According to a study published in The Lancet, specific non-health public policies, such as restrictive migration entry and integration policies, can negatively affect the health of migrants. A Health in All Policies paradigm should be adopted to improve health inequality between migrant and native populations.
The researchers behind this systematic review and meta-analysis sought to examine the effect of non-health specific policies at multiple stages of the migration process on migrant health outcomes in high-income countries. Led by Helena Honkaniemi, PhD, of the Department of Public Health Sciences at Stockholm University in Sweden, researchers searched relevant databases, including PubMed, Embase, and Web of Science, for 46 quantitative studies comparing the health outcomes related to non-health public policies on migrant populations with comparison populations.
Of the 46 articles included, 19 qualified for the meta-analysis. Outcomes of interest included the effect of policy measures by migration stage (entry, integration, and exit) and by health outcome. Sub-analyses were used to classify policies as generous or restrictive and to evaluate health effects for heterogeneity by migrant population and context. Investigators performed both a random-effects meta-analysis of pooled estimates and a narrative synthesis of all included studies; outcomes were summarized as odds ratios (ORs) or as standardized mean differences (SMDs). Certainty of findings was estimated using the Grading of Recommendations Assessment, Development, and Evaluation.
Results of the meta-analysis (supported by narrative synthesis) showed that restrictive entry policies, including temporary visa status, restrictive border control policies, and reduced mobility in detainment, were associated with poor mental health outcomes (SMD 0.44; 95% CI, 0.13-0.75). At the integration stage, general restrictive policies, as well as policies regarding welfare eligibility and documentation were associated with increased odds of poor self-rated health (OR 1.67; 95% CI, 1.35-1.98) and mortality (OR 1.38; 95% CI, 1.1-1.65), but these subcategories of integration policies revealed mixed associations with mental health. Restricted welfare eligibility did not significantly affect public health insurance coverage (OR 0.89; 95% CI, 0.71-1.07), nor did it affect the number of uninsured individuals (OR 1.06; 95% CI, 0.9-1.21); however, welfare restrictions were associated with a reduced likelihood of migrants using general healthcare services (OR 0.92; 95% CI, 0.85-0.98).
Limitations to the study included low certainty due to the predominance of studies with high risk of bias; exclusion of some studies due to restricted search on languages; inadequate reporting of policy implementation practices; and lack of evidence for exit policies.
The researchers found that restrictive entry and integration policies associated with the migration process were linked to negative effects on mental health, self-rated health, and mortality in migrant vs native populations. The authors further suggest that the use of restrictive migration policies should be avoided in order to improve health inequality.
Juárez SP, Honkaniemi H, Dunlavy AC, et al. Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis [published online March 6, 2019]. Lancet Glob Health. doi: 10.1016/S2214-109X(18)30560-6