6th European Public Health Conference: Thursday 14 November, 16:00–17:30
Methods Review of secondary data sources using information from web pages, publications and personal contacts. Cohort identification was based on relevant web pages (i. a. birthcohorts.net, chicosproject.eu). Birth cohorts were included if they were located in a European country. Publically available material of each birth cohort was screened for information on the inclusion of ethnic minority groups. To obtain more detailed information, birth cohorts were contacted individually between November 2012 and April 2013. Results Seventy-four European birth cohorts were identified, totaling more than 550,000 children in 21 different European countries. Of these, 55 (74%) birth cohorts collected information on ethnicity and 25 (34%) stated the percentage of ethnic minorities among study participants. Twelve studies (16%) could provide information stratified by different ethnic groups in their study and five studies (7%) used information on ethnicity for comparative analyses. In 51 (69%) of the birth cohorts participation of ethnic minorities was limited to persons who had adequate language skills of the country in which the study took place, which limited the ability of ethnic minorities to take part in the study. Conclusions The majority of birth cohorts assessed participants’ ethnic background; however, information on the proportion of ethnic groups and use of ethnicity for comparative analyses were scarce. Birth cohorts from countries with a high proportion of ethnic minorities often enrolled a comparatively low proportion of ethnic groups. More birth cohort studies are needed that explicitly include ethnic minority groups, actively enable participation of ethnic minority groups and conduct comparative analyses. Key messages In European birth cohorts, ethnicity is often measured, but seldom reported or used for stratified analyses. Birth cohorts should actively enable participation of ethnic minority groups and conduct comparative analyses. Measuring SES in immigration countries: ‘blind spot’ regarding specific resources and liabilities of migrants? Cross-sectional study Oliver Razum O Razum1, S Voigtla¨nder2, M Fauser3, H Tuncer3, E Liebau4, J Breckenkamp1, T Faist3 1 School of Public Health, Bielefeld University, Bielefeld, Germany 2 Bayerisches Landesamt fu¨r Gesundheit und Lebensmittelsicherheit, Sachgebiet GE6, Erlangen, Germany 3 Faculty of Sociology, Bielefeld University, Bielefeld, Germany 4 DIW, German Socio-Economic Panel, Berlin, Germany Contact:
[email protected]
Background Germany is an immigration country. Almost 20% of the population have a migrant background. Migrants experience health disadvantages, relative to the majority population. However, empirical data also show health advantages of migrants. Possibly, migrant-specific resources and liabilities are not validly reflected in the classical, national-state measures of SES such as income, as these do not consider transnational links and resource flows from, or to, the country of origin. For example, migrants may face liabilities due to remittances to their country of origin, so that their SES, if quantified by classical measures, is substantially overestimated. Methods Cross-sectional study using data of the German Socioeconomic Panel (SOEP) 2006-2010. Only persons who migrated themselves were included. Their degree of transnationality was measured using the dimensions ‘‘financial transfers’’, ‘‘personal relations’’, ‘‘transnational identification’’, and ‘‘cultural practices’’. Weighted logistic regression modelling allowed assessing the association between endowments with capital (economic, cultural, social) on the one hand and degree of transnationality on the other.
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Results The highest chance of transfers to their country of origin were found among migrants in the highest income tercile (OR = 4.7; p < 0.01), education tercile (OR = 3.1; p < 0.05), and with regular contact to neighbours (OR = 1.5; n.s.). The same applies regarding their chance of visits to the country of origin (OR = 2.4; p < 0.05; OR = 1.6; n.s. and OR = 1.9; p < 0.01) and for regular contacts with friends outside the host country (OR = 1.9; p < 0.05; OR = 1.5; n.s. and OR = 1.9; p < 0.01). No significant association with capital endowments was found for transnational ties to relatives, attachment to country of origin, and dual citizenship. Conclusions Transnational ties and resource flows can be observed among migrants of all socioeconomic strata; these flows tend to increase with higher capital endowments in Germany. Transnational ties and resource flows may thus partly explain apparently paradox (i.e., not explained by classical SES measures) health outcomes among migrants. A prospective panel study will be set up to establish whether a transnational lifestyle, provided it is associated with capital endowments, may even be conducive to migrants’ health. Funding DFG via SFB 882 ‘‘From heterogeneities to inequalities‘‘ Key messages Maintaining transnational ties is not associated with low socioeconomic status among immigrants in Germany and is thus not a sign of inadequate integration. Transnational ties and resource flows may partly explain apparently paradox (i.e., not explained by classical SES measures) health outcomes among immigrants. Health changes of refugees from Afghanistan, Iran and Somalia: role of residence status and experienced living difficulties in the resettlement process Majda Lamkaddem M Lamkaddem1, M Essink-Bot1, AAM Gerritsen5, W Deville´2,3,4, K Stronks1 1 University of Amsterdam, Dept. of Public Health, Faculty of Medicine, Amsterdam, The Netherlands 2 NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands 3 University of Amsterdam, Medical Anthropology and Sociology Unit, Faculty of Social and Behavioural Sciences, Amsterdam, The Netherlands 4 Pharos, Utrecht, The Netherlands 5 Epidemiologist at Epi Results, Louis Trichardt, South Africa Contact:
[email protected]
Introduction Refugees and asylum seekers are an important group of new immigrants in today’s Europe. Despite recent research efforts information on changes in health upon resettlement is scarce. We analyzed the mechanisms underlying changes in mental and physical health after arrival in The Netherlands in a longitudinal study among resettled refugees from Afghanistan, Iran and Somalia. Methods We examined the mechanisms underlying health changes by comparing cohorts of ‘new’ and longstanding refugees (n = 172) at two time-points (2003-2011). Mental health (PTSD, anxiety/depression) and general health (number of chronic conditions, self-reported general health) were assessed by questionnaire in face-to-face interviews. Multivariate analyses were used to assess the role of living difficulties (employment, social/family support, housing, cultural issues, social position), obtaining a residence permit, and use of mental health services, in health changes. Results Generally, mental and general health of ‘new’ refugees improved after obtaining a permit, while the health of refugees who already had a permit remained unchanged. Mediation analyses showed that positive changes in work and social support were key to the improvements in health of new refugees upon getting a permit. Timely use of mental health
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European Journal of Public Health, Vol. 23, Supplement 1, 2013
care was significantly associated with a decrease of symptoms of PTSD (OR: 7.58, 95% CI: 1.01-56.86), next to improvements in living difficulties. Conclusion The physical and social environment upon arrival are of key importance for the health developments of newly arrived refugees. Likewise, the timely use of mental health care appears to be essential for the course of PTSD symptoms in refugees. Key messages The physical and social environment upon arrival are of key importance for the health developments of newly arrived refugees. The timely use of mental health care appears to be essential for the course of PTSD symptoms in refugees.
women who make inadequate use of prenatal care. These insights need to be taken into account when developing measures to improve prenatal care utilization by non-western women in The Netherlands and other industrialized western countries. Key messages There are common factors explaining inadequate prenatal care utilization by first and second generation non-western women. Besides these common factors there also some factors explaining inadequate prenatal care utilization by specifically first generation non-western women.
Factors explaining inadequate prenatal care utilization by first and second generation non-western women in The Netherlands
Paul Kadetz
Agatha Boerleider AW Boerleider1, J Mannie¨n2, TA Wiegers1, AL Francke1,3, WLJM Deville´1,4,5 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands 2 Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands 3 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands 4 Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands 5 National Knowledge and Advisory Center on Migrants, Refugees and Health (Pharos), Utrecht, The Netherlands Contact:
[email protected]
Background In many industrialized western countries non-western women constitute a substantial part of the prenatal care client population. In The Netherlands, these women have also been shown to be more likely to make inadequate use of prenatal care. Explanatory factors for this include, among others, poor language proficiency, lower education and teenage pregnancies. However, these studies did not take into account the number of prenatal visits, and did not distinguish between first and second generation non-western women. By taking both prenatal care initiation and the number of prenatal visits into account, this quantitative study aims to provide a more in depth understanding of the factors explaining first and second generation non-western women’s inadequate prenatal care utilization in The Netherlands. Methods Data on prenatal care utilization and possible explaining factors were derived from the national DELIVER study, a cohort of 7907 women recruited between September 2009 and February 2011 from 20 primary midwifery care practices in The Netherlands. To assess prenatal care utilization, the Kotelchuck index was modified to the Dutch primary midwifery care context. Possible explanatory variables were grouped according to an elaborated version of the Andersen model of healthcare utilization. After initial descriptive and univariate analysis, logistic block wise regression analyses were conducted and percentage change in odds ratio calculated. Results Preliminary results show that whether or not having a partner, the partner’s ethnic origin and the language spoken at home, explain a substantial part of second generation non-western women’s inadequate prenatal care utilization. Explanatory factors for first generation women are: the two earlier mentioned factors plus planning and wantedness of pregnancy and socioeconomic status. Conclusions These results demonstrate that there are similarities and differences between first and second generation non-western
The benevolent dragon? How Sino-African health aid problematises the normative health diplomacy discourse P Kadetz1,2 Leiden University College The Hague, The Netherlands 2 China Centre for Health and Humanity, University College London, London, United Kingdom Contact:
[email protected]
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Background In 1955, Zhou Enlai met with other Asian leaders in Bandung, Indonesia, to chart a distinctly anti-colonial approach to diplomacy on the African continent. From its first health aid to Algeria in 1964, China has sought to distinguish its diplomatic work in Africa from that of the ‘‘global North’’, particularly in terms of political economic ideology. The practice of health diplomacy aims to prioritize the health care aspects of humanitarian aid as a mechanism for political economic negotiations between donor and recipient nations. Existing research concerning health diplomacy has failed to assess the context-appropriateness of the health care aid transferred, the manner in which health diplomacy is implemented, and the political and economic ideologies embedded in such transfers. This paper examines how health diplomacy may be understood in terms of the above-mentioned criteria. China’s health diplomacy is contrasted with examples of that of the US in order to assess whether the former constitutes an alternative and more successful approach to the normative health diplomacy of the ‘‘global North’’. Methods Archival research and semi-structured interviews with African and Chinese stakeholders were conducted in Beijing over a three week period in June 2012. Research was also conducted over a one month period in 2012 for the the Institute for Global Health of Peking University and UNAIDS. Results In terms of both structure and the actual health care interventions transferred, China’s health diplomacy is identified as being both distinct from normative (Western) health diplomacy and reportedly more effective according to stakeholder interviews and the review of Pew Trust opinion polls in African states. Conclusions The purported success of China’s health programming appears to be, at least in part, due to the context appropriateness of these interventions. Horizontal transfers, such as the building of health care infrastructure and human resources along with low technological transfers (such as herbal medicines) have been distinguished as particularly appropriate to local level contexts in African states. These findings could inform all health diplomacy to achieve health care interventions with more improved outcomes for health care systems and population health. Key message ‘South-South’ health care transfers in service of diplomacy offer alternative paradigms and different outcomes to health care systems & population health than normative ‘NorthSouth’ health diplomacy.
