Annali online dell’Università degli Studi di Ferrara Lessons on Health and Immigration in Europe International Course, Ferrara (Italy) September 22th-24th, 2014 Edited by Emanuela Gualdi-Russo Kari Hemminki Luciana Zaccagni ISSN 2038-1034 Sezione di Didattica e della Formazione docente Vol. 10 n.9 (2015) 2 Organized by: Università degli Studi di Ferrara TekneHub, Tecnopolo dell’Università degli Studi di Ferrara In collaboration with: German Cancer Research Center (DKFZ), Heidelberg, Germany With the patronage of: I.U.S.S. – Ferrara 1391 Scuola di Medicina dell’Università degli Studi di Ferrara Conference Venue: Polo Chimico-Biomedico, via Borsari n. 46, 44100 Ferrara (Italy) 3 Autorizzazione del Tribunale di Ferrara n. 36/21.5.53 Gualdi-Russo E., Hemminki K. & Zaccagni L. (Eds.) 2015. Lessons on Health and Immigration to Europe. Proceedings of International Course. Ferrara (Italy), 22th-24th September, 2014. Annali Online dell'Università degli Studi di Ferrara, Sezione di Didattica e della Formazione docente, Volume 10, n.9. ISSN 2038-1034 Copyright © 2015 by Università degli Studi di Ferrara Ferrara 4 Contents Preface Emanuela Gualdi-Russo, Kari Hemminki, Luciana Zaccagni 7 SECTION 1 - IMMIGRATION TO EUROPE 9 Achievements of the EU immigrant health related project EUNAM Kari Hemminki 11 Migration dans l’espace méditerranéen: Histoire et perspectives [Migration in the Mediterranean: History and perspectives] Chérifa Lakhoua, Hassène Kassar 35 Current immigration to Europe from North Africa. Health and physical activity Luciana Zaccagni, Davide Barbieri, Emanuela Gualdi-Russo 69 SECTION 2 - INEQUALITIES AND PSYCHO-SOCIAL FACTORS 79 Immigrants and ethnic disparities in health Vanessa S. Manzon 81 Adattamento psico-sociale nei bambini immigrati di seconda generazione [Psychosocial adaptation in second-generation immigrant children] Sabrina Masotti 97 Migration and mental health Giulia Piazza, Laura Negrelli, Sara Massarenti, Luigi Grassi 113 5 SECTION 3 - EPIDEMIOLOGICAL TRENDS 137 Establishment of Cancer Registries in Egypt and Morocco: Prevalent Cancers in both Countries Wagida Anwar, Dalia Sos, Karima Bendahhou, Abdellatif Benider, Amal S. Ibrahim, Kari Hemminki, Meriem Khyatti 139 Most salient communicable diseases in North Africa Meriem Khyatti, Yassine Zouheir, Wafaa Mohamed, Roxana-Delia Trimbitas, Mohammed Attaleb, Kari Hemminki, Wagida Anwar 159 Infections in migrants: global and local epidemiological issues Carlo Contini, Martina Maritati, Rosario Cultrera, Maria C. Di Nuzzo 191 Assessment of nutritional status and body image perception on immigrants Emanuela Gualdi-Russo 237 Obesità nelle popolazioni immigrate [Obesity among immigrant populations] Stefania Toselli 253 APPENDIX A 273 Anthropometric Techniques Natascia Rinaldo, Emanuela Gualdi-Russo 275 LIST OF AUTHORS 290 6 Preface This issue is published by the Ferrara University Press, Ferrara (Italy) under the auspices of the School of Medicine (University of Ferrara). The issue contains original contributions or reviews presented - with some integration - during the international course on “Health and Immigration” held at Ferrara in September 2014. The health of migrants is a critical issue for Europe. The main purpose of this course, organized as part of the European project EUNAM “EU and North African Migrants: Health and Health Systems” (leadership: Prof. Kari Hemminki, German Cancer Research Center, Heidelberg, Germany), was to depict the health status and disease, well-being, and use of health services among immigrant groups. The participants had the opportunity to assess the complexity of the migration dynamics and the health risks associated to changes in lifestyle and in social and cultural environments, learning appropriate care strategies and preventive measures to improve health for immigrants. The course lectures, encouraging participation and exchange information among participants, have been conducted by experts from various countries in Europe and North Africa, providing not only essential knowledge but also the opportunity to share different experiences and visions. The editors and the contributors hope that this issue will also be useful for anyone working to ensure the health of migrant and native population in the host country. The Editors 7 8 SECTION 1 IMMIGRATION TO EUROPE 9 10 Annali Online dell’Università di Ferrara Sezione di Didattica e della Formazione docente Vol. 10, n. 9, 2015. ISSN 2038-1034 Achievements of the EU immigrant health related project EUNAM Kari Hemminki Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany and Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden Abstract – The studies conducted by EUNAM show that immigrants are a vulnerable population experiencing in some aspects discrimination and hardship similar to the socially weakest national population groups. Immigration has changed the disease spectrum, particularly in infectious diseases and recessive conditions such as sickle cell disease and familial Mediterranean fever. Importantly, health questions of immigrant cannot be separated from those of any human health issues. Abstract – Gli studi condotti da EUNAM mostrano che gli immigrati costituiscono una popolazione vulnerabile, costretta a vivere in qualche modo la discriminazione e difficoltà simili a quelle dei gruppi socialmente più deboli della popolazione nazionale. L’immigrazione ha determinato un cambiamento nello spettro delle malattie, specialmente nelle malattie infettive e in alcune condizioni recessive quali l’anemia falciforme e la Febbre Mediterranea Familiare. E’ importante sottolineare che le questioni inerenti la salute dell’immigrato non possono essere disgiunte da quelle generali relative alla salute umana. 1.Introduction The EUNAM (EU and North African Migrants: Health and Health Systems) project delineated its task as “...it is important to survey wellbeing, health status, disease panorama and use of health services of immigrants compared to the native population; such analyses would be incomplete without casting a view on the same indicators and parameters in the country of origin”. While the EUNAM application was prepared already 5 years ago, when the Euro-Mediterranean spirit was at its peak, EUNAM has been alert to follow the events within its domain when the optimism vanished and 11 ensuing events caused new types of immigration and health problems (Hemminki, 2014a). Kassar and Dourgnon have visited refugee camps and researched on illegal migration routes (Dourgnon & Kassar, 2014; Kassar & Dourgnon, 2014). Kassar has shown that North Africa is a transit zone for migration from Sub-Saharan Africa, currently and historically (Kassar et al, 2014)(17). During its granting period EUNAM has met jointly twice annually and additionally in smaller groups discussing the thematic issues. In this final report we summarize the results and conclusions of the numerous scientific articles that EUNAM partners have published under the auspices of this funding scheme. We want to highlight the outcome by work-package (WP) described in the original work description. 2. Health and biological and psychosocial well being of North African immigrants in EU vs. natives and other immigrant groups (WP1) Epidemiological data show that the generally good health status of immigrants (“health immigrant effect”) declines after their arrival in the new country. Stress and factors linked to a new life-style can partly explain the deteriorating health status of the immigrant population and the emerging risks of diseases such as cardiovascular disorders, diabetes mellitus and asthma. The study by Moullan and Jusot (2014) discussed and provided new data on the concept of ‘health migrant effect’. They presented the ‘healthy migrant selection effect’ which postulates that migrants have a better health status than their countrymen, because only those in the best health emigrate while unhealthy migrants may also be more likely to return in their home countries. This health selection at migration could explain the better health status of immigrants. However, the results of Moullan and Jusot challenge the existence of a “health migrant effect” in Europe. Their study was based on large datasets from National Health Interview surveys from Belgium, France, Spain and Italy providing information on self-assessed health status. The results show a large health gap in favour of natives in Belgium and France and to a lesser degree in Spain. The exception was Italy where immigrants had a better health status than natives with respect to certain communicable diseases. They point out that the findings are consistent with the results of several recent studies on immigrants as compared to natives in Belgium, France and Spain. Their findings agree with the review and conclusions of Nielsen and Krasnick, who concluded that “In regard to self-perceived health, most migrants and ethnic minority groups appeared to be disadvantaged as 12 compared to the majority population even after controlling for age, gender, and socioeconomic factors” (Nielsen & Krasnik, 2010). The controversies about ‘health migrant effect’ are probably due to the definition of ‘health’. At least upon entry into the new country migrants are physically healthy, but the stress of the new social environment negatively influences self-assessed health status. Migration leads to lifestyle, psychological, and social environmental changes, which in turn may affect nutritional