Social Determinants of Migrant's Health in Italy - Evidence from Duration of Stay and Migration History

Migrant health is known to be generally good and better than natives'. However, it is also acknowledged that health conditions of migrants deteriorate with length of stay in the host country. We believe it is essential to understand which factors contribute to this deterioration process which can become a public health issue with consequences on the overall health care system sustainability. Despite the recognition of its importance, European countries are still lacking a comprehensive knowledge of the health conditions of their immigrant populations. Indeed, according to the WHO, in Europe, strategies aiming at monitoring and managing the health consequences of migration have not been sufficiently addressed. In Italy in particular, the exceptional growth of the foreign population has not been followed by a deep analysis of the health conditions of migrants that remain still little explored, unlike other migration-related topics. This thesis is a contribution to the filling of this knowledge gap in Italy. The first research aim of this thesis is to shed light on the health conditions of migrants in Italy, paying particular attention to differences by country of birth. Second, we aim at studying the migrant/native health differential, finding evidence for the health advantage of migrants and its weakening over duration of stay in the host country. Consequently, we aim at understanding if the weakening leads to a convergence process of migrants towards natives that is able to bridge the differential or even overturn it. Third, we analyze the potential determinants of the convergence process focusing on the `social determinants of health' framework, which gives emphasis on social and structural explanations. In particular, we analyze the impact of socioeconomic status, integration and migration history on migrants' health and their interaction effects with duration of stay. Afterwards, we focus on migrant workers in order to analyze the association between working conditions and health status. Finally, we carry out an in-depth analysis on individuals in exogamous couples in order to study the impact of intermarriage with a native spouse, as a facilitator of integration, on the health conditions of the migrant spouse. Our results show that migrants in Italy enjoy good health conditions in the first years of arrival. However, they lose the health advantage towards natives in a short period of time. We identified many social determinants that are partly responsible of their health deterioration. It emerges that all the social determinants of health that we took into account interact with length of stay in the country. The observed detrimental impact of duration of stay on health is intensified by poor social, economic and working conditions. More specifically, we found that migrants who feel alone in Italy, who perceive themselves as being discriminated at work, who are not generally satisfied with their job and who have never experienced upward occupational mobility, are much more vulnerable to the effects of length of stay on health than migrants with better socioeconomic and working conditions in the HC. These results show a clear indication that it is not only the disadvantaged condition that has an impact on the health of migrants, but it is also the combination of such conditions with long duration of stay that is particularly detrimental. Indeed, the social, economic and working conditions of migrants need to be improved in order to guarantee the enjoyment of equal health conditions for all segments of the residing population in Italy.