Abstract
BackgroundTo integrate immigrants into their societies, European countries have adopted different types of policies, which may influence health through both material and psychosocial determinants. Recent studies have suggested poorer health outcomes for immigrants living in countries with poorly rated integration policies.ObjectiveTo analyse mortality differences of immigrants from the same country of origin living in countries with distinct integration policy contexts.MethodsFrom the mortality dataset collected in the Migrant Ethnic Health Observatory (MEHO) project, we chose the Netherlands (linked data from 1996-2006), France (unlinked; 2005-2007) and Denmark (linked; 1992-2001) as representatives of the inclusive, assimilationist and exclusionist policy models, respectively, based on the Migrant Integration Policy Index. We calculated for each country sex- and age-standardized mortality rates for Turkish-, Moroccan- and local-born populations aged 20-69 years. Poisson regression was used to estimate the mortality rate ratios (MRRs) for cross-country and within-country comparisons. The analyses were further stratified by age group and cause of death.ResultsCompared with their peers in the Netherlands, Turkish-born immigrants had higher all-cause mortality in Denmark (MRR men 1.92; 95% CI 1.74-2.13 and women 2.11; 1.80-2.47) but lower in France (men 0.64; 0.59-0.69 and women 0.58; 0.51-0.67). A similar pattern emerged for Moroccan-born immigrants. The relative differences between immigrants and the local-born population were also largest in Denmark and lowest in France (e.g., Turkish-born men MRR 1.52; 95% CI 1.38-1.67 and 0.62; 0.58-0.66, respectively). These patterns were consistent across all age groups, and more marked for cardiovascular diseases.ConclusionsAlthough confounders and data comparability issues (e.g., French cross-sectional data) may affect the findings, this study suggests that different macro-level policy contexts may influence immigrants’ mortality. Comparable mortality registration systems across Europe along with detailed socio-demographic information on immigrants may help to better assess this association.
Highlights
Immigrants’ integration policy models in EuropeIn the context of decolonisation and economic expansion in the decades following World War II, Western European countries welcomed large numbers of immigrants to meet the increasing labour demand
From the mortality dataset collected in the Migrant Ethnic Health Observatory (MEHO) project, we chose the Netherlands, France and Denmark as representatives of the inclusive, assimilationist and exclusionist policy models, respectively, based on the Migrant Integration Policy Index
We found that residence in Denmark, a country with an “exclusionist” integration model, is associated with the highest mortality rates for immigrants from Turkey and Morocco, followed by the “inclusive” Netherlands and the “assimilationist” France
Summary
Immigrants’ integration policy models in EuropeIn the context of decolonisation and economic expansion in the decades following World War II, Western European countries welcomed large numbers of immigrants to meet the increasing labour demand. The “ethnic minorities”, “multicultural” or “individualistic-civic” model combines social and political tolerance and respect of cultural differences with facilities to acquire citizenship through residence or place of birth (ius soli), with the UK, Netherlands and Sweden consistently classified in this group. The “guest worker”, “differential exclusionist” or “collectivistic-ethnic” model, with Germany as historical prototype, assumes a conjunctural presence of immigrants based on the labour market needs. This model bases citizenship on ancestry (ius sanguinis), puts in place few active integration policies, and goes along with low levels of social and political tolerance. To integrate immigrants into their societies, European countries have adopted different types of policies, which may influence health through both material and psychosocial determinants. Recent studies have suggested poorer health outcomes for immigrants living in countries with poorly rated integration policies
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