Elsevier

Health & Place

Volume 18, Issue 6, November 2012, Pages 1282-1291
Health & Place

Heterogeneous patterns of health status among immigrants in Spain

https://doi.org/10.1016/j.healthplace.2012.09.009Get rights and content

Abstract

Objectives

(1) To analyse differences in the self-perceived health and mental health status between the Spanish population and immigrants from the seven leading countries in terms of number of immigrants; (2) to examine whether differences are accounted for by socio-economic charateristics, and (3) to determine whether the patterns of associations differ by gender.

Methods

Data come from the 2006 Spanish National Health Survey. The sample was composed of all 20–64 year old Spaniards and immigrants from the seven countries with most immigrants in Spain (Argentina, Bolivia, Colombia, Ecuador, Peru, Romania and Morocco) [n=20,731].

Results

In both sexes, people from Bolivia had poorer health outcomes, above all Bolivian males. Conversely, people from Argentina and Colombia had the best health outcomes. For the rest of the countries varied results depending on gender, country and health indicator were found.

Conclusions

Differences in health status between people born in Spain and foreign-born people depend on relationships between country of birth, characteristics of the migration process, gender, ethnicity and the health outcome analyzed.

Highlights

► There is a high heterogeneity in the relationship between immigration and health. ► Patterns of differences with Spain are different among countries with similar HDI. ► Patterns of differences with Spain differ among countries of the same geographical area. ► Health differences between Spaniards and immigrants differ by gender.

Introduction

In recent years a large number of studies on migration and health have been carried out mainly in the US, Canada, United Kingdom and Northern European countries. However, the results are not conclusive since some studies observe that immigrants have better health status than people from the host country while others find the opposite (Argeseanu Cunningham et al., 2008, Hyman, 2004, Lindström et al., 2001). These contradictory findings can be explained by several factors such as differences in the social, cultural, economical and political context both in the country of birth and in host countries, as well as for methodological reasons.

Most studies carried out in the US indicate that foreign-born individuals have a better health status than native-born Americans, including individuals of the same race/ethnicity (Argeseanu Cunningham et al., 2008). There are various possible explanations for this phenomenon including immigrant self-selection, where healthier and wealthier people tend to be migrants, health screening by recipient countries, healthy behaviour prior to migration, family networks and social support (Antecol and Bedard, 2006, Finch and Vega, 2003, Grant et al., 2004, Urquia and Gagnon, 2011).

Conversely, most studies carried out in Europe have observed poorer health status among immigrants (Borrell et al., 2010, Newbold and Danforth, 2003, Nielsen and Krasnik, 2010), which several explanations are proposed: immigrant health is negatively affected by the stress of the migration process, by poorer working and living conditions resulting from low occupational status, by more limited access to health care or lower likelihood of seeking medical assistance and preventive care (Nielsen and Krasnik, 2010).

There are several criticisms of previous research into immigration and health. For example, it has been pointed out that studies have often classified the migration phenomenon atheoretically (Bhopal, 2007). Many studies have compared the non-immigrant population with the immigrant population as if migrants were an homogenous group (Borrell et al., 2010, Carrasco-Garrido et al., 2009, Leao et al., 2009, Newbold, 2005), some have aggregated countries into high or low-income groups (Malmusi et al., 2010), and some have used the census categories for labelling ethnicity and race (Bhopal, 2007). Yet, it is important to bear in mind that migrants and ethnic minorities constitute heterogeneous groups with respect to their ethnic features, historical roots, culture, and health practices. Also, several factors may influence the health of the minority population such as the situation in the country of birth, characteristics of the migration process and socioeconomic factors in the host country (e.g. poor socioeconomic conditions or loss of social status) (Fang et al., 1996).

Moreover, some studies have not considered the potentially different gender patterns and have merely adjusted the analysis for sex assuming that factors explaining the association between immigration and health are similar for men and women (Hernandez-Quevedo and Jiménez-Rubio, 2009, Llácer et al., 2009, Newbold, 2005, Newbold and Danforth, 2003).

After decades of being a country with net emigration, in recent years immigration to Spain has grown rapidly. It was only at the beginning of the 21st century that immigration underwent a spectacular upsurge and in a very short time the Spanish foreign population came to represent more than 10% of the population. In 2005, Spain had one of the highest net immigration rates (15.0 per 1000) in Europe, only bettered by Cyprus (27.2 per 1000) and ahead of Ireland (11.4 per 1000). This is not only a much higher percentage than that of other Southern European migration regimes such as Italy, but also of “historical” immigration countries such as Germany and the Netherlands (Arango and Finotelli, 2009, Fernández, 2007). The Spanish economy has responded to the remarkable inflow from Eastern European countries (mainly Romania and Bulgaria) in recent years. However, prior to the accession of these countries, the economic crisis that hit Latin America and the Caribbean in the late 1990s encouraged many people from this region to migrate to Spain, a country with a shared language and cultural ties (Muñoz de Bustillo and Antón, 2010), including the possibility of obtaining Spanish citizenship in a relatively short period of time (just two years). Due to being a recent phenomenon, little is known on immigration and health in Spain compared with the number of studies in other European countries.

The objectives of this study are (1) to analyse differences in the self-perceived health and mental health status between the Spanish population and immigrants from the seven countries with most immigrants in Spain; (2) to examine whether differences are accounted for by socio-economic position, employment status, family characteristics and social support and (3) to determine whether the pattern of association differs by gender. Our hypotheses are: (1) patterns of associations between health and country of birth differ even among countries from the same region or with similar development level; (2) they also differ by gender; and (3) the associations between country of birth and health status are largely explained by socio-economic position, employment status, family characteristics and social support.

Section snippets

Study population and data collection

Data were obtained from the 2006 Spanish National Health Survey (SNHS), a cross-sectional survey based on a representative sample of the non-institutionalised population of Spain. A sample was selected using a multiple stage random sampling strategy. The first-stage units were census tracts. The second-stage units were family households. The sample size was 29,476. Data were collected through face-to-face interviews at home between June 2006 and June 2007 (Ministerio de Sanidad y Consumo, 2006

General description of the population

Table 1 shows the general description of the sample. Gender distribution differed by country. Whereas women were in the majority among immigrants from Ecuador, Bolivia and Colombia, there were no differences in gender proportions among people from Argentina, Peru or Romania, and males were in the majority among people from Spain and from Morocco. Among people born in Spain, women were older than men, but no gender differences in age were found for the rest of the countries. Women from Spain,

Discussion

This study, based on a large representative sample of the Spanish population, examined the differences in self-perceived health and mental health status among people born in Spain and those living in Spain but born in seven different countries (five South-American countries, Romania and Morocco) all having a lower human development index (HDI) (United Nations Development Programme, 2009) than Spain (classified as Very High Human Development index). We confirmed our first two hypotheses since

Conclusions

In conclusion, there is a high heterogeneity in the relationship between immigration and health among countries with lower HDI than Spain. While migrants from some countries have poorer health, there are no differences in other cases and some groups enjoy better health status than people from Spain. These patterns were not consistent with HDI or with the geographical region and differed by gender and the health outcome analyzed. These results emphasize the importance, in studies about migration

Funding

This work was partially supported by the CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.

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