Dossier n. 217/2011 [Abstract] Immigrants’ health in Emilia-Romagna Region

Like many European countries Italy is currently facing increasing migration flows. During the last 15-20 years the number of immigrants has rapidly risen in Italy, reaching in 2009 7% of total population. For many years this has been the pattern in Emilia-Romagna, which can be explained with job opportunities as the reason for immigration. Also immigrant women are now entering occupational world, in particular for the increasing request of caregivers. The immigration phenomenon is therefore becoming structural and more stable, for family reunifications, mixed marriages and second generation youths.

Emilia-Romagna, with Umbria, Lombardia and Veneto, is characterised by the high prevalence of foreigners, reaching 10.5% in 2009.

Italy hosts many people coming from traditionally low income countries, that in the new country experience poverty, discrimination and barriers in accessing healthcare services. For this reason monitoring immigrants’ health status is an important tool for planning actions to tackle health inequalities and to improve their health conditions.

National immigration policies of last years have dealt with regulation and legal framework in a stricter way considering illegal immigration as a specific crime (Law n. 125/2008) and as an aggravating factor in case of crime, and transforming “ Centres for Temporary Permanence” into “Centres of identification and expulsion”, where foreigners can be kept even three times longer than in CPTs.

On the contrary Emilia-Romagna Region re-stated its engagement in policies for migrants’ integration. Through the second Programme for social integration of foreign citizens (2009-2011) and the 2008-2010 Regional Social and Health Plan, the Region confirms actions favouring universal and equal access to regional welfare services, without any reference to patients’ juridical condition.

Immigrants come from more than 190 different countries and their health is a crucial capital for the labour market, where they play an important role, even if the achievement of social integration is still a challenge.

From 2007 to 2009, a project coordinated by the Italian Centre for Disease Prevention and Monitoring of the Ministry of Health joined some national institutions (ISTAT: National Statistic Institute; INAIL: The Workers’ Compensation National Authority; AIE: Italian Epidemiological Association) and many Italian Regions. A standardized method to monitor the health profile of immigrants was implemented, and a minimum set of indicators using administrative data was developed, referring to both national and regional level, with the possibility to draw historical series. The study population is based on citizenship. Immigrants from countries with high emigration flows are compared to Italian citizens and to immigrants from developed countries. In 2010 a second phase of the project started and this Dossier is a first application of the national project at a regional level.

The first results in Emilia-Romagna confirm that by now there are only moderate health problems among immigrants, that generally are young and healthy (“healthy migrant effect”). Hospitalization is lower among immigrants than among Italians, both for men and women, when excluding obstetric causes Even if hospital admissions of immigrants increased from 3.1% of total in 2002 to 7.4% in 2009, the number continues to be lower if compared to the percentage of residents in the total population. However, immigrants tend to have more frequently urgent hospitalizations, probably due to limited knowledge of territorial health services and GPs.

Immigrants’ hospitalizations are on the average less expensive if compared to Italian population.

Most contacts with health services are due to physiological events such as pregnancy, or caused by lack of prevention measures such as injuries for men and abortion for women. Infectious diseases still represent a major issue among immigrants, both for men and women, but they seam to be restricted within their communities, as seen in the case of tuberculosis.

As for antenatal care, if compared to Italians, the proportion of immigrant women undertaking less than 4 visits during pregnancy or having their first visit after the first trimester is higher.

Immigrant pregnant women mainly attend public advisory centres, where they find care practices that respond to their specific needs. Moreover their deliveries are less frequenty caesarean.

Some new born babies parameters show a mild disadvantage among babies born from immigrant mothers, that is however less evident if compared with the differences observed in antenatal care.

As immigrants are healthy and young, their crude mortality rates are lower than Italian ones; this difference is presumed to decrease in the next future considering the progressive stabilisation of immigrant population in the new country and their relative ageing, together with their worse socio-economic conditions.

Besides answering a wide range monitoring demand, this work attempts to focus on some major issues related to immigrants’ health needs, without expecting to be exhaustive but with a standardised method. Given the complexity and the strong dynamism of the studied phenomenon, authors’ aim is also to arouse a methodological debate to share effective ways of data collection and dissemination. The wish is to contribute in building a stronger culture, able to make social cohesion and integration prevail on exclusion dynamics, often based on suspicion that are not supported by real data.