In a recently published joint systematic review and meta-analysis synthesising all available evidence from the scientific literature, researchers from the Department of Public Health Sciences found that international migrants facing anti-immigrant policies restricting entry and reducing access to welfare are less likely to use general healthcare services (hindering individual and public health) and are at greater risk of poor mental health and dying from any cause compared to native populations.

Sol Juárez, Associate Professor at the Department of Public Health Sciences, Stockholm University. Photo: E Dalin

The researchers note that efforts to improve the health of migrants would benefit from adopting a ‘Health in All Policies’ perspective, which considers the health effects of all migrant-oriented policies, and by embracing a human-rights framework that emphasises the rights of migrants under international law.

“The steady rise in international migration from an estimated 155 million people in 2000 to 258 million in 2017 has been met with increasingly hostile policy responses across the world—putting migrants at risk of ill-health and psychological damage, and profoundly undermining their human rights”, says Dr Sol Pía Juárez, Associate Professor at the Department of Public Health Sciences, Stockholm University, who led the research alongside Professor Mikael Rostila, also of Stockholm University, and Dr Srinivasa Vittal Katikireddi, from the University of Glasgow, UK.

Andrea Dunlavy, PhD in Sociology at the Department of Public Health Sciences. Photo: N Björling

Co-author Dr Andrea Dunlavy adds: “More inclusive approaches to support the integration of migrants into their host societies is likely to have a positive effect on migrants’ health and life opportunities, as well as benefiting local populations. While international law supports improving the health of migrants, its enforcement is weak, and countries must be held to account. Without sustained and strong political action, healthy migration policies will not be achieved, to the detriment of all.”

Previous research on migrant health has largely focused on mental health, infectious diseases, or health inequalities between migrant groups, rather than looking at the effects of migration policies targeting social determinants of health such as access to labour markets, education, housing, and welfare services.

Mikael Rostila, Professor in Public Health Sciences, Stockholm University. Photo: N Björling

In this study, the researchers used a novel approach to isolate the effects of different public policy types (i.e., whether access to health-promoting resources and opportunities was generous, restrictive, or inclusive) at multiple stages of the migration process (i.e., entry, integration, exit) on health outcomes among international migrants.

They conducted a systematic review and meta-analysis of all quantitative studies published between January 2000 and September 2017, examining the impact of non-health-related public policies on migrant health, compared with other populations who had not been exposed to these policies. Data were analysed for 46 articles conducted in high-income countries that focused on the health-related impact of integration and entry policies. Pooled estimates from 19 articles were included in the meta-analysis.

The results suggested that more restrictive entry policies, including those pertaining to temporary visa status and detention, were associated with increased levels of poor mental health among migrants, among those psychological distress, depression, and anxiety.

Compared to groups exposed to less restrictive integration policies (particularly those related to welfare eligibility and documentation requirements), international migrants were more likely to report poor general health, faced greater risk of poor mental health and adverse birth outcomes (e.g., inadequate prenatal care and reduced perinatal outcomes), and were at higher risk of death.

Helena Honkaniemi, PhD Student at the Department of Public Health Sciences. Photo: N Björling

"Migration policies contribute to health inequalities and are key social determinants of health—impacting health directly through access to care, and indirectly via social and economic policies. Future research on how these policies impact medium- and long-term health, as well as whether the effects differ by gender, age, socioeconomic position, and reason for migration are missing and will be equally important for informing healthy migration policies”, says co-author Helena Honkaniemi, also from the Department of Public Health Sciences at Stockholm University.

There are several limitations in the study, including that the effects of migration policies have yet to be studied in low- and middle-income countries and across other dimensions of migration policy, such as housing and educational opportunities, and deportation and exit procedures. They also highlight some methodological limitations such as potential confounding (e.g., differences in unmeasured factors which may have affected the health outcomes of the study), and a lack of natural experimental studies to isolate policy effects—which limit the conclusions that can be drawn.

This text is based on the Lancet Global Health press release, announced at the time of the article’s online publication.
If you have any questions or feedback for their press release, please contact The Lancet Press Office: pressoffice@lancet.com

Publication in Lancet Global Health

The article was published online on March 6, 2019 and is available via Open access.
Juárez, S. P., Honkaniemi, H., Dunlavy, A. C., Aldridge, R. W., Barreto, M. L., Katikireddi, S. V., & Rostila, M. (2019). Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis. The Lancet Global Health 7(4):PE420-E435
https://doi.org/10.1016/S2214-109X(18)30560-6

"Health in All Policies"

WHO’s ‘Health in All Policies’ approach is particularly relevant for the health of migrant populations, who are affected by both general and migrant-specific policies in the destination country, including those pertaining to entry (visa and entry criteria), resettlement (dispersal policies), short-term integration (language classes), long-term integration (anti-discriminatory policies in the labour market, democratic participation, and citizenship policies), and forced and voluntary return migration (deportation procedures).

Related links

About the study

This study was funded by Swedish Council for Health, Working Life, and Social Research; UK Medical Research Council; Scottish Government Chief Scientist Office. It was conducted by researchers from Stockholm University, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; University College London, London, UK; Centre for Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil; University of Glasgow, Glasgow, UK.

Researchers from the Department of Public Health Sciences

Mikael Rostila, Professor in Public Health Sciences and project leader of the research group
Sol Juarez, Associate Professor in Public Health Sciences and leader of the research project
Helena Honkaniemi, PhD student in Public Health Sciences
Andrea Dunlavy, PhD in Sociology