10 th summer institute on migration and global health june 22-25, 2015 oakland, california, usa
TRANSCRIPT
10th Summer Institute on Migration and Global Health
June 22-25, 2015Oakland, California, USA
Marc Schenker M.D., [email protected]
University of California at Davis
An Overview of Global Migration and Health
•••••Summer Institute
•••••June 22, 2015
OutlineOverview of global migration
Migration demographics and economics
Health status and care for immigrants
Occupational health of migrant, vulnerable workers
Future directions
1. Migration has always been and will continue to be a natural phenomena for living species.
One seventh of the global human population is migrant.
Gray Whale Migration
Major Migration Flows (2000’s)
2. The major causes of global migration are likely to increase
in the future.
Natural disastersBiologic, geophysical,
climate-related (hydrologic,
meteorological)
Haiti, 1/13/2010
Philippines, 11/9/2013Indonesia, 12/26/2004
Dhaka, Bangladesh
Mexico: Migration to Cope with Drought and Disaster
Extreme EventsNot Enough Water
Too Much Water
Mexico:Migration to Cope with
Drought and Disaster
Experts predict 50 million environmental refugees by 2020,
200 million by 2050
2. The major causes of global migration are likely to increase
in the future.
Environmental Change Political Change (refugees)
The UN High Commissioner for Refugees estimates there were 40 million refugees
and IDP worldwide in 2012
UN Estimates 60 Million Refugees Worldwide – June 18, 2015
The major causes of global migration are likely to increase
in the future.
Environmental Change Political Change (refugees) Demographic and Economic
Disparities
Farmworker in Oaxaca earns (U.S.) $1.50/hr
Same farmworker in California earns $10/hr
1 hr Calif = 1 day Mexico
Global Migration• 232 million people live outside their country of birth (46 million
in the U.S.)
• 750 million internal migrants
• Demographics will make increased migration inevitable
• In 2016 there will be 87 entrants in workforce for 100 retirees.
• Only immigrants can make up this gap
• 342 candidates for every 100 jobs in developing countries.
Changing U.S. Immigrant Sources
1890 – 14.6% born abroad, mostly W & N Europe
1930 – 11.5% born abroad, most common Italy, Poland, Russia
2000 – Latin America and Asia
Ellis Island, 1902
Pew Center
Global Migration Money Flow
• World Bank estimates $542 billion sent in remittances annually
• 3.8 times the combined global foreign aid budgets
• 60 countries receive > $1 billion
• 22 countries remittances are > 10% of GDP
• Western Union has 5x the locations of McDonalds, Starbucks, Burger King and Wal-Mart combined!
3. Migration can have negative impacts on health in the origin, transit and destination locations Mental health Chronic diseases Occupational health Infectious disease ………etc
4. Social protections in health are reduced for the majority of
immigrants
Less workplace protection Less preventive (public) health care Migrants have less financial
resources Migrants may be excluded from
health care access (e.g. ACA)
Mexican Immigrant Adults Lack Connection to Health Care Facilities, California
Recent Mexican Immigrants
Longer-stay Mex-ican immigrants
Mexican Amer-ican
U.S.-Born Whites
39.6% 31.1%14.7% 9.0%
14.5%46.2% 66.3% 79.4%
42.4%20.9% 14.7% 9.2%
Doctor's office or health center Clinic None
Mexican immigrant adults have highest levels of
no medical visits in the past two years, U.S.
Mexican immigrant adults have the lowest levels of emergency room visits
Recent Mexican Im-migrants
Longer-stayed Mexican immigrants
Mexican-Americans U.S.-Born Whites
7.1%
11.9%
16.7%15.5%
Adults age 18 and over with no dental visit in past year
Recent Mexican migrants
Long-stay migrants (10+ years)
Mexican- Amer-icans
U.S. Born whites
62.4%
46.1%
34.3%26.8%
Chart Title
Mexican immigrant adults have the highest use of health or dental services -
Recent Mexican Immigrants
Longer-stayed Mexican im-
migrants
Mexican-Amer-icans
U.S.-Born Whites
8.1%
12.9%
5.3%
0.7%
10.6% 10.5%
0.9% 0.2%
Low income Other
in Mexico
Health Among Hispanics in the United States — 2009–2013
“Hispanics had better health outcomes than whites for most analyzed health factors, despite facing worse socioeconomic barriers, but they had much higher death rates from diabetes, chronic liver disease/cirrhosis, and homicide, and a higher prevalence of obesity. There were substantial differences among Hispanics by origin, nativity, and sex.”
MMWR, May 8, 2015
Active and Passive Smoking by Years in U.S., Mexican Women
Social Determinants of Health among Latino Immigrants
• Health care access• Poverty• Education• Employment• Language• Violence/safety• Discrimination• Fear of authorities (for undocumented)• Access to healthy foods• Housing and environment
Health Care for immigrants………
It Depends on Your Visa!
Mexican Immigrants have High Levels of Poverty
United States, all adults
Source: SSA, Inmigrantes Mexicanos y Centroamericanos en Estados Unidos, 2006http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196 and U.S Census, CPS 2006
Immigration and Occupation
Postville, Iowa
May 12, 2008
Source: Bureau Labor Statistics, Household Data Annual Averages
Employed Latinos in U.S. by Industry, 2010 (%)
Fatality Rate and % of Fatalities to Foreign Born Workers in the U.S.
Occupation and Industry Injury and Fatality Rates, ACS
Variable Natives Immigrants
Industry Injury Rate* 140.5 148.7
Occupational Injury Rate* 108.8 139.7
Industry Fatality Rate+ 4.7 6.5
Occupational Fatality Rate+ 5.9 7.5
Orrenius. Demography. 46:535, 2009*per 10,000 workers+per 100,000 workers
Why do some immigrants have worse occupational health outcomes than natives?
Work in more hazardous industries and jobs Different perceptions or knowledge of job risks Lower level of education, social capital, English
ability They have few alternatives
Precarious job (= Undocumented status)-- Unwilling to complain-- Risk taking
Poor Self-Rated Health in Female Workers by Employment Contract Type, ITSAL (Spain)
% Poor Health
Employment Contract Type
Permanent Temporary _x0004_None0
5
10
15
20
25
30
35
40
Spanish-Born
Foreign-Born (New)
Foreign-Born (Estab-lished)
Sousa, Int J Pub Hlth, 2010
Domestic Workers
Health issues of female foreign domestic workers: a systematic review
Malhotra, Arambepola et al. IJOEH, 2013
32 research papers or reports, 1990 – 2012 Most in Middle East or SE Asia
Work hours 14 – 18/day No rest days or hours common >50% report underpayment Sub-standard living conditions Other abuses: restricted mobility, food
deprivation, etc.
New Operational Frameworks are Needed
Monitor and study migrant worker health Health systems sensitive to migrant
worker status Equal health and safety protection and
enforcement for all workers Multinational approaches for immigrant
workers
Social campaigns to improve work conditions in overseas factories
“Every ethnic minority, in seeking in its own freedom, helped
strengthen the fabric of liberty in American life.
Similarly, every aspect of the American economy has profited from the
contributions of immigrants.”
John F. Kennedy A Nation of Immigrants (1958)
Migration and Health: A Research Methods
Handbook
Editors: Schenker
Castañeda Rodriguez-Lainz
UC Press
www.ucpress.edu2014
Thank [email protected]
www.ucghi.universityofcalifornia.edu/
@migranthealth
http://mahrc.ucdavis.edu/