the migrant health and wellbeing survey (maamu)

The Migrant Health and Wellbeing

Survey (Maamu)

Results

Aims of the survey

• to describe health and wellbeing, and the use of services in migrant populations

• based on the survey, a monitoring system is developed to plan and evaluate actions

• to promote integration and employment of migrants

• to promote health and wellbeing of migrants and their families

2 The Migrant Health and Wellbeing Survey (Maamu)

3

• The survey was coordinated by the National Institute for Health and Welfare, in collaboration with

– The Ministry of Social Affairs and Health

– The Finnish Institute of Occupational Health

– The Family Federation

– Municipalities

– Statistics Finland

• Funded by

– The European Social Fund

– The Social Insurance Institution of Finland

– The Finnish Work Environment Fund

– The National Institute for Health and Welfare

– Municipalities

The Migrant Health and Wellbeing Survey (Maamu)

Sample and participants

• Random sample from the Population Register

• 3 000 persons, 1 000 persons / ethnic group

• 6 cities: Helsinki, Espoo, Vantaa, Turku, Tampere, Vaasa

• Selection criteria

– Age 18–64-years

– country of birth: Somalia, Iraq/Iran, Russia/Soviet Union

– mother tongue: Kurdish, Russian/Finnish

– minimum one year residence in Finland

• Comparable information for the Finnish overall population from the Health 2011 Survey (same age frame and same cities)


Why these target groups?

• All among the largest migrant populations in Finland

• Potentially vulnerable groups

• To include both refugees and people who have other reasons for migration

• To cover different areas of origin (country of birth)


Implementation

• Planning and preparation started in 2008

– Including expert groups, focus groups and consultations with migrant organizations and health care professionals with the selected ethnic origins

• Pilot stage August-October 2010

• Data collection between December 2010 and May 2012.

• Basic results published in November 2012: Castaneda AE, Rask S, Koponen P, Mulki M, Koskinen S (eds.) Migrant health and wellbeing. A study on persons of Russian, Somali and Kurdish origin in Finland. THL Report 61/2012.


7

• The study consisted of

– an computer-assisted structured interview (60-90 minutes)

– a health examination (45-60 minutes)

– a short-interview for those refusing or not able to participate in the longer interview (15-20 minutes)

• Conducted by bilingual fieldwork personnel recruited and trained by THL

– Fieldwork coordinators for each team (3)

– Interviewers (13)

– Nurses (6)

– Students and other assistants (14)


Content of interviews:

• Background information

• Health status and chronic conditions

• Health behavior

• Experiences of discrimination and violence

• Health services

• Oral health

• Living conditions

• Social wellbeing

• Work


Content of health examinations: • blood pressure and pulse

• height and weight, waist and hip circumference

• oral health

• fingertip blood sample to measure haemoglobin (anemia)

• functional capacity: self reported and tested (hand grip strength, balance test, chair stand)

• Depression and anxiety (HSCL-25) and other symptoms (e.g. pain and allergy)

• blood samples (e.g. fasting glucose, blood lipids, liver function tests and inflammatory markers, vitamin D)

• Questions on HIV-awareness

• HIV, hepatitis and syphilis tests (with specific consent)


Participation

10

Russian Somali Kurdish

N % N % N %

Participation, at least one part 702 70,2 512 51,2 632 63,2

Health examination + full interview 466 46,6 317 31,7 480 48,0

Health examination + short interview 1 0,1 42 4,2 26 2,6

Only interview 79 7,9 34 3,4 28 2,8

Only health examination 1 0,1 19 1,9 14 1,4

Only short interview 155 15,5 101 10,1 81 8,1

Refused / no show / no appointment 201 20,1 299 29,9 226 22,6

Not contacted 84 8,4 144 14,4 134 13,4

Wrong address 22 2,2 38 3,8 54 5,4

Tried home visit 5 times 62 6,2 106 10,6 80 8,0

Moved / abroad 13 1,3 45 4,5 8 0,8

Total 1000 100 1000 100 1000 100


Socio-demographic factors and living conditions


Migration background

• Average migration age was 24–25 years.

• Those with Somali background had moved to Finland at younger age than other groups and they had lived longest in Finland.

• Mean time lived in Finland was over 10 years in all study groups.


0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

Russianmen

Russianwomen

Somalimen

Somaliwomen

Kurdishmen

Kurdishwomen

Other

Remigrant

Work-based immigrant,his or her spouse orchildren

Family-reunification

Aslum seeker orrefugee

Residence permit, by gender (%)


Basic education, by gender (%)

14

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

Russianmen

Russianwomen

Somalimen

Somaliwomen

Kurdishmen

Kurdishwomen

Finnishmen

Finnishwomen

High school

Elemanetary school

No education


0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

Russianmen

Russianwomen

Somalianmen

Somalianwomen

Kurdishmen

Kurdishwomen

Finnishmen

Finnishwomen

Retired or other

Unemployed

Work athome/housewife

Student

Employed

The main activity, by gender (%)


0%

10%

20%

30%

40%

50%

60%

70%


Men

Women

Experienced financial difficulties, by gender (%)


Self-rated health and long-term illnesses


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Russian Somali Kurdish Finnish

Men

Women

Self-rated health good or rather good, by gender (%)


0%

5%

10%

15%

20%

25%

30%


Men

Women

Prevalence of constant pain and aches, by gender (%)


Chronic disease risk factors


Body Mass Index (BMI), by gender (%)

21

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

Russianmen

Russianwomen

Somalimen

Somaliwomen

Kurdishmen

Kurdishwomen

Finnishmen

Finnishwomen

BMI ≥ 30

BMI 25-29,99

BMI < 25


0%

5%

10%

15%

20%

25%

30%

35%

40%


Men

Women

Prevalence of high blood pressure (systolic ≥ 140 or diastolic

≥ 90 mmHg and/or use of medication for high BP), by gender (%)


Lipids

• Total cholesterol levels were significantly lower among those of Somali and Kurdish background compared to the total population.

• Lipid levels of those with Russian background were very close to the levels of total population.

• HDL cholesterol levels were lower in all groups (except Russian men) than in the total population.


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Men

Women

Prevalence of low levels of vitamin D (< 50 nmol/l), by gender (%)


Infectious diseases


• Infectious diseases were rarely screened upon arrival to Finland, except among those who were refugees or asylum seekers.

• Over 95 % of those who participated to the health examination agreed to be tested for HIV, hepatitis and syfilis.

• Less than half of the participants had contacted health care professionals before visiting their country of origin (e.g. to be vaccinated)

• Infectious diseases were relatively uncommon; the most common was hepatitis B, no HIV infections were found

• The prevalence of infectious diseases reflected their prevalence in the country of origin.

• Awareness of HIV was low especially among those with Somali and Kurdish background.


0%

10%

20%

30%

40%

50%

60%


Men

Women

Correct answers to all five HIV awareness questions (UNGASS), by gender (%)


Oral health


Oral health • In all migrant groups the perceived oral health status

was worse than in the total population.

• 34-54 % of the participants reported having had tooth pain or other problems in teeth or dentures during the past 12 months, this was most common among women with Somali origin.

• Those with Russian and Somali background reported that they were brushing thier teeth at least twice a day as often than those in the total population. A third of those of Kurdish background reported brushing their teeth less often than recommended.


Reproductive health


Number of lifetime abortions among women aged 18–54 years (%)

31

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %


3 or more

1-2

None


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Somali Kurdish

Circumcision

Problems related tocircumcision

Prevalence of female circumcisions and problems related to the circumcision (% of female participants)


Mental health


0%

10%

20%

30%

40%

50%

60%


Men

Women

Prevalence of severe depression and anxiety symptoms over the last 7 days, by gender (%)


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Russian Somali Kurdi

Men

Women

Prevalence of trauma experiences in the country of origin, by gender (%).


0%

5%

10%

15%

20%

25%


Men

Women

Health service use due to mental health problems over last 12 months, by gender (%).


Lifestyle factors


0%

5%

10%

15%

20%

25%

30%

35%

40%


Men

Women

Prevalence of daily smoking, by gender (%)


Alcohol and substance use

• Nearly 40 % of those with Russian background aged 18–29 years had used cannabis.

• Compared to other groups there were less of those not using any alcohol at all and more of those using at least six doses of alcohol at one occasion among participants of Russian origin .

• Using any alcohol was rare among those with Somali background.


Eating habits and physical exercise

• Those with Somali background used fresh vegetables, fruits and berries less often than other groups.

• Men and women with Somali background and women of Kurdish background reported working strenuously less often than those in the total population.


0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


Men

Women

Fitness training for several hours per week, by gender (%)


Functional and working capacity


0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


Men

Women

Having difficulties or being unable to climb up the stairs (several floors without rest), by gender (%)


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Men

Women

Standing balance test performed successfully (for 60 seconds), by gender (%)


Understands spoken Finnish or Swedish not at all or poorly, by gender (%)

45

0%

5%

10%

15%

20%

25%

30%

35%

40%


Men

Women


46

Unable to use internet, by gender (%)

0%

5%

10%

15%

20%

25%

30%

35%

40%


Men

Women


Work ability, by gender (%)

47

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

Russianmen

Russianwomen

Somalimen

Somaliwomen

Kurdishmen

Kurdishwomen

Finnishmen

Finnishmen

Fully unable towork

To some extentunable to work

Fully able towork


Social wellbeing


49

Quality of life good or very good, by gender (%)

0%

20%

40%

60%

80%

100%

120%


Men

Women


Experiencing own life very or a lot meaningful, by gender (%)

50

0%

20%

40%

60%

80%

100%

120%


Men

Women


Having at least one good Finnish friend, by gender (%)

51

0%

10%

20%

30%

40%

50%

60%

70%

80%


Men

Women


Experiences on discrimination and violence


Experiences of discrimination in everyday life in Finland

0% 5% 10% 15% 20% 25% 30% 35% 40%

threatening/harassing

name-calling

disrespectful treatment

unpolite treatment

Russian

Somalian

Kurdish


0%

2%

4%

6%

8%

10%

12%

14%

16%


Men

Women

Experienced violence over the last 12 months, by gender (%)


Health care services


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Health check-up Eye examination

Health check-up or eyesight examination over last 5 years (%).

56

• Also women had

participated in cancer

screening less often

compared to the total

population


Outpatient and primary care visits during the past 12 months

• Compared to the total population

– Those with Somali- and Kurdish background reported more visits to municipal health centers

– Those with Kurdish background reported more visits to hospital outpatient clinics

– All migrant groups reported less visits to occupational health care and private clinics

• Women reported more physician consultations than men in all other groups except those with Kurdish background

• Visiting physicians outside Finland was common among women with Russian background (22 % of these women reported visits to physicians outside Finland during the past 12 months)


0%

10%

20%

30%

40%

50%

60%

70%

80%


Men

Women

Reported need for dental health services, by gender (%)


0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%


Need for continuous care

Unmet need for care

Reported need for continuous care by a physician and those not receiving the care they expected (%)


Satisfaction with latest physician visit

• Those with Russian background were most critical and those with Somali background most satisfied with the care they had received

• The participants were least satisfied with getting information on their own health (54-81 % reported getting enough information) and with possibilities to take part in decisions about their care (50-77 % reported being able to take part).

• 54-75 % thought that the care they had received had helped them


Conclusions


Achievements and challenges

• New information on health, wellbeing and integration

• Strengths among the migrant groups

• Good perceived heath

• Good quality of life and trust in the services

• Many issues improved by longer stay in Finland

• Worries among the migrant groups

• Mental health

• Experiences of discrimination

• Restrictions in functional capacity

• Overweight and obesity with Somali and Kurdish women

• Low vitamin D levels


Conclusions to developing heath care

• Culture sensitive, participatory approaches to health promotion are needed, activating migrants is essential

• Goals need to be set to prevent obesity and to promote physical activity, especially among women with Somali and Kurdish background

• Development of family planning and actions to promote reproductive health are needed especially among women with Russian and Somali background

• Work against female circumcision is needed also in Kurdish communities, not only the Somali communities.


Health promotion: information and support in collaboration

• Migrant groups need more information on health and health services

• Health in all policies: services and organizations (also non governmental) in the fields of e.g. sports and physical activity, education, housing, as well as those who organize activities to support migrant integration need to work together

• Support to health promoting choices and integration of migrants at individual, family and community levels by removing obstacles

– in cultural, educational, practical and economical factors

• Focus on health disparities


Conclusions about services

• Migrants’ insufficient knowledge about health services

• Professionals’ insufficient knowledge about migrants;

their culture and specific needs

65

• Understanding differences between migrant groups and

between individuals (e.g. culture and life experiences)

manifesting in differences in seeking health services

and in expressing personal problems and needs


Conclusions about mental health services

• Prevalence of depression and anxiety symptoms vs. use of mental health care services

– Unmet need for mental health care

• Challenges to mental health care:

– Stigmatization

– Self-refection, giving conceptualizing symptoms

– Culture specific characteristics taken into account both in identifying symptoms and in therapy Training professionals

– Complicated care system Easier access to care

– Limited language skills Challenges to develop interpreting services


Development of migrant health care

• Migrant specific services, e.g.

– Consulting team for migrants’ psychiatric care, specific hours for migrant women in sports centers and swimming halls

• Universal services, e.g.

– Child health care: focus to coping among migrant parents, mental health issues and promoting migrant women’s health (especially mental wellbeing among parents of Kurdish origin, prevention of obesity among women of Somali origin)

– Primary health care services: education for staff members to encounters with migrant patients and more use of interpreters when needed


Monitoring system

• Interactive database Terveytemme (Our health) www.terveytemme.fi

• TOIMIA-database www.toimia.fi

– Questionnaires and methods, and a recommendation on how to measure functional capacity in migrant populations

• New survey on work and wellbeing of people of foreign origin www.thl.fi/uth to be repeated in 4-5 year intervals


http://www.terveytemme.fi/

http://www.toimia.fi/

http://www.thl.fi/uth

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