what is migration health? alfonso rodriguez-lainz, phd cdc division of global migration and...
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What is Migration Health?
Alfonso Rodriguez-Lainz, PhDCDC Division of Global Migration and Quarantine
5th Summer Institute onMigration and Health
May 11, 2010
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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
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What is Migration Health?
Migration + Health
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What is Migration Health?
Migration + Health
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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)
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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)
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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)
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Migration and the determinants of health
• Biological • Behavioral• Social environment• Physical
environment• Policies and
interventions• Access to care
• MIGRATION-Related factors
HEALTH
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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
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What is Migration Health?
Migration + Health
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What is Migration Health?
Migration + Health
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What is migration?
Photo: IOM
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What is migration?
There is no universally accepted definition and consistency in the use of terminology to describe
migration
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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)
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Who is an International Migrant?
•No internationally adopted definition
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Who is an International Migrant?
• Immigrants?• Aliens?• Migrants?• Illegals?• Foreign-born?• Migrant workers?• Mexicans?
• Refugees?• Foreigners?• Ethnic groups?• Minorities?• Farmworkers?• Seasonal workers• Etc.
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Why do we care about definitions?
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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
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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
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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)
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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)
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International migrant definitions
UN Recommendations
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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)
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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)
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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)
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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
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Some statistics …
International migrants
214 million (2010)
Internal migrants ~740 million (2009)
International visitors (recreational or business travel)
922 million (2008)
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International migrants:Major categories
• Authorized migrants (temporary or permanent residence visas)
• Refugees• Asylum-seekers• Unauthorized migrants
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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)
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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)
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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)
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Post-migration mobility patterns
• Settled permanently• Internal migration• Migrate to other country(ies)• Return migration• Circular migration
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INTERNATIONAL MIGRATIONDEMOGRAPHICS
WEB-BASED DATA SOURCES
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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
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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)
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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
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Migration Policy Institute Migration Information Source
http://www.migrationinformation.org/
• “Non-partisan”• U.S and Global data• Many reports and statistics
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International migrant:Country-level definitions
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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)
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International migrant:U.S definitions
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International migrant:U.S definitions
• Department of Homeland Security
• U.S Census Bureau
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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)
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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
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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
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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)
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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
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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)
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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!
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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
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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/
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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
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Encampment in an empty parking lot
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Unauthorized migrantsEstimation Methods
• Complex estimation calculations – Combination of data sources, and – Multiple assumptions
• U.S. Reports:– Department of Homeland Security– Pew Hispanic Center
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Migration-relevant information on U.S health
data sources
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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
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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
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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
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General-Population Health Surveys
•Limitations:– Few migration-related variables– Questionnaires not validated for other
languages– Low response rate– Small sample size for migrants
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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
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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)
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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)
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Migration DataThe Way Forward (Cont.)
6. Collect data on comparison groups of non-migrants
7. Specialized migrant surveys
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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)
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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