Abstract
Germany is a country of immigration; 27% of the population are people with a migration background (PMB). As other countries, Germany faces difficulties in adequately including hard-to-survey populations like PMB into national public health monitoring. The IMIRA project was initiated to develop strategies to adequately include PMB into public health monitoring and to represent diversity in public health reporting. Here, we aim to synthesize the lessons learned for diversity-oriented public health monitoring and reporting in Germany. We also aim to derive recommendations for further research on migration and health. We conducted two feasibility studies (interview and examination surveys) to improve the inclusion of PMB. Study materials were developed in focus groups with PMB. A systematic review investigated the usability of the concept of acculturation. A scoping review was conducted on discrimination as a health determinant. Furthermore, core indicators were defined for public health reporting on PMB. The translated questionnaires were well accepted among the different migrant groups. Home visits increased the participation of hard-to-survey populations. In examination surveys, multilingual explanation videos and video-interpretation services were effective. Instead of using the concept of acculturation, we derived several dimensions to capture the effects of migration status on health, which were more differentiated. We also developed an instrument to measure subjectively perceived discrimination. For future public health reporting, a set of 25 core indicators was defined to report on the health of PMB. A diversity-oriented public health monitoring should include the following: (1) multilingual, diversity-sensitive materials, and tools; (2) different modes of administration; (3) diversity-sensitive concepts; (4) increase the participation of PMB; and (5) continuous public health reporting, including constant reflection and development of concepts and methods.
Highlights
According to the International Organization for Migration (IOM), the number of international migrants has been rising during the past 50 years, with most migrants residing in Asia and Europe in 2019 [1]
The Improving Health Monitoring in Migrant Populations (IMIRA) project was initiated at the Robert Koch Institute (RKI) in 2016. The aims of this project were (a) to develop strategies to improve the inclusion of people with migration background into public health monitoring, (b) to revise concepts and survey instruments, and (c) to further develop public health reporting on people with a migration background
Stratification for other migration-related characteristics was less frequent. These results show that comparability is lacking because countries defined migration background differently, and the quality of data diverges
Summary
According to the International Organization for Migration (IOM), the number of international migrants has been rising during the past 50 years, with most migrants residing in Asia and Europe in 2019 [1]. As the second top destination country after the United States of America [1], is a country of immigration. In 2020, more than every fourth resident (26.7%) had a so-called migration background, meaning that the person or at least one of their parents were born with a nationality other than German [2]. A total of 62.1% of this group were born abroad and migrated themselves, while 52.8% have. People with a migration background form a very heterogeneous subpopulation, differing (for example) in terms of time spent living in Germany, reasons for migration, living situation before and after migration, legal status, and many other
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