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Linking evidence for inequalities in physical and in psychological health by socioeconomic and immigration status: implications for health social work. Varda Soskolne School of Social Work, Bar-Ilan University, Ramat-Gan and Hadassah Medical Center, Jerusalem, Israel.

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Varda Soskolne School of Social Work, Bar-Ilan University, Ramat-Gan and Hadassah Medical Center, Jerusalem, Israel


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slide1

Linking evidence for inequalities in physical and in psychological health by socioeconomic and immigration status: implications for health social work

Varda Soskolne

School of Social Work, Bar-Ilan University, Ramat-Gan

and Hadassah Medical Center, Jerusalem, Israel

slide2
Health inequalities: immigrants

Linkages between health inequalities by immigration status and socio-economic position

A Case example of immigrants from the former Soviet Union to Israel

Physical health vs. psychological distress

Differences in utilization of health social work services

Implications for social work interventions & policy

Topics

Dr. Varda Soskolne, Bar-Ilan Universiy

slide3
Diverse patterns of inequalities

The “healthy immigrant” effect: better health than those that stay behind

Poorer health than the native, non-immigrant population in the host country

Health inequalities: immigrants

Dr. Varda Soskolne, Bar-Ilan Universiy

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BUT other examples:

Japanese who migrated to USA - worse health status than counterparts in Japan but better than Americans

Chinese in Australia - higher IHD and CVD rates than in China, but similar to the host population

Over time - a decline of differences

Health inequalities: immigrants

Dr. Varda Soskolne, Bar-Ilan Universiy

slide5
Mental health

General psychological distress – higher than the non-immigrants; variation between cultural groups

Mental disease – no consistent indication for higher ‘caseness’

Health inequalities: immigrants

Dr. Varda Soskolne, Bar-Ilan Universiy

slide6
Type of immigration: involuntary immigration or voluntary, single or in families, chain migration, legal status in the new country, etc.

Risk factors from the country of origin persist, often for more than a generation

Post-immigration factors: lower socio-economic position (SEP), limited psychosocial resources compared to non-immigrants

Determinants ofimmigrants’health inequalities

Dr. Varda Soskolne, Bar-Ilan Universiy

slide7

Social inequalities in health: Differences in health status by socio-economic position (SEP)The social gradient:With each decrease in SEP, there is an increase in morbidity and mortality rates

Dr. Varda Soskolne, Bar-Ilan Universiy

major explanations for social inequalities in health
Major explanations for social inequalities in health
  • Material deprivation
  • Psychosocial explanation:

Individual-level

Community-level

  • Life-course
  • Neo-materialist

Dr. Varda Soskolne, Bar-Ilan Universiy

immigrants from the former soviet union to israel as a case example
Immigrants from the former Soviet Union to Israel as a case example

Dr. Varda Soskolne, Bar-Ilan Universiy

research questions
Research questions
  • Do socioeconomic factors explain the adverse health status of the immigrants?
  • Do psychosocial factors and health behavior further explain the adverse health status of immigrants?
  • Are the associations with immigration status different for physical health and psychological distress?

Dr. Varda Soskolne, Bar-Ilan Universiy

why study social inequalities in health in israel
Why study social inequalities in health in Israel?
  • National Health Insurance Law, committed to assure “the principles of justice, equality and reciprocity”
  • From previous research - evidence for social inequalities in health: higher mortality and morbidity rates in the more disadvantaged sectors

Dr. Varda Soskolne, Bar-Ilan Universiy

slide12
In 1990 – 2000: close to one million

Surveys in the early 1990’s:

Social inequalities: Higher education level but lower income, occupation level

Health inequalities: Poorer physical health status, higher psychological distress

A higher proportion of elderly persons compared to the non-immigrants

Recent immigrants from the former Soviet Union

Dr. Varda Soskolne, Bar-Ilan Universiy

methods
Methods
  • A national random sample of 1328 people, aged 30-70 years, from a variety of Jewish urban areas*
  • Interviewed at home
  • For this analysis 1274 respondents:

1050 veteran residents and 224 immigrants from the former Soviet Union

* Manor & Soskolne, 2005

Dr. Varda Soskolne, Bar-Ilan Universiy

slide14

RESULTS*

* Part of the following analysis is based on the MPH thesis of Dmitry Taran, The Hebrew University – Hadassah School of Public Health, Jerusalem, 2006

Dr. Varda Soskolne, Bar-Ilan Universiy

slide15
Mean years of residence in Israel - 8.64 (SD=3.84)
  • The immigrants did not differ from the non-immigrants in age, gender or marital status
  • SEP indicators: significant differences

The immigrants (compared to non-immigrants) had

  • higher education
  • lower-level occupations
  • no cars in family
  • lower income

Dr. Varda Soskolne, Bar-Ilan Universiy

significant differences in health measures
Significant differences in Health measures

***p<0.001, #p=0.08

Dr. Varda Soskolne, Bar-Ilan Universiy

slide17
Research question 1:Do socioeconomic factors explain the adverse health status of the immigrants?

Physical health: SEP indicators factors do not explain inequalities in self-rated health

Depressive symptoms: Yes, current SEP indicators explain inequalities

Dr. Varda Soskolne, Bar-Ilan Universiy

slide18
Research question 2:Do psychosocial factors further explain the adverse health status of the immigrants?

Physical health: No

(the poorer health status of the immigrants remains significant)

Depressive symptoms: Small added explanation to that of current SEP indicators

Dr. Varda Soskolne, Bar-Ilan Universiy

slide19

Research question 3:Are the associations with immigration status different for physical health and psychological distress?

Yes.

SEP indicators and psychosocial factors do not explain inequalities in self-rated health

But, current SEP indicators and more psychosocial factors explain inequalities in depressive symptoms

Dr. Varda Soskolne, Bar-Ilan Universiy

slide20
Despite the higher health needs:

No difference in utilization of medical services between the immigrants and non-immigrants

Utilization of health social work services was lower among immigrant patients compared to non-immigrant patients

Different reasons for non-utilization

Insights from a study on

utilization of health services*

* Auslander, Soskolne & Ben-Shahar, 2005

Dr. Varda Soskolne, Bar-Ilan Universiy

conclusions
Conclusions
  • Effects of the ‘old’ countryon poorer physical health persist even a decade after immigration
  • Effects of the current SEP context, stressors and resources on inequalities in depressive symptoms
  • Utilization of social work services is highly influenced by perception from the Soviet Union
  • Relevance to immigrants from the former Soviet Union or from other East European countries

Dr. Varda Soskolne, Bar-Ilan Universiy

implications for social work
Implications for social work
  • Use evidence-base to identify most vulnerable immigrants
  • Promote utilization of social work services (raise awareness; decrease suspicion; outreach)

c) Better, culturally appropriate interventions, not necessarily more services; better interface with other services

d) Be the voices about the determinants of health inequalities

e) A greater involvement of social workers in health policy decision-making; the reduction of health inequalities should be a target of a national health policy

Dr. Varda Soskolne, Bar-Ilan Universiy