What is Migration Health? Alfonso Rodriguez-Lainz, PhD CDC Division of Global Migration and Quarantine 5 th Summer Institute on Migration and Health May 11, 2010
Dec 25, 2015
What is Migration Health?
Alfonso Rodriguez-Lainz, PhDCDC Division of Global Migration and Quarantine
5th Summer Institute onMigration and Health
May 11, 2010
Outline
• What is migration health? • What is migration?• Who is an international migrant?• Sources of international migration
data• Migrant health data sources• Migration data: the way forward
What is Migration Health?
Migration + Health
What is Migration Health?
Migration + Health
What is Health?
• “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (WHO, 1948)
What is Health?
• “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (WHO, 1948)
• … it also applies to migrant populations
(IOM, 2006)
Migration Health:beyond migrants themselves
• Health issues, conditions and risks related to migrant populations, and the way in which it also affects:– Population of origin,
– Communities in the places of transit and destination, and
– Second and later migrant generations
(Roux, 2004)(Roux, 2004)
Migration and the determinants of health
• Biological • Behavioral• Social environment• Physical
environment• Policies and
interventions• Access to care
• MIGRATION-Related factors
HEALTH
Migration-related factorsExamples
• Migration process – Reasons for migration (forced vs. voluntary)– Mode of travel
• Country of birth• Duration of residence (e.g., recent vs. long-term)• Migration status (e.g., legal residents, temporary
workers, refugees, unauthorized)• Language proficiency• Multi-country exposures (origin, transit,
destination)– Culture– Environment– Disease prevalence – Living and working conditions– Access to care
What is Migration Health?
Migration + Health
What is Migration Health?
Migration + Health
What is migration?
Photo: IOM
What is migration?
There is no universally accepted definition and consistency in the use of terminology to describe
migration
What is migration?
• Any process of movement of people, – either across an international border
(i.e., international migration) or within a country (i.e., internal migration)
– permanently or an a temporary basis,– whatever its causes
Source: J. Weekers (IOM) Global Consultation on Migrant and Health, Madrid, Spain (3–5 March 2010); adapted from IOM Glossary on Migration (2004)
Who is an International Migrant?
•No internationally adopted definition
Who is an International Migrant?
• Immigrants?• Aliens?• Migrants?• Illegals?• Foreign-born?• Migrant workers?• Mexicans?
• Refugees?• Foreigners?• Ethnic groups?• Minorities?• Farmworkers?• Seasonal workers• Etc.
Why do we care about definitions?
Why do we care about definitions?
• To better understand migrant communities and migration patterns– Limit contradictory or misleading information
• Achieve comparability of migration statistics among countries
• Evidence-based program/policy-making
Great diversity among migrants
• Country of birth• Migration pattern• Reasons for
migration• Culture• SES• Education• Occupation• Language• Migration status• Health Risks
Source: California Immigrant Integration Initiative of Grantmakers Concerned with Immigrants and Refugees
Migration Data Limitations
• Available data on migration has many limitations– “Enormous blind spot” – Even basic questions: e.g., How many?
Demographics?
• “Old problem”
• Some improvements in recent years
(Source: Commission on International Migration Data, 2009)(Source: Commission on International Migration Data, 2009)
Initiatives to Harmonize and Improve Migration Data
• United Nations – Recommendations on statistics of international
migration rev. 1 (1998)– Principles and Recommendations for Population
and Housing Censuses rev. 2 (2007)
• European Parliament and the Council of the EU Regulation (EC) No. 862/2007 (2007)
• Commission on International Migration Data (2009)
International migrant definitions
UN Recommendations
International Migrant UN Recommendations (1998)
• A person changing his/her country of usual residence
• “Country of usual residence”: Where a person has lived (or intends to live) continuously for at least 12 months
Sources: Sources: -UN Recommendations on International Migration Statistics (1998)UN Recommendations on International Migration Statistics (1998)- UN Expert Group Meeting on the use of censuses and surveys to measure international migration, UN Expert Group Meeting on the use of censuses and surveys to measure international migration, ESA/STAT/AC.132/1 (2007)ESA/STAT/AC.132/1 (2007)
International migrants:Immigrant vs. Emigrant
• From the perspective of …– the country of departure the person
will be an “emigrant”– the country of arrival the person will be
an “immigrant”
• “Migrant”: – More neutral term– It disregards the direction of
movement UN Recommendations on International Migration Statistics (1998)UN Recommendations on International Migration Statistics (1998)
Internal Migrant UN Recommendations (1998)
• A person changing his/her usual residence but within the same country– Rural to urban migration– Internally displaced persons (forced
migration)
International Visitors• Persons traveling to another country, and who
are admitted for short stays for purposes of: – Tourism– Visits to friends or relatives– Business– Religious pilgrimages
• Do not intend to establish a usual residence in the destination country
• Not generally considered international migrants
Some statistics …
International migrants
214 million (2010)
Internal migrants ~740 million (2009)
International visitors (recreational or business travel)
922 million (2008)
International migrants:Major categories
• Authorized migrants (temporary or permanent residence visas)
• Refugees• Asylum-seekers• Unauthorized migrants
Refugees• A person with a well-founded fear
of being persecuted for reasons of race, religion, nationality, social group or political opinion,
• is outside the country of his/her nationality and
• is unable or unwilling to avail himself of the protection of that country
• 15.2 million (2009)
(Source: UN Convention Related to the Status of Refugees and the 1967 Protocol) (Source: UN Convention Related to the Status of Refugees and the 1967 Protocol)
Asylum-seekers
• Similar to a refugee, but the person is in the country of intended residence at the time of his/her application
• 838,000 (2009)
Unauthorized migrants
• “A person who, owing to illegal entry or the expiry of his/her visa, lacks legal status in a transit or host country”– A.K.A: irregular, clandestine or illegal
migrant
(IOM Glossary of Migration, 2004)
Post-migration mobility patterns
• Settled permanently• Internal migration• Migrate to other country(ies)• Return migration• Circular migration
INTERNATIONAL MIGRATIONDEMOGRAPHICS
WEB-BASED DATA SOURCES
WEB DATA SITES
o UN Population Division
o Organization for Economic Cooperation and Development (OECD)
o Research Centers, Think Tanks, Advocacy Groups: e.g., Migration Policy Institute
UN Population Divisionhttp://www.un.org/esa/population/migration/inde
x.html
• Global Migration Database (1960-2010)
• CDs for purchase:– Trends in International Migration Stock: The
2008 Revision (CD)– International Migration Flows to and from
Selected Countries: The 2008 Revision (CD)
• International Migration 2009– Excel Table and Wall chart (Note: estimates
of 2010 data)
Organization for Economic Cooperation and Development
• 30 countries (e.g., E.U. States, U.S, Canada, Australia, Mexico, Japan)
• OECD Migration Databases– http://stats.oecd.org/Index.aspx?datasetcode=MIG
• International Migration Data 2009– Excel Tables (2007 data)– Reports:
• Sources and Comparability of Migration Statistics• Report: International Migration Outlook, 2009
Migration Policy Institute Migration Information Source
http://www.migrationinformation.org/
• “Non-partisan”• U.S and Global data• Many reports and statistics
International migrant:Country-level definitions
International migrant
• Countries use different criteria:– Country of birth (i.e., native vs. foreign born)– Country of citizenship (i.e., nationals vs.
foreigners)– Duration of residence– Legal admission categories– Purpose of entry– Country of residence – Ethnicity (e.g., Ethnic-Russian)
International migrant:U.S definitions
International migrant:U.S definitions
• Department of Homeland Security
• U.S Census Bureau
Department of Homeland Security
• Immigrants (LPRs or Green Card): Aliens (or foreign nationals) admitted to the U.S. for lawful permanent residence, as defined in the Immigration & Nationality Act
• Naturalized citizens: immigrants that acquire the U.S citizenship
• (Nonimmigrant) temporary admissions – Temporary visitors (tourists and business travelers)– Temporary workers, students, others
• Refugees and asylees
• Unauthorized migrants (estimates)
Department of Homeland Security
(Annual) Yearbook of Immigration
Statistics Immigrants (LPRs) 12.4 million
Naturalized citizens 14.3 million
(Nonimmigrant) temporary admissions-Tourists/business travelers
-Other temporary visas
33.3 million
3.7 million
Unauthorized migrants 11.6 million
Source: http://www.dhs.gov/files/statistics/immigration.shtmSource: http://www.dhs.gov/files/statistics/immigration.shtm
U.S Census Bureau
• Native: anyone who was a U.S. citizen at birth. Includes:- born in the U.S, Puerto Rico, American
Samoa, Guam, the Northern Marianas, or the U.S. Virgin Islands, or
- born abroad of at least one U.S. citizen parent
- Foreign-born: anyone who is not a U.S citizen at birth
U.S Census Bureau
• Foreign-born population: 37.9 million– Naturalized citizens: 16.0 million– Non U.S citizens 21.9 million
– Does not collect additional migration status information (e.g., LPRs, temporary visas, unauthorized, refugees)
Race/ethnicity vs. Foreign-born
Source: American Community Survey, 2008
Percentage of foreing-born and natives among major race/ethnic groups, U.S., 2008
3.9 8.0
39.1
67.1
96.1 92.0
60.9
32.9
0
10
20
30
40
50
60
70
80
90
100
White alone,not hispanic
Black orAfrican
Americanalone
Hispanic orLatino
Asian alone
%
Native
Forein-born
Migrant (Farm-) Workers • Occupational group• ~1 million (average in 2006)• 78% are foreign-born• ~50% are undocumented• Migration patterns
– Settled 53%– Shuttler migrants* 21%– Follow-the-crop migrants* 13%– Newcomers 13%
• Source: Kandel, William. Profile of Hired Farmworkers, A 2008 Update, Economic Research Report No. 60, Economic Research Service, U.S. Department of Agriculture, June 2008.
*International or within the U.S)*International or within the U.S)
American Community Survey (ACS) U.S Census Bureau
• Started in 2004• Replaces Decennial Census long form (in
2010)• By mail => phone => personal visit • Annual sample: 3 million households• Local-level data• Response rate: ~98%• Annual release of data!
ACSMigration Data
• Place of birth/nativity• U.S. citizenship• Year of entry• Ancestry • Language spoken at home• Year of naturalization (starting in 2008)• Place of residence 1 year ago• Health insurance coverage (since 2008) and
food stamp participation
Accessing U.S Census Data
1. Public Use Microdata Samples (IPUMS)
http://usa.ipums.org/usa/• Individual household level (no
identifiers)
• American Factfinder (pregenerated tables) Website: http://factfinder.census.gov/
U.S Census Bureau Data Limitations
• Undercounts migrants– Many not be present at time of census– No participation
• Undocumented• Distrust of government• May be illiterate or speak languages not
available in census forms
– Census often misses unofficial dwellings
Encampment in an empty parking lot
Unauthorized migrantsEstimation Methods
• Complex estimation calculations – Combination of data sources, and – Multiple assumptions
• U.S. Reports:– Department of Homeland Security– Pew Hispanic Center
Migration-relevant information on U.S health
data sources
U.S health data sources (1)
Data Sources Migration-related variables
Death registry Country of birth
Birth registry Country of birthParent’s country of birth
Cancer registry Country of birth
Caveats: -High % of missing or incorrect data
-Misclassification is not random
•Usefulness depends on accuracy and completeness of migration-related data•Usefulness depends on accuracy and completeness of migration-related data
U.S health data sources (2)
Data Sources Migration-related variables
Notifiable diseases
TB: country of birth & time in the U.SHIV: country of birth (recommended)Other diseases: none or limited
Hospital discharge data None
U.S health data sources (3)
Data Sources Migration-related variables
Population health surveys: - NHIS
- BRFSS
Country of birth & time in the U.S
None
General-Population Health Surveys
•Limitations:– Few migration-related variables– Questionnaires not validated for other
languages– Low response rate– Small sample size for migrants
International Migration Data Conclusions
• Many different sources of data• Limited migration data• Quality of data varies among countries
and agencies within countries• Comparability (definitions) issues• Undercoverage (e.g., unauthorized
migrants) • More recent data has better quality
Migration DataThe Way Forward
1. Harmonize definitions and data collection methods
2. Include a standardized module of key migration questions on main data sources
3. Use/disseminate currently available data (Adapted from Commission on International Migration Data, 2009)
Migration DataThe Way Forward (Cont.)
4. International coordination in data collection and exchange (including origin and destination countries)
5. Disaggregate data (e.g, gender, age, country of birth, time since arrival)
Migration DataThe Way Forward (Cont.)
6. Collect data on comparison groups of non-migrants
7. Specialized migrant surveys
Opportunity
• Major further progress can be made:– in the short term,– with limited cost, – within existing institutions, and– by implementing a few simple steps
(Commission on International Migration Data, 2009)
References
• International Organization for Migration (2004). Glossary on Migration
• Batalova J, Mittlestadt M, Mather M, Lee M. 2008. Immigration: Data matters. Washington, DC. Migration Policy Institute and Population Reference Bureau.
http://www.migrationpolicy.org/pubs/2008DataGuide.pdf
• Center for Global Development. Commission on International Migration Data for Development Research and Policy (2009) Migrants Count Five Steps Toward Better Migration Data. http://www.cgdev.org/content/publications/detail/1422146/
• UN Expert Group Meeting on the use of censuses and UN Expert Group Meeting on the use of censuses and surveys to measure international migration, surveys to measure international migration, ESA/STAT/AC.132/1 (2007)ESA/STAT/AC.132/1 (2007)
• International Organization for Migration. Managing Migration, 2004. www.iom.int//DOCUMENTS/PUBLICATION/EN/Migration_dec_2004.pdf