction.

Of the three indicators, the illness rate is the most difficult to interpret since it depends not only on the state of health but also on the person's concern for their job (and thus also directly on the economic situation). Among foreign men and women the illness rate, at 9.7% and 10.2% respectively, is lower overall than among German citizens (11.6% and 13.1%). One exception is the economically active middle-age group (40-64) where, partly due to the increased frequency of having hard, physical jobs on building sites or "underground" jobs, the rate is higher among foreigners.

Health satisfaction

Satisfaction with one's own health is indeed a subjective measure; however, it is a very good illustrator of state of health. Satisfaction with one's health decreases with age. This decline takes its course at different speeds among different populations and so gives insight into differences in health prospects and health burdens.

Evaluations carried out by the German Socio-Economic Panel (SOEP) show that decreasing satisfaction with their health as they grow older is more marked among Turkish immigrants than among Germans. Even among immigrants from Eastern Europe, despite increasing socio-economic success over time, there is evidence of a stronger decline in the subjective perception of health with increasing age than among people with no migration background.

Mental illness

Less well-documented, and therefore hard to quantify, are illnesses caused by psychosocial stress associated with being separated from one's family or with political persecution in the country of origin. Persons without a legally secured residence status are especially vulnerable to mental illness. However, there is hardly any dependable data available regarding their health situation.

The migration experience cannot sweepingly be equated with mental stress. However, a series of mental disorders can occur in conjunction with migration. These include depression, psychosomatic complaints, somatisation and post-traumatic stress. Reasons for increased incidence include:

• Migration, being a critical life event, can overburden the previously acquired ability to make adjustments, cope and use problem-solving strategies.

• Stress caused by a risk-laden journey to the destination country can result in anxiety, depression or dissociative symptoms.

• Stress can arise from being uprooted or separated from family, partners and familiar customs or values.

• Stress can arise during the acculturation process, due to uncertainties with regard to living conditions, housing, stigmatisation etc.

• Economic and professional issues in the wake of a migration can elevate stress levels.

• Stress can be caused by social isolation, especially in the absence of family and friend networks, which represent an important resource for coping with stress.

• Stress can arise from disruptions to the parent-child-relationship when children are "forced" to adhere to cultural traditions that are different from those in the receiving society.

Available findings suggest that migrants are particularly vulnerable to mental illness shortly after immigration. Once they have been in the country longer and settled into their new life, the stress frequently diminishes.

Social status and health

Most routine records lack detailed information on the socio-economic status of the registered cases. That makes it more difficult to analyse the causes of possible health disadvantages and point to strategies for overcoming them. If people with a migration background are, on average, in a worse state of health than the majority population, then this might be the outcome of some sort of disadvantage to this group. However, it might also be the consequence of a generally less favourable socio-economic situation, as is also the case within the non-migrant German population. Any explanation firstly requires data records on the health of migrants that contain socio-economic variables, and secondly requires the further development of models with which to explain the association between migration and illness. These explanatory models are examined in more detail below.