I urval från Stockholms universitets publikationsdatabas

• Effects of non-health-targeted policies on migrant health

  2019. Sol Juárez (et al.). The Lancet Global Health

  Artikel

  Background: Government policies can strongly influence migrants' health. Using a Health in All Policies approach, we systematically reviewed evidence on the impact of public policies outside of the health-care system on migrant health. Methods: We searched the PubMed, Embase, and Web of Science databases from Jan 1, 2000, to Sept 1, 2017, for quantitative studies comparing the health effects of non-health-targeted public policies on migrants with those on a relevant comparison population. We searched for articles written in English, Swedish, Danish, Norwegian, Finnish, French, Spanish, or Portuguese. Qualitative studies and grey literature were excluded. We evaluated policy effects by migration stage (entry, integration, and exit) and by health outcome using narrative synthesis (all included studies) and random-effects meta-analysis (all studies whose results were amenable to statistical pooling). We summarised meta-analysis outcomes as standardised mean difference (SMD, 95% CI) or odds ratio (OR, 95% CI). To assess certainty, we created tables containing a summary of the findings according to the Grading of Recommendations Assessment, Development, and Evaluation. Our study was registered with PROSPERO, number CRD42017076104. Findings: We identified 43 243 potentially eligible records. 46 articles were narratively synthesised and 19 contributed to the meta-analysis. All studies were published in high-income countries and examined policies of entry (nine articles) and integration (37 articles). Restrictive entry policies (eg, temporary visa status, detention) were associated with poor mental health (SMD 0·44, 95% CI 0·13–0·75; I²=92·1%). In the integration phase, restrictive policies in general, and specifically regarding welfare eligibility and documentation requirements, were found to increase odds of poor selfrated health (OR 1·67, 95% CI 1·35–1·98; I²=82·0%) and mortality (1·38, 1·10–1·65; I²=98·9%). Restricted eligibility for welfare support decreased the odds of general health-care service use (0·92, 0·85–0·98; I²=0·0%), but did not reduce public health insurance coverage (0·89, 0·71–1·07; I²=99·4%), nor markedly affect proportions of people without health insurance (1·06, 0·90–1·21; I²=54·9%). Interpretation: Restrictive entry and integration policies are linked to poor migrant health outcomes in high-income countries. Efforts to improve the health of migrants would benefit from adopting a Health in All Policies perspective.

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• Unemployment status and risk of all-cause mortality among native- and foreign-origin persons in Sweden

  Andrea Dunlavy, Sol Juarez, Mikael Rostila.

  Background: The association between exposure to unemployment and increased risk of mortality is well established. Yet migrants and their children often experience a number of stressors in the country of residence which could exacerbate the negative effects of job loss or unemployment. This study examined the extent to which region of origin and generational status modified associations between employment status and risk of all-cause mortality.

  Methods: Using population-based registers, an open cohort study of 2,178,321 individuals aged 25-64 was followed from 1993-2008. Hazard ratios for mortality were calculated using Cox regression. Employment status and socio-demographic covariates were included as time-varying variables in all models.

  Results: Relative to employed native-origin Swedes, excess risk of mortality was found among most groups of foreign-origin persons exposed to unemployment. The excess risk of mortality found among African women exposed to long-term unemployment (HR=3.26, 95% CI: 2.30-4.63),  Finnish men exposed to short-and long-term unemployment (HR=2.74, 95% CI: 2.32-3.24 and HR=2.39, 95% CI: 2.12-2.69), and  second generation Swedish men exposed to short-term unemployment (HR=2.34, 95% CI: 2.06-2.64) was significantly greater (p<0.05) than that found among their unemployed native-origin counterparts. Decreased risk of mortality was observed among the employed in nearly all foreign-origin groups.

  Conclusions: Our findings suggest that the mortality health advantage often observed among foreign-origin groups is most evident among the employed, while the magnitude of excess risk for mortality in the foreign-origin exposed to unemployment varies by generational status and region of origin.

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• Between Two Worlds

  2017. Andrea Dunlavy (et al.).

  Avhandling (Dok)

  This thesis aims to investigate the extent to which work-related factors contribute to the health inequalities often observed between foreign-origin and native-origin persons in Sweden. Four empirical studies using survey data and population-based registers assessed the health impact of different labor market adversities among groups of foreign-origin persons who were both in and outside the labor market relative to native-origin Swedes.

  Studies I and II examined associations between different measures of working life quality, including adverse psychosocial and physical working conditions and educational mismatch, and self-reported health among the employed. Adverse psychosocial and physical working conditions minimally contributed to the excess risk of poor health found among workers from low- and middle-income countries. Over-education had a stronger association with increased risk of poor health, most notably among foreign-born workers from countries outside of Western Europe. Under-educated women from these countries also demonstrated an elevated risk of poor health.  There was no association between educational mismatch and poor health among native-born workers. 

  Studies III and IV focused on the health implications of labor market exclusion, and examined relationships between employment status and risk of all-cause mortality and suicide. The majority of foreign-origin groups that experienced unemployment showed an elevated risk of both mortality and suicide. The magnitude of excess risk varied by generational status and region of origin. Variations in patterns of suicide risk were also evident among migrants by age at arrival and duration of residence. Yet within many foreign-origin groups, health advantages were observed among the employed.

  The health of migrants is affected by the confluence of several different pre- and post-migration factors.  The extent to which health inequalities are found among persons of foreign-origin in Sweden is influenced by the degree to which they experience labor market adversities, as well as differential vulnerability to the negative effects of these adversities across foreign-origin groups.

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• Arbetsmiljön bland utrikesfödda anställda i Sverige

  2017. Andrea Dunlavy, Mikael Rostila. Arbetsmarknad & Arbetsliv 23 (1), 46-65

  Artikel

  Denna artikel syftar till att utöka kunskapen kring arbetsmiljöförhållanden bland utlandsfödda på den svenska arbetsmarknaden. Studien undersöker hur exponering för bristfälliga psykosociala, strukturella och fysiska arbetsmiljöförhållanden varierar mellan olika grupper av anställda kvinnor och män beroende på födelseland. Resultaten visar skillnader när det gäller exponering för bristfälliga arbetsmiljöförhållanden mellan utlandsfödda och inrikes födda anställda på den svenska arbetsmarknaden. Dessa skillnader beror på den grupp som undersöks och det arbetsmiljöproblem som studeras.

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• Educational mismatch and health status among foreign-born workers in Sweden

  2016. Andrea C. Dunlavy, Anthony M. Garcy, Mikael Rostila. Social Science and Medicine 154, 36-44

  Artikel

  Foreign-born workers have been shown to experience poorer working conditions than native-born workers. Yet relationships between health and educational mismatch have been largely overlooked among foreign-born workers. This study uses objective and self-reported measures of educational mismatch to compare the prevalence of educational mismatch among native (n = 2359) and foreign born (n = 1789) workers in Sweden and to examine associations between educational mismatch and poor self-rated health. Findings from weighted multivariate logistic regression which controlled for social position and individual-level demographic characteristics suggested that over-educated foreign-born workers had greater odds ratios for poor-self rated health compared to native-born matched workers. This association was particularly evident among men (OR = 2.14, 95% CI: 1.04-4.39) and women (OR = 2.13, 95% CI: 1.12-4.03) from countries outside of Western Europe, North America, and Australia/New Zealand. Associations between under-education and poor-self rated health were also found among women from countries outside of Western Europe, North America, and Australia/New Zealand (OR = 2.02, 95% CI: 1.27-3.18). These findings suggest that educational mismatch may be an important work-related social determinant of health among foreign-born workers. Future studies are needed to examine the effects of long-term versus short-term states of educational mismatch on health and to study relationships over time.

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• Health Inequalities among Workers with a Foreign Background in Sweden

  2013. Andrea C. Dunlavy, Mikael Rostila. International Journal of Environmental Research and Public Health 10 (7), 2871-2887

  Artikel

  Employment and working conditions are key social determinants of health, yet current information is lacking regarding relationships between foreign background status, working conditions and health among workers in Sweden. This study utilized cross-sectional data from the 2010 Swedish Level of Living Survey (LNU) and the Level of Living Survey for Foreign Born Persons and their Children (LNU-UFB) to assess whether or not health inequalities exist between native Swedish and foreign background workers and if exposure to adverse psychosocial and physical working conditions contributes to the risk for poor health among foreign background workers. A sub-sample of 4,021 employed individuals aged 18–65 was analyzed using logistic regression. Eastern European, Latin American and Other Non-Western workers had an increased risk of both poor self-rated health and mental distress compared to native Swedish workers. Exposure to adverse working conditions only minimally influenced the risk of poor health. Further research should examine workers who are less integrated or who have less secure labor market attachments and also investigate how additional working conditions may influence associations between health and foreign background status.

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