The political determinants of the health of undocumented immigrants: a comparative analysis of mortality patterns in Switzerland

Impact of legal status regularization on undocumented migrants’ self-reported and mental health in Switzerland

Undocumented migrants face cumulative difficulties like precarious living and working conditions or exclusion from health services that might negatively influence their health. Little is known about the evolution of undocumented migrants' self-reported health (SRH) and mental health after they get documented. This study aims to observe the effect of legal status regularization on SRH and mental health in a cohort of migrants undergoing regularization in Geneva, Switzerland. We evaluate SRH with the first item of the Short Form Survey (SF12) and depression as a proxy of mental health with the PHQ-9 questionnaire over four years among 387 undocumented and newly documented migrants. Using hybrid linear models, our data show that regularization has no direct effect on SRH, but has direct positive effects on mental health in a longitudinal perspective, even when controlling for competing factors. The arrival of the pandemic did not alter these effects. Migrants tend to evaluate their subjective health status more positively than the prevalence of screened depression shows. Those findings point towards better targeted policies that could reduce the burden of depression among undocumented migrants.

Learning from the COVID-19 pandemic response to strengthen undocumented migrant-sensitive health systems: case studies from four countries

Undocumented migrants are a vulnerable population group in the context of the COVID-19 pandemic due to increased risk of infection, severe morbidity, and mortality. In this Personal View, we analyze the COVID-19 pandemic responses, particularly vaccination campaigns, vis à vis undocumented migrants, and discuss lessons learned. Our empirical observations as clinicians and public health practitioners in Italy, Switzerland, France, and the United States are supplemented by a literature review, and presented through country case studies focusing on Governance, Service Delivery, and Information. We propose recommendations to capitalize on the COVID-19 pandemic response as an entry point to strengthen migrant-sensitive provisions into health system frameworks, by: providing specific guidance in health policies and plans; developing tailored implementation approaches with outreach and mobile services, with translated and socio-culturally adapted information, and engagement of migrant communities and third sector actors; and developing systematic monitoring & evaluation systems with disaggregated migrant data from National Health Service and third sector providers.

Healthcare Services for Undocumented Migrants: Organisation and Costs from the Italian NHS Perspective

Based on the principle of health equity, the Italian National Health Service is known worldwide for being a universalistic system that guarantees healthcare services for all its population, among which there are undocumented migrants. A commitment for their health needs is further motivated by their lower utilisation rates of healthcare services, which becomes even more crucial when considering chronic conditions such as diabetes that require adherence and continuity of care. However, the need for more official data has resulted in little research documenting these healthcare usage patterns. For this reason, our objective has been to deepen, from the Italian NHS perspective, the quantity, costs, type, preventability and organisation of healthcare services directed to undocumented migrants. We used official healthcare data from the Lombardy Region, which enable the identification of people receiving the STP code (undocumented migrants) and of people with foreign citizenship (documented migrants). After quantifying the average annual amount and expenditure for healthcare services grouped by Italian citizens, documented migrants and undocumented migrants for all clinical conditions (quantity and costs), we performed three primary investigations where we enlightened differences between the three mentioned groups focusing on the diagnosis of diabetes: (i) mapping the types of healthcare services used and their characteristics (type); (ii) quantifying the impact of preventable hospital admissions (preventability); (iii) examining the healthcare patterns linking pharmaceutical prescriptions with hospital accesses (organisation). Our results reveal significant differences among the three groups, such as more urgent hospital admissions, more preventable complications, and a higher recurrence in terms of access and costs to hospital services rather than pharmaceutical prescriptions for undocumented migrants. These findings can represent the leverage to raise awareness toward the emerging challenges of the migrant health burden.

The Challenge of Reaching Undocumented Migrants with COVID-19 Vaccination

Access to vaccination against a health threat such as that presented by the COVID-19 pandemic is an imperative driven, in principle, by at least three compelling factors: (1) the right to health of all people, irrespective of their status; (2) humanitarian need of undocumented migrants, as well as of others including documented migrants, refugees and displaced people who are sometimes vulnerable and living in precarious situations; and (3) the need to ensure heath security globally and nationally, which in the case of a global pandemic requires operating on the basis that, for vaccination strategies to succeed in fighting a pandemic, the highest possible levels of vaccine uptake are required. Yet some population segments have had limited access to mainstream health systems, both prior to as well as during the COVID-19 pandemic. People with irregular resident status are among those who face extremely high barriers in accessing both preventative and curative health care. This is due to a range of factors that drive exclusion, both on the supply side (e.g., systemic and practical restrictions in service delivery) and the demand side (e.g., in uptake, including due to fears that personal data would be transmitted to immigration authorities). Moreover, undocumented people have often been at increased risk of infection due to their role as "essential workers", including those experiencing higher exposure to the SARS-CoV-2 virus due to frontline occupations while lacking protective equipment. Often, they have also been largely left out of social protection measures granted by governments to their populations during successive lockdowns. This article reviews the factors that serve as supply-side and demand-side barriers to vaccination for undocumented migrants and considers what steps need to be taken to ensure that inclusive approaches operate in practice.