Physical and mental health inequalities between native and immigrant Swedes
| Author | Vania Ranjbar,Ann Ekberg‐Jansson,Gunnel Hensing,Robin Fornazar,Henry Ascher |
| Published date | 01 April 2017 |
| Date | 01 April 2017 |
| DOI | http://doi.org/10.1111/imig.12312 |
Physical and mental health inequalities
between native and immigrant Swedes
Vania Ranjbar*, Robin Fornazar**, Henry Ascher*
,
**, Ann Ekberg-Jansson* and
Gunnel Hensing**
ABSTRACT
To study health inequalities between native and immigrant Swedes, we investigated differences
in self-rated health (SRH), mental wellbeing (MW), common symptoms (CS), and persistent
illness (PI), and if socioeconomic status (SES), negative status inconsistency, or social support
could account for such differences. A secondary analysis was conducted on questionnaire data
from a random adult population sample of 4,023 individuals and register data from Statistics
Sweden. v
2
tests and binary logistic regressions were used to identify health differences and
study these after accounting for explanatory variables. Compared with natives, immigrants
more commonly reported negative status inconsistency, poorer SES, and poorer social support
as well as poor SRH, very poor MW, and high level of CS but not PI. Significant differences
were accounted for by work-related factors and social support. We encourage future research
to address how pre- and peri-migration factors relate to immigrants’post-migration SES, social
support, and health status.
Policy Implications
•Given the relationship between work-related factors (employment status, hours worked per
week, and income) and all health outcomes in this study, labour market interventions that
facilitate the integration of immigrants into the labour market, and into occupations that
better correspond with their capacity, will arguably have public health benefits.
•Feelings of loneliness was, in our study, important in accounting for immigrants’poorer
self-rated health compared with natives’. Therefore, we endorse interventions that facilitate
immigrants’social networking and integration and thereby reduce feelings of loneliness.
•Common physical and mental symptoms may be important indicators of health and we,
thus, suggest these to be taken into account when developing ill-health prevention
programmes.
INTRODUCTION
Research has illustrated differences in self-rated mental and physical health between native and
immigrant Swedes, with immigrants reporting poorer health than natives (Leao et al., 2009; Rostila,
* Angered Hospital, Gothenburg
** Department of Public Health and Community Medicine, University of Gothenburg
doi: 10.1111/imig.12312
©2017 The Authors
International Migration ©2017 IOM
International Migration Vol. 55 (2) 2017
ISS N 00 20- 7985 Published by John Wiley & Sons Ltd.
2013; Tingh€
og et al., 2010). The healthy migrant effect found in some studies (HME; the hypothe-
sis that immigrants report better health than natives because those who migrate are a population’s
healthiest individuals) appears, therefore, not to be as applicable in the Swedish context. This is not
so surprising, given that previous research indicates that the healthy migrant effect is not applicable
to all types of migrants and in particular not so applicable to refugees (Domnich et al., 2012;
Ju
arez and Revuelta-Eugercios, 2016; Norredam et al., 2014), and refugees, including refugee fam-
ily reunifications, is one of the largest migrant categories in Sweden (other categories primarily
include other family reunifications, labour market immigrants, students, and EEA agreements;
Swedish Migration Agency, 2016a).
Explanatory models for the observed differences in health between native and immigrant Swedes
include pre-migration, peri-migration, and post-migration factors (Hjern, 2012). Although many
suggest an association between foreign origin and health, this association decreases significantly
once socioeconomic differences are accounted for (Andersen et al., 2011, Johansson et al., 2012,
Tingh€
og et al., 2010). Other factors associated with poorer health and often more common in
immigrants are unemployment, being in unqualified work, lack of mental stimulation, lack of uti-
lization of one’s skills, poor socio-cultural adaptation, financial difficulties, and low level of educa-
tion (Fritzell et al., 2004; World Health Organization, 2003; Padyab et al., 2013; Rostila, 2013;
Tingh€
og et al., 2010). Furthermore, immigrants tend to struggle more than natives to enter the
labour market, and those with work often acquire positions with lower status and salary, compared
with natives and in relation to their acquired education (Hjern, 2012); thus, negative status inconsis-
tency (high educational but low occupational status; Lenski, 1954) is arguably more common
among immigrant than native Swedes. Immigrants also tend to experience poorer work conditions,
including the ability to exercise influence (Hjern, 2012). The subsequent lower socioeconomic sta-
tus (SES) of immigrants is, thus, often argued to account for health inequalities between the native
and immigrant population.
This argument is reinforced by the negative relationship between SES and deprivation (Malmusi
et al., 2010): those with lower SES tend to have fewer material and social resources, and the fewer
resources an individual is perceived to have, the worse they tend to rate their health (Andersen
et al., 2011, Danielsson et al., 2012). Fewer resources entail a reduction in possibilities to attend to
various needs and possibly also a reduction in individual capacity for choices in private and profes-
sional life. Reduction in choice and lack of control may lead to stress (World Health Organization,
2003). Although stress typically results from excessive demands, it may also stem from insufficient
demands (Danielsson et al., 2012), that is, from lack of adequate stimulation. This can be particu-
larly pertinent to immigrants with negative status inconsistency, that is, those whose occupational
demands do not correspond with their level of education. The stress resulting from this status
inconsistency has the potential to affect immigrants’health negatively.
Another source of stress, and ill-health, is discrimination (Hjern, 2012, Johnston and Lordan,
2012). The mere experience of injustice may have implications for health (Levy and Sidel, 2013).
Racial discrimination may negatively influence social inclusion and job opportunities (World Health
Organization, 2003) which, in turn, may negatively affect an individual’s SES and resources,
including their social network and prospect for social support. The lack of a (supportive) social net-
work is an important factor when attempting to explain health inequalities (Leao et al., 2009, Ros-
tila, 2013), not least because such a network may alleviate the effects of stress by providing
emotional or instrumental support (Rostila, 2013). Immigrants often lose their social networks
through migration, and social exclusion in the arrival country further contributes to a lack of social
support (Leao et al., 2009, Rostila, 2013, Tingh€
og et al., 2010, World Health Organization, 2003).
In conclusion, post-migration factors such as social deprivation and exclusion appear more
important than foreign origin in explaining health inequalities. Previous studies, however, predomi-
nantly address only self-rated health, and few studies have focussed on the importance of status
inconsistency in explaining health inequalities between natives and foreign-born individuals. Our
Health inequalities among Swedes 81
©2017 The Authors. International Migration ©2017 IOM
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