Migration and Health: Immigrant Health Issues in Germany

Definitions and Key Concepts

Migration refers to the movement of an individual from one center of living to another over a socially significant distance (Spallek, Zeeb, & Razum, 2010). More formally, it is the movement of an individual or a group of persons across a political or administrative border — from one geographical unit to another — for permanent or temporary residence (DMP, 2004).

International migration is an instance in which migration occurs across a national border (Spallek, Zeeb, & Razum, 2010).

Circular migration refers to the movement of migrants who take up residence in one country for a short period of time before returning to their country of origin (DMP, 2004).

Irregular migration is a type of migration that does not conform to the policies, rules, or regulations of the countries involved. It includes human trafficking, which can result in migrants hiding in host countries. Both individual migrant health and public health risks are heightened in cases of irregular migration (DMP, 2004).

Mobility pattern refers to a trend of migration that repeats itself over time. Movement from poor to rich countries, or from rural to urban centers, are common examples of mobility patterns (DMP, 2004).

Health refers to a state of social, mental, and physical well-being — not merely the absence of infirmity or disease. In the context of migration, health encompasses the social, mental, and physical well-being of mobile populations and other migrants (DMP, 2004). You can read the WHO's foundational definition of health in its Constitution.

Public health is the process of protecting communities and populations from disease, or of establishing programs and policies that promote healthy living environments for every member of the community (DMP, 2004).

Psychosocial describes an approach to understanding and managing human behavior and wellness that places equal importance on both social factors and individual psychological factors (DMP, 2004).

Trauma is a wound to the mind or body that causes psychological or physical injury, inhibiting normative functioning and thus requiring treatment or healing. Trauma is closely associated with mental health and stress problems. Serious or repeated trauma may be diagnosed as post-traumatic stress disorder (DMP, 2004).

Migration health is a specialized branch of the health sciences that focuses on the well-being of communities and migrants in nations or regions of destination, transit, origin, and return. It has a dual focus: it addresses both the public health concerns of host communities and the health needs of individual migrants (DMP, 2004).

Health and Migration: An Overview

Migration has traditionally played a key role in shaping societies and bringing about demographic changes (Reyes et al., 2014). Trends in migration flows can fluctuate greatly over time, with both the composition and size of migrant communities reflecting historical and current patterns of migration (Reyes et al., 2014).

Migration affects all countries of the European Union and exerts a double influence on both the public health of host communities and the individual health of migrants themselves (Spallek, Zeeb, & Razum, 2010). Infectious diseases remain highly relevant in the migration context. Additionally, experiences during travel and in destination countries have the potential to negatively affect migrants' health. Despite the different contexts and environments in which migrants and host communities live, they ultimately tend to develop similar health problems (Spallek, Zeeb, & Razum, 2010).

There is increasing global awareness of and attention toward migrant health, reflecting a growing recognition that health systems must adapt to increasingly diverse populations.

Factors Influencing Migrant Health

The health of migrants is influenced by several factors across three broad phases of the migration experience (Spallek, Zeeb, & Razum, 2010):

Conditions in the country of origin prior to migration — for instance, lack of quality healthcare, different nutritional exposures, war, violence, torture, and the high prevalence of infectious diseases in many lower-income countries.

Conditions during transit — including stress, violence, hunger, racism, psychosocial burdens, and separation from family.

Conditions in the destination country — both immediate (such as feeling foreign, racism, language barriers, and family separation) and long-term conditions affecting future generations (such as different cultural and social ways of life, continuing language and comprehension difficulties, racism, social standing, and lower educational status).

Health Issues of Immigrants in Germany

It has been frequently observed that immigrants tend to have a mortality advantage over host populations (Spallek, Zeeb, & Razum, 2010). This phenomenon is referred to as the Healthy Migrant Effect, and it arises from the fact that migrant workers are generally required to be in good health to be considered for employment or residence in a new country (Spallek, Zeeb, & Razum, 2010).

However, changes to the initial health risks brought about by the act of migration, combined with the emergence of new risks over time, can produce health profiles that differ substantially from those of the broader host country population (Spallek, Zeeb, & Razum, 2010).

Despite any initial health advantages, immigrant populations are generally considered a vulnerable group in health terms (Spallek, Zeeb, & Razum, 2010). Their needs should therefore receive appropriate attention in health research, so that excess risks among particular immigrant populations can be identified and high-risk groups targeted accordingly (Spallek, Zeeb, & Razum, 2010).

Immigrant populations differ from the broader population in two key ways: their utilization of health resources and their health-related behaviors (Spallek, Zeeb, & Razum, 2010). Many immigrants maintain different social and cultural ways of life and often hold different understandings of health and illness. This can result in disparities in health-related habits in areas such as living and working environments, nutrition, smoking, and alcohol consumption (Reeske, Spallek, & Razum, 2009; Oort et al., 2006; Bhopal et al., 2004).

Differences in the health of migrant populations compared to host populations may be attributable to social deprivation, health-related behaviors, differing environmental exposures, or different genetic compositions (Spallek, Zeeb, & Razum, 2010). Disparities in health outcomes can also serve as indicators of insufficient prevention, diagnosis, or treatment of disease. Of particular interest are studies that have documented differentials in access to healthcare (Spallek, Zeeb, & Razum, 2010).

Two specific examples illustrate these disparities in Germany:

Example 1: Children of Turkish immigrants appear to have marginally increased risks for Hodgkin disease, leukemia, and non-Hodgkin lymphoma compared to native German children (Spallek et al., 2008).

Example 2: Foreign-born women have higher maternal mortality rates compared to native German women (Razum et al., 1999; Razum & Zeeb, 2004; Razum et al., 2008).

Infant mortality among immigrant women in Germany also remains relatively high compared to that among native German women, despite increases in access to healthcare (Spallek, Zeeb, & Razum, 2010).

Studies on children's participation in regular health screening tests have also documented lower participation rates within immigrant groups in Germany (Windorfer & Bruns-Philipps, 2002; Stadt Bielefeld, 2004; Zeeb et al., 2004). Research conducted in Bielefeld (Zeeb et al., 2004) and Berlin (Delekat, 2003) among school-age children found that children born to immigrants had lower immunization rates and lower participation in routine health checks, highlighting the need to improve information strategies directed at immigrants to increase their engagement with the German health system (Spallek, Zeeb, & Razum, 2010).

Conclusion

Immigrants are a heterogeneous population and thus present heterogeneous health problems. Some may have specific health conditions, such as infectious diseases; however, most of the health problems faced by immigrants are similar to those of the autochthonous populations of host countries. This is particularly true for immigrants who have resided in the new country for extended periods and for the descendants of immigrant populations (Spallek, Zeeb, & Razum, 2010).

For a broader perspective on how international bodies address these challenges, the International Organization for Migration's migration and health resources provide current policy guidance and research relevant to the issues discussed throughout this paper.

References

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