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[移民与健康——从缺陷分析到多元视角?]

[Migration and health--from deficiency analysis to diversity vision?].

作者信息

Weber A, Hörmann G

机构信息

Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen (MDS) e. V.

出版信息

Gesundheitswesen. 2011 May;73(5):298-307. doi: 10.1055/s-0030-1249648. Epub 2010 Apr 9.

Abstract

In times of globalization the subjects migration and health are gaining more and more in importance. At the same time, one can observe a discrepancy between published opinions, politically intended messages and scientifically proved evidence. With approximately 15.4 million people with a migration background (this is equivalent to approximately 19% of the German population), migrants perform as an important "customer group" for health care and social security. In 2005, the category migrant background was introduced for the first time by the Federal Statistical Office. This category suggests homogeneity, which in fact is not given. Persons with migration background (including active immigrants, their children and grandchildren, repatriates, foreigners), have to be examined in a differentiated way concerning the consequences that the migration process has on health. Apart from potentially pathogenic influences associated with migration (e. g., ethnicity, national origin, cultural/religious characteristics, migration-related stressors), for example, education, social status, life-style and participation in work and society have to be taken into consideration as important "confounders". In this, a recent sociological approach (sinus migrant milieu) could be useful for socio-medical research and practice. Health-relevant information on migrants results on the one hand from scientific studies primarily designed for this purpose and, on the other hand, from routine data from official health reports. In the interpretation of secondary data, the problem arises that the definition of the target group (migrants) is different in the diverse data sources (for example, Germans, non-Germans, foreigners, migration background) and that important confounders (for example, from socio-cultural milieu) are not included. This may result in, among other things, an under- or overestimation of health risks or even incorrect conclusions. In consideration of these limitations, by means of data sets from official statistics (among others, Federal Statistical Office, social insurance agencies) and recent scientific research the present article analyses chosen aspects of migrant health (for example, health behaviour, morbidity, sickness absence, early retirement, health-care system, rehabilitation and mortality). Finally, possible implications for a more intensive discussion and further development of health care practice are pointed out.

摘要

在全球化时代,移民与健康问题愈发重要。与此同时,人们可以观察到已发表观点、政治意图传达的信息与科学证实的证据之间存在差异。拥有移民背景的人数约为1540万(约占德国人口的19%),移民成为医疗保健和社会保障的重要“客户群体”。2005年,联邦统计局首次引入“移民背景”这一类别。该类别暗示了同质性,但实际上并非如此。具有移民背景的人群(包括现居移民、他们的子女和孙辈、归国者、外国人),必须从移民过程对健康产生的影响方面进行差异化审视。除了与移民相关的潜在致病因素(例如种族、国籍、文化/宗教特征、与移民相关的压力源)之外,例如教育程度、社会地位、生活方式以及参与工作和社会的情况等,也必须作为重要的“混杂因素”加以考虑。在此方面,一种近期的社会学方法(移民社会环境)可能对社会医学研究与实践有所助益。关于移民的健康相关信息一方面源于主要为此目的而开展的科学研究,另一方面则来自官方健康报告中的常规数据。在对二手数据的解读中,出现了这样的问题:不同数据源中目标群体(移民)的定义各不相同(例如德国人、非德国人、外国人、移民背景),而且重要的混杂因素(例如来自社会文化环境的因素)未被纳入。这可能导致除其他情况外,对健康风险的低估或高估,甚至得出错误结论。考虑到这些局限性,本文借助官方统计数据集(包括联邦统计局、社会保险机构等的数据)以及近期的科学研究,分析了移民健康的某些选定方面(例如健康行为、发病率、病假、提前退休、医疗保健系统、康复和死亡率)。最后,指出了对医疗保健实践进行更深入讨论和进一步发展可能产生的影响。

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