The Effects of Immigrant Status and Age at Migration on Changes in - PDF document

The Effects of Immigrant Status and Age at Migration on Changes in Older Europeans’ Health Introduction During the last half-century, two important processes, international migration and demographic ageing, have greatly influenced the age structure and ethnic composition of national populations in Europe. Many immigrants from the early post-World War II period did not go back to their countries of origin, as expected, but settled down definitively and aged in their countries of destination, mainly in Northwest Europe. This phenomenon has recently elicited interest in the ageing and health status of immigrant populations due to the demographic significance of their middle-aged and older members, which has rapidly increased in the last few decades. From 2008 to 2015, the number of elderly people living in Europe who have aged in countries other than where they were born increased from 7 million to 15 million (AAMEE 2008). In Germany, the most important “ old ” immigration country, annual registration data show that the older foreign-born population aged 60 or over has doubled roughly every 10 years, from 80,000 in 1970 to 160,000 in 1980, 320,000 in 1992 (after a short- term reduction in the late 1980s), and nearly 670,000 in 2001. In addition, the proportion of older people will increase in the coming decades (White 2006). Another reason for interest in foreign- born people is that a growing body of research has shown that the health status of older adults living in Europe is partly determined by their “immigration status , ” since some immigrant groups tend to have poorer health later in life than native-born people (Silveira and Ebrahim 1998; Pudaric et al. 2003; Solé-Aurò and Crimmins 2008; Leão et al. 2009; Vaillant and Wolff 2010). Other studies have documented great variations in the ageing process among immigrants, indicating that certain groups undergo successful ageing, whereas others do not (e.g., Lanari et al. 2015). 1

T he “health vulnerability” of immigrants aged 50 and over living in Northern and Western Europe has recently been highlighted (Lanari and Bussini 2012). The authors found that some immigrant groups are more likely to perceive and self-rate worse health and to suffer from depression more than native-born groups, even when demographic and socio-economic variables are taken into account. In particular, the facts of being born and living in a specific country, in addition to duration of residence and citizenship, give rise to an increased health status risk in particular immigrant groups. For example, people born in Eastern Europe living in Germany, France, and Sweden have poorer health than native-born people. A rapid deterioration in the health status of immigrants from Eastern Europe living in Germany has been shown by Ronellenfitsch and Razum (2004), despite their initial health advantages on arrival and improved socio-economic status over time. Other studies conducted in the United States have shown that, according to the “immigrant health paradox” literature, even when immigrants are relatively healthy when they arrive, this advantage decreases over time and eventually disappears, as some immigrants undergo a relatively fast decline in health and end up being disadvantaged in later life. Specifically, despite a health advantage at age 50, Hispanic young adult immigrants suffer a steeper decline in self-rated health afterward, whereas both non-Hispanic and Hispanic immigrants who migrated in late adulthood undergo much faster health declines in old age (Guberskaya 2014). Socio-economic disadvantages, cultural and linguistic barriers, unequal access to healthcare and social services, discrimination, the psychological stress of living in a new environment, and the lack of social and family relationships are all factors that can explain the increased risk of perceiving worse health among foreign-born groups compared to the majority of the population (Ringbäck et al. 1999; Silveira et al. 2002; Ronellenfitsch and Razum 2004). In addition, according to the theory of cumulative disadvantage (Dowd and Bengtson 1978), the successive addition of adverse circumstances over time — such as social and economic disadvantages — does not promote successful ageing but the opposite, potentially resulting in the onset of poor mental and physical health, which deteriorates with length of residence. Also, other research on inequalities in women’s 2

health in the United States support the “weathering” theory , according to which, early health deterioration of African women compared to native-born women is a consequence of the cumulative impact of repeated experience with social, economic, or political exclusion (Geronimus 2001). Other studies focused on the role of negative acculturation, reporting that “greater” degrees of acculturation were associated with problematic health outcomes (Alegría et al. 2008, 2007). The negative acculturation theory places significant importance on changes concerning immigrants’ tastes and preferences (worsening of dietary styles), adoption of risky behaviors (consumption of tobacco and alcohol and lack of physical exercise), and environmental exposure (living conditions) becoming more similar to that of the native population for adapting in the host country (Ceballos and Palloni 2010; Antecol and Bedard 2006; Abraido-Lanza et al. 2005). Additional explanations for the deterioration of immigrants’ health over time may be related to the political and economic context of the host country (racism, xenophobia, poor living conditions) and the disruption of religious and family ties, which could serve as important sources of support and protection against stressors (Viruell-Fuentes 2007; Silveira and Ebrahim 1998). Socio-economic factors in the host country, such as loss of social status and poor working conditions, may contribute to explaining immigrants’ health worsening, since many ageing migrants entered a country with little education and were employed in low-skilled and low-paid manual work (Warnes et al. 2004). Consequently, the higher probability for foreign-born people to be employed in jobs that are more dangerous or to perform riskier tasks than natives could result in more frequent fatalities and work-related injuries or other health problems that may explain deterioration in health. For minority populations such as asylum seekers and refugees, other factors related to the situation in their countries of birth may influence health since they may have experienced trauma, war, discrimination, and poverty (Akhtar 1999). This may be the case for individuals who migrate as adolescents or adults, who are likely to have vivid memories of life prior to migration compared to those who migrated as young children (Portes and Rumbaut 2006). These results emphasize the importance of considering the various 3

factors related to the social and political environments in their areas of origin and the receiving countries in explaining the health disadvantage of immigrants. Another hypothesis is that foreign- born people are less likely to have adequate healthcare coverage or familiarity with and established connections to healthcare systems (Carrasquillo et al. 2000). In general, migrants suffer lower access to specialist and preventive care and higher usage of emergency departments (Morris et al. 2005; Gravelle et al. 2003; Cots et al. 2007). In addition, the lack of language skills can be a great barrier to a proper understanding of the health system and may lead to later diagnosis and less optimal choice of treatment (Davies et al. 2006). Further evidence shows that experience with discrimination is a decisive factor in access to healthcare services (Agudelo-Suárez et al. 2009). In view of the above demographic trends and the higher probability of some immigrant groups facing health disadvantages, changes in various aspects of their health status during ageing have become a central concern for policy-makers. On one hand, the rising proportion of older people is placing further pressure on the overall healthcare spending and welfare systems of the host countries; on the other, better understanding of immigrants’ health status and behavior is needed so that clearly defined policy measures can be adopted and relevant healthcare services can be planned. It is equally important to understand how the effects of immigrant status on health may vary by country of origin and age at migration. Patterns of migration flows in Europe have changed over time; the size and composition of migrant populations reflects both current and historical patterns of migration flows. Many immigrants moved either from south to north or from east to west within Europe, mainly for economic or political reasons and limited opportunities in the country of origin. Others came from regions of similarly restricted opportunities, such as North Africa and South-East Asia after the independence of former colonies (Fassmann and Münz 1992). These international migrants have cultural, religious, and socio-economic backgrounds that differ from those of the host populations and that may influence their overall health. Another important key variable related to immigration status is “ age at migration ,” because it captures the length of exposure in both countries of origin and destination and the ability to 4