Thesis title: The Health of Immigrants in Europe: Perspective from Multiple Countries
This doctoral thesis explores the health of immigrants in three European countries: Italy, Sweden, and Germany. It gives new insights into several aspects of immigrant health: risky behaviours among adolescents, immigrants’ contribution to life expectancy, and mental health among refugees. Results show that immigrants may be both advantaged and disadvantaged compared to other immigrants and natives of the host country. There is considerable variation among groups of immigrants, reflecting how heterogeneity in the immigrant population affects their health.
Chapter 1 provides the background to the three empirical studies. First, it describes the history of immigration in Europe after World War II, focusing, in particular, on immigration patterns in Italy, Sweden, and Germany. The chapter also provides statistics on the immigrant population of each country. Second, Chapter 1 outlines research on immigrant health in recent years.
Chapter 2 explores risky behaviours among adolescents in Italy, comparing native teenagers with adolescents with an immigration background. The study analyses data from the 2018 Italian HBSC, which includes 58,976 adolescents. The analysis focuses on three risky behaviours: alcohol consumption in the last month, smoking cigarettes in the last month and binge drinking in the last year. The immigrant background is assessed by considering both the adolescent’s immigrant status and their maternal geographical/cultural background. Maternal origin countries were categorized according to the Inglehart-Welzel Cultural Map of 2022, which divides countries based on geographical distribution and cultural values. The results indicate that 1.5- and second-generation immigrants are less likely than “native” Italians to consume alcohol and smoke cigarettes. Regarding binge drinking, only second-generation migrants are less at risk. No significant differences were found between the 1.5- and the second-generation in any model. However, several differences emerge based on the maternal geographical/cultural backgrounds with the reference category Catholic-Europe, which includes the natives. These findings show that immigrant adolescents are at less risk than natives, although there are considerable differences between groups of immigrant adolescents.
Chapter 3 investigates the impact of migrants from different origin regions and permit types on life expectancy in Sweden. Previous research found that non-Western immigrants contributed positively to the life expectancy of the Swedish population, and in 2019, their positive contribution exceeded the negative of Western immigrants. However, research indicates that immigrants are disproportionately likely to die from COVID-19, especially those from non-Western countries. Using population registers, this study analyses the life expectancy of the entire Swedish population from 2010 to 2021. The data allow us to account for the country of birth, permit type, date of birth and date of death. For both sexes, the results show that the refugee group has a higher life expectancy than Swedish natives, and their contribution to the general life expectancy is always positive, except during the COVID-19 pandemic. The ulterior decomposition of refugees and other permit immigrant groups for the origin area shows that not all refugees always contribute positively to the general life expectancy. Also, the findings highlight that some origin groups were more affected by the COVID-19 pandemic.
Chapter 4 investigates how the mental health of refugees who arrived between 2013 and 2016 in Germany is affected by pre-arrival and post-arrival characteristics. Previous research has shown that the mental health of refugees is affected by pre-, during-travel and post-immigration conditions. Using data from the German IAB-BAMF-SOEP Survey of Refugees from 2016 to 2020, we investigate which pre-arrival characteristics are associated with refugees’ mental health at the first interview and how the refugees’ lives affect their mental health over the first five years in Germany. For the pre-arrival analysis, we included variables about the origin country, the life of the refugees there, and the travel experience. For the post-arrival analysis, we considered the socio-economic status, the permit type and the worries about the future. The mental health status is measured through the Mental Component Score (MCS) derived from the SF-12 questionnaire, assessed at the first interview and after every second year of the surveys. The pre-arrival analysis shows that the refugees' mental health is affected by the conditions in the origin country and the trauma during the journey to Germany. On the other hand, in the longitudinal analysis, the MCS is influenced by changes in the employment status and the worries about life in Germany.
Chapter 5 contains the discussion and conclusion derived from the three studies.