Selected aspects of migrants` health

● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.3/2016 ●
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 3/2016 (10-14)
Selected aspects of migrants’ health
(Wybrane aspekty zdrowia migrantów)
A S Baranowska A-F
Abstract – The subject of the article is selected aspects of migrants’ health. The author has introduced a definition of migration as well as statistical data picturing the volume of the current
migration flows. The author has characterized health problems
occurring most frequently in voluntary migrants and refugees.
She has also explained the reasons for increased risk of disease
incidence and higher susceptibility to injuries in the population of
migrants. The author has also brought up the issue of barriers in
using host country’s healthcare system by migrants and has indicated the necessity of adequately prepared medical staff and psychologists working with culturally different people.
Key words - migrations, voluntary migrants, refugees, disease,
adaptation, healthcare.
Streszczenie – Autorka przedmiotem artykułu uczyniła wybrane
aspekty zdrowia migrantów. Przedstawiła pojęcie migracji oraz
dane statystyczne obrazujące wielkość współczesnych ruchów
migracyjnych. Dokonała charakterystyki problemów zdrowotnych najczęściej występujących u migrantów dobrowolnych oraz
u uchodźców. Wyjaśniła przyczyny zwiększonego ryzyka zachorowalności na choroby oraz większej podatności na urazy w populacji migrantów. Poruszyła zagadnienie barier w korzystaniu
przez migrantów z opieki medycznej w kraju przyjmującym oraz
wskazała na konieczność odpowiedniego przygotowania personelu medycznego i psychologów do pracy z osobami odmiennymi
kulturowo.
Słowa kluczowe - migracje, migranci dobrowolni, uchodźcy,
choroba, adaptacja, opieka medyczna.
Author Affiliations:
Adam Mickiewicz University in Poznań
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Correspondence to:
Aneta Sylwia Baranowska, Szamarzewskiego Str. 89, 60-568
Poznań, 722-180-780, [email protected]
Accepted for publication: July 2, 2016.
I. INTRODUCTION
O
ne of aggregate problems concerning almost every
part of the world is migration [1], defined in the literature as “territorial relocation connected with a relatively permanent change of the place of residence” [2].
Migrations constitute an answer of a local society to: the
deteriorating existential situation in the native country, the
lack of employment perspectives, and little chance of further development [3]. According to the data provided by
the Organization for Economic Co-operation and Development (OECD), almost 3% of the world’s population,
which is ca. 190 million people, permanently live outside
of their place of birth, and tens of millions of people reside
abroad illegally [4].
The change of the geographical surrounding brings a lot
of consequences, both in positive and negative terms. The
positive implication of migration is that the migrating people acquire the economic, cultural, and social capital by
participating in formal educational systems (universities,
educational programs), professional activity, and social life
of the host country [5]. Unfortunately, staying abroad also
creates a possibility of denationalization, breaking family
and social ties [6] as well as the occurrence of health problems. As various studies have demonstrated, migration is a
stressful event in the life of every relocating person, causing high level of both emotional and physical burden and
therefore the risk of the loss of the somatic and psychological health [7].
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II. HEALTH PROBLEMS OF VOLUNTARY
MIGRANTS
According to the research carried out by the International Centre for Migration and Health, there are occurrences
of various diseases that have risen among immigrants voluntarily living in the EU, e.g.: infectious diseases like tuberculosis and HIV/AIDS, neurological diseases, mortality
as a result of cardiological diseases, suicides among women and children aged 15-24. Characteristic for immigrants
are also: changes of mood, chronic apathy, irritation, annoyance, sleeplessness, the feeling of isolation and alienation, helplessness, psychological disorders (depression) as
well as the somatization of psycho-social situation resulting in recurring stomach aches, headaches, limb pain, fatigue, sleeplessness, gastrointestinal problems, genitourinary problems [8].
Due to the fact that migrants usually perform hard and
dangerous work, they are highly vulnerable to accidents
and physical injuries. World Health Organization’s data
may serve as evidence indicating that work-related accident rate in Europe is almost two times higher for the immigrant workers than for the native workers. According to
Gustav Verduzco and Maria Isabel Lozano’s research conducted among Mexican workers hired in Canada, 16.8% of
the respondents had had a work-related accident which
resulted in musculoskeletal injuries, and 31% of the subjects had suffered from ulcers, stomach diseases, skin disorders, allergies, back problems or muscle pains during
work. Migrants working as farmers in the United States
had also experienced many health problems e.g.: musculoskeletal system disorders, arterial hypertension, infectious
diseases, diabetes, eye diseases, urinary diseases [9].
It is worth mentioning that the above-mentioned health
problems are mainly noticeable during the first months of
the stay in a foreign country, because migrants are characterized by “the lack of orientation, weak ability to use the
health care system, and difficulties in communication in
the medical context”. All foreigners are concerned, also
those who come from cultures similar to the culture of the
host country in terms of language, symbols, or axiology
[10].
III. REFUGEES’ HEALTH
A group of migrants which is the most vulnerable to
health loss are refugees – people fleeing form persecution
in their native country due to their race, religion, ethnicity,
political beliefs or social group affiliation [11]. It should be
emphasized that refugees constitute a community with nu-
merous health problems even before they arrive in the host
country. Often already before and after the migration, they
have experienced war, tortures, imprisonment, the loss of
the loved ones, prolonged stays at refugee camps, socioeconomic difficulties, etc. These events have affected their
psycho-physical functioning [12]. Refugees struggle not
only with health problems characteristic of voluntary migrants, but they also suffer from posttraumatic stress disorder (PTSD). PTSD is characterized by the following symptoms: recreating the traumatic event some way, for example due to persistent memories, recurring nightmares,
strong anxiety disorders connected with stimuli associated
with the event; constant avoidance of the stimuli associated
with the trauma; reduced overall reactivity; the feeling of
alienation; pessimistic assessment of the future; persisting
high level of excitation resulting in sleep disorders, outbursts of anger, problems with concentration, the feeling of
strong distress and impairment of various social or professional functions [13].
IV. REASONS FOR MIGRANTS’ HEALTH
PROBLEMS
In the analysis of migrants’ health, it is worthwhile to
focus on the reasons of its deterioration in exile. Migrants’
weaker psycho-physical functioning is rooted mainly in the
difficulties and dilemmas they have to face once they have
arrived in the host country [14].
A prolonged stay abroad and the accompanying change
of cultural context implies the necessity of developing a lot
of elementary everyday life skills from the very beginning
[15]. Migrants begin to live their life in the society whose
standards and values are unknown to them. They also notice that the knowledge and abilities acquired in their native country are useless or even contradictory to the rules
of functioning in the foreign place [16].
Immigrants in a foreign country experience difficulties
in communication among the host community. The problem is not only the unfamiliarity of the language of the host
country but also the lack of knowledge concerning the
rules of nonverbal and relational communication in the
new culture [17]. As a consequence, ethnocentricity is displayed, which means interpreting other people’s behaviour
from the perspective of one’s own culture [15]. The aforementioned difficulties intensify the level of stress observed
in the host country.
In the course of adaptation, or the process of “acquiring
the qualities, characteristics and abilities enabling to function efficiently in a given, new situation” [18], migrants
frequently experience a culture shock. Culture shock is
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defined as “the result of difficulties encountered in the host
country and its essence is experiencing unpleasant emotions which accumulate and result in the deterioration of
the overall state of being, life satisfaction, and consequently the whole human existence” [19]. Culture shock is a
dynamic and active process of handling the change, a
negative reaction to a new culture [17]. This culture shock
is characterized by three different values: sadness caused
by various losses (of home, natural surroundings, people,
language, autonomy, identity), the feeling of stress and fear
as well as an identity crisis [20]. Among other symptoms,
culture shock also involves: boredom with the surrounding,
overall anxiety and distrust, exaggerated reactions to insignificant issues, decreased appetite, avoiding contact with
other people, especially with those outside of one’s culture
group [17], overload of the nervous system, fatigue, and
most significantly – lower psychological resilience [19].
Another stressor that may cause health problems, particularly of psychological nature, is an unfriendly attitude of
the host community towards migrants. The native society
usually shows foreigners their dissatisfaction or latent distrust [21]. They perceive migrants with anxiety, as migrants appear to them as intruders who want to deprive
them of their jobs or identity [20]. The host community
usually manifests discriminatory attitude towards migrants,
which is a tendency to treat people unevenly according to
their specific feature, e.g. appearance; insulting immigrants
in public through vandalism; propagating hatred e.g. by
publishing brochures with anti-Semitic remarks; limiting
full participation in public life [22].
Another source of stress in exile is a difficulty in finding
a job due to a gender, racial, or ethnic affiliation as well as
an unregulated legal situation. Migrants frequently experience segmentation on the job market. In practice, it means
that chances of being employed depend not only on the
human resources, e.g. education or soft skills, but also on
the cultural gender, race, ethnicity and legal status. Unemployment makes it harder to use health services, and thus
when diseases occur, their treatment is also more difficult.
On the other hand, migrants who have succeeded in obtaining a job usually perform the hardest and the least popular
jobs. They are employed in: dirty, hard, underpaid and
dangerous kinds of work, in domestic works such as cleaning, hotels, restaurants and other services related to tourism, on the black market, in industries with high seasonal
fluctuation as in agriculture, roadworks and construction
works [23]. Most of these jobs generate a high risk of deterioration of health, both in physical (e.g. construction
work) and psychological (e.g. working as a domestic help,
since women performing this kind of work frequently experience psychological violence) terms [24].
Another factor contributing to the deterioration of migrants’ health in the host country are housing conditions.
Migrants usually live in cheap, small places, not infrequently lacking sanitation. There are two main reasons for
this situation: firstly, migrants cannot afford renting an
apartment of a higher standard, and secondly, migrants
tend to save all the money they earn abroad [23]. Refugees
complain about particularly bad housing conditions. According to a study carried out in 2010 among 58 people
who have applied for a refugee status in Poland, refugees
live in overcrowded places, which lack privacy and basic
installations and appliances, e.g. running water, electricity,
or central heating [25].
The difficulties experienced by migrants are also intensified due to the lack of migration support groups, “which
are sets of interpersonal relations linking migrants, exmigrants and non-migrants in the native country with the
hosts by means of social bonds” [26]. If migrants have no
colleagues or friends who would help them to adapt to the
new socio-cultural surrounding, they have difficulties in
handling the problems they experience. Some of them cannot even rely on the support of the rest of the family staying in their native country. Migration is a phenomenon
which changes families and modifies family bonds; marital
conflicts are sometimes emerging, causing marriages to
break-up [5]. Refugees complain on the lack of support
similarly as on the housing conditions, because in many
refugee camps, there are no psychologists, who would help
them to overcome the trauma they have experienced [25].
In the light of the experienced problems, migrants have
developed various strategies to handle them. Some choose
constructive ways of managing difficulties, others decide
on destructive ways. The latter can be categorised according to three criteria: intrinsic or extrinsic direction; leading
to isolation or confrontation; and decreasing, defusing or
increasing stimulation. Various psychosomatic symptoms
belong to the group of strategies which decrease stimulation, lead to isolation and are directed intrinsically. Bad
mood provides a justification for migrants and the environment for the suffered failures, which of course does not
mean that immigrants plan or elicit them deliberately. A
confrontation with the environment directed extrinsically
and searching for stimulation is connected with displaying
risky behaviours, which compensate for the hardships related to the change of their place of residence. One of those
risky behaviours is alcohol or drug abuse, which in turn
leads to health problems [15].
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Factors that intensify the occurrence of diseases in migrants also include: the ill-judged decision to go abroad,
unsure future, strong longing for the homeland [14]. The
probability of health difficulties may also be generated by:
the choice of marginalisation or separation as a dominant
acclimatisation strategy, which is “the way of handling the
duality of the cultural situation every immigrant is facing”
[19], as well as individual features of migrants themselves,
such as: the lack of reorganisation, adaptation, and improvisation abilities, low stress-resistance, the lack of openness
to other people and no desire of affiliation [20]. The homeland is also worth mentioning, as the culture in which migrants grew up has prominent influence on the symptoms
and disorders displayed by them [27].
V. HOW MIGRANTS USE HEALTH SERVICES
Migrants experiencing health problems usually do not
make use of medical services in the host country. They
treat their conditions in home countries, when they visit
relatives, or decide on self-treatment [8]. Only in a lifethreatening situation they decide to visit a doctor in a foreign country. One of the barriers impeding migrants in the
use of medical treatment is poor knowledge of the host
country’s language. Foreigners usually have a problem
with understanding medical terminology and administrative issues accompanying the treatment, especially when
they are suffering from a disease, which further burdens
the patient. Therefore, migrants using medical services in a
foreign country cannot adhere to the doctor’s advice,
which in turn influences their health. Language barriers not
only make it harder for migrants to understand the doctor’s
advice, but also to register to the person qualified to give
medical advice. As migrants cannot come to understanding
with staff working at the registration desk, they resign
from the possibility to consult a doctor [10].
Another barrier are cultural differences between migrants and the host country’s society, e.g. Chechen women
must not be examined by male doctors. In a situation when
only male doctors work in a clinic, there is a high risk that
an ill Chechen woman will not undergo examination,
which in turn may lead to the deterioration of her health.
The reluctance to use medical services offered by the host
country frequently results from migrants’ bad experiences,
stereotypes, and the lack of health insurance due to their
irregular status [8].
Empirical studies carried out in the project “Factors Assisting and Restricting the Integration of Third Country
Nationals into the Labour Market, the Health Service and
Education: An Anthropological Case Study of the City of
Poznań” have shown that the studied foreigners encounter
the following barriers in using medical services of the host
country: unfamiliarity with the law concerning healthcare
in Poland; open discrimination due to their language, cultural or physical distinctness; the lack of commonly accessible, complete and up-to-date information on the
healthcare system in foreign languages; unfamiliarity with
the law concerning treating foreign patients by hospital
staff; ignoring foreign insurance by medical staff; prescribing drugs to doctors or the patient’s companion if they
have Polish citizenship and current health insurance, no
will from public institutions to help foreigners; and treating
immigrants stereotypically [10]. On the other hand, a research conducted on the immigrants in the USA and Canada concludes that using medical services are impeded due
to: the lack of independent transport in a situation when a
migrant’s workplace is remote from the hospital; long
working hours; and reluctance to inform employers about
health problems out of fear of losing their current or future
employment [9].
VI. CONCLUSIONS
To conclude, migrants constitute a high-risk group for
many diseases, especially infectious diseases, mental illnesses, and injuries resulting from accidents, usually in the
work environment. For that reason, this group should be
provided with the access to healthcare because healthy
migrants means greater public health safety (especially
concerning epidemics) [28]. Immigrant patients should be
treated by properly prepared medical staff who know the
law and procedures concerning foreigners and are aware of
cultural differences between people [10]. Refugees should
be under special care, especially psychological one. Every
refugee camp should offer them twenty-four-hour psychological help provided by psychologists capable of working
with culturally different people, victims of trauma, torture
or those suffering from PTSD [29]. Migrants’ health
should become a more significant issue of public
healthcare.
VII.
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