Health monitoring should account for diversity of people with a migration background

Issue 3/2019 of the Journal of Health Monitoring presents new data on the health of children and adolescents with a migration background and describes the progress that has been made in establishing migration-sensitive health monitoring at the Robert Koch Institute (RKI).

Further developing methods and shaping scientific standards are of particular importance for the tasks of the RKI."

Professor Lothar H. Wieler, president, Robert Koch Institute

The RKI uses large surveys to analyze long-term trends in population health. 'Health monitoring should reflect population diversity' emphasizes Wieler, 'therefore, it is important that the German Federal Ministry of Health supports activities to increase the participation of people with a migration background in health surveys.' More than 20% of the people living in Germany have a migration background; this means that either they or at least one of their parents were born without German citizenship. Over one third of minors have a migration background.

People with a migration background are a highly heterogeneous group. Accounting for the diversity of people with a migration background and simultaneously ensuring comparability of different data sources presents a significant challenge. People with a migration background also participate less frequently in surveys, partly because of language barriers but also due to concerns about sensitive questions. Therefore, a migration-sensitive approach is essential in order to better involve people with a migration background in health surveys. In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is unique in Germany, this was realized during the baseline study (2003-2006) and KiGGS Wave 2 (2014-2017).

For the most recent analysis of the health situation, not only the migration background of the children and adolescents was taken into account, but also the length of stay of the parents in Germany, the language spoken at home and the socioeconomic status of the family. The latest issue of the Journal of Health Monitoring presents results from four health indicators for the 11 to 17 years age group: self-assessed general health, the utilization of pediatric and general medical services, overweight, and risky alcohol consumption. Regarding general health, for example, no differences were identified between 11- to 17-year-olds with and without a migration background. The vast majority of participants assessed their general health as very good or good.

People with a migration background will also be better included in future health surveys of the adult population. The IMIRA project (Improving Health Monitoring in Migrant Populations, www.rki.de/imira), which will be completed by the end of 2019, provides a basis for improving participation. The issue presents experiences with new concepts for migration-sensitive health monitoring. Feasibility studies have shown, for example, that increased personal contact and video interpreting improve the inclusion of hard-to-reach populations.

Numerous associations exist between migration and health. Immigrants who have recently arrived are often in particularly good health (the 'healthy migrant effect'). However, unfavorable working conditions and difficult socioeconomic situations can lead to deterioration in health.