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