Population policies in advanced societies: pronatalist and migration strategies

Core health indicators in countries with high proportion of expatriates: Case study of Qatar

Background

Population size and structure have a huge impact on health indicators. In countries with a high proportion of expatriates, there are some limitations in estimating, aggregating and reporting of the health indicators, and corrections may be required in the established estimation methodologies. We review the case of Qatar to see how its specific population characteristics affect its health indicators.

Methods

We used routinely collected data and reviewed and calculated a selected list of health indicators for Qatari and non-Qatari populations residing in Qatar. Mortality and cancer incidence rates, stratified by nationality, were used for this purpose. Also, a direct method was used to estimate completeness of the death registry, compared to the mortuary data.

Results

Age and sex distribution of Qatari and non-Qatari populations are completely different. Compared to the mortuary data, completeness of death registration for the total population was estimated at 98.9 and 94.3%, with and without considering overseas deaths, respectively. Both estimates were considerably higher than estimates from the indirect methods. Mortality patterns were different even after standardization of age and stratification of sex groups; male age-standardized mortality rates were 502.7 and 242.3 per 100,000 individuals, respectively for Qataris and non-Qataris. The rates were closer in female populations (315.6 and 291.5, respectively). The leading types of cancer incidents were different in Qataris and non-Qataris.

Conclusions

Expatriates are a dynamic population with high-turnover, different from Qatari population in their age-sex structure and health status. They are more likely to be young or middle-aged and are less affected by age related diseases and cancers. Also, they might be at higher risks for specific diseases or injuries. Aggregating indicators of Qatari and non-Qatari populations might be mis-leading for policy making purposes, and common estimation correction approaches cannot alleviate the limitations. High-proportion of expatriate population also imposes significant errors to some of the key demographic estimates (such as completeness of death registry). We recommend a standardized approach to consider nationality in addition to age and sex distributions for analysis of health data in countries with a high proportion of expatriates.

Does Europe Need Immigrants? Population and Work Force Projections

It has been argued that Europe needs more immigrants to restore its age structure and its work force. Even if low European fertility continues, decline in the work force is relatively modest in the medium term and is considerably lower than the potential reserve labor force in Europe. It seems eccentric to propose the resumption of immigration for low-grade labor when there are 15 million unemployed in Europe, most under age 25 and many themselves immigrants, especially since future demand for labor emphasizes high skills. A resumption of general immigration to ensure population stabilization would require inflows much higher even than those previously considered unacceptable. Instead, attention should be given to making it easier for women to combine their desires for children with those for work.

Trends in European fertility: should Europe try to increase its fertility rate...or just manage the consequences?1

Currently across Europe, birth rates are falling and the population is aging. This paper describes these trends and assesses which policies can prevent or mitigate the adverse consequences of these two trends.