Leader: Patrizia Farina (UNIMIB); Other collaborator(s):
In the next years, also foreigners will contribute significantly to population aging in Italy. What is worrying is that they will constitute a vulnerable group for three main reasons. A) The “healthy migrant effect” wears out at advanced ages, because of the unfavourable working and living conditions of foreigners. B) The absence of family networks undermines their well-being and health, and the ethnic network support may not be a sufficient compensation. C) Linguistic and cultural differences, and the difficulty of navigating the complex maze of services, could hamper their access to health services.
Brief description of the activities and of the intermediate results
Several actions were carried out during the period. Firstly, we are working on a paper titled “Immigrant presence in the Italian Health System. History of a Slow Discovery” for an upcoming international conference in Venice on May 22-24. Additionally, we are preparing a long abstract titled "Migration and Health: Evidence and Challenges in the Italian Context" for the SIS conference in Bari, which will take place in June. Both of these contributions focus on the health of non-native populations and anticipate the use of data from a survey we are currently designing. We have also collaborated on drafting a research project for Fondazione Cariplo's call for proposals, "Inequalities Research - Generating Knowledge to Reduce Inequalities." This project, titled "Loneliness and Aging: migrants and natives between Vulnerabilities and Resilience," explores the unique challenges faced by migrant populations. Finally, we have revised the health section of a survey questionnaire that is currently being implemented.
Main policy, industrial and scientific implications
As global populations age, the health concerns of aging migrant communities take on greater urgency. Whether migrants by choice or circumstance, their journey often presents distinct obstacles that can compound the effects of aging. These challenges encompass various dimensions.
Addressing these challenges necessitates policy interventions tailored to the specific needs of aging migrants. Key considerations include:
Addressing the health needs of aging migrant populations requires a collaborative approach involving policymakers, community organizations, healthcare providers, and stakeholders. By crafting policies that are culturally sensitive, inclusive, and responsive to the diverse needs of aging migrants, we can advance health equity and enhance outcomes for this vulnerable demographic.
Brief description of the activities and of the intermediate results
On 22-24 May 2024, in Venice, the research group presented the paper "Immigrant presence in the Italian Health System. History of a Slow Discovery". It proposes a narrative review of the approaches used to study the issue of health and migration and the analyses carried out over the last forty years. The maturing of the migratory phenomenon has in fact forced a change, from the first recognition of the "Salgari syndrome", which affected doctors in particular and conditioned relations with patients, to the disappearance of approaches that insist on the profile of the "healthy migrant". Undoubtedly, the number of people who arrive in a less than satisfactory state of health due to the conditions under which they travelled and/or left the country of origin has increased, as have those arriving to join family members and through ethnic networks, for whom a precarious state of health is not an obstacle. These factors have completely changed the profiles of those who have arrived in the last thirty years. We also presented during the 52nd SIS Conference, held in Bari, on June 2024, 17th-20th, the long abstract titled "Migration and Health: Evidence and Challenges in the Italian Context" [Methodological and Applied Statistics and Demography IV], which analyses the databases available to examine migrant population health. Additionally, we collaborated on drafting a research project in response to Fondazione Cariplo's call for proposals, "Inequalities Research - Generating Knowledge to Reduce Inequalities." The proposed project, titled "Loneliness and Aging: migrants and natives between Vulnerabilities and Resilience," explores the unique challenges faced by migrant populations. Finally, we have revised the health section of a survey questionnaire that is currently being implemented.
Main policy, industrial and scientific implications
Our analysis recognises that the studies and analyses conducted over the decades have been conditioned by legislative provisions and the slowly improved provision of standardised information in national health information systems. These elements have been central to composing the ongoing jigsaw puzzle depicting the evolution of the challenging study of the health conditions of different segments of the population resident in Italy. More accurate, standardised, and harmonised data are needed to better understand health conditions and related needs in a population highly diversified.
Brief description of the activities and of the intermediate results
The group has carried out a narrative literature review on the ageing migrant population in Italy, and a systematic analysis of the existing literature on the health of the ageing migrant population is currently underway. Rather than focusing on scientific medical literature, the analysis examines the state of health, understood as well-being, and the health needs of the population aged 55 and over. This age limit is chosen to take account of the demanding living conditions that migrants encounter throughout their lives, as well as the concept of old age, which is strongly linked to the society and culture of origin and differs for demographic reasons. The survey, which has so far been limited to Italian-language literature, has yielded modest quantitative results, demonstrating that the subject requires considerable effort both from the point of view of academic research and from the point of view of social and health policy. A survey of the international literature in English and French, the languages most widely used in countries that have been interested in the phenomenon of non-native ageing for longer, is still in progress. The result should allow the creation of a more detailed and specific reference framework (and database), especially in relation to migration experiences similar to those in Italy.
Main policy, industrial and scientific implications
The analysis of the scarce Italian literature points to the limitations of policies and services that cannot promote specific strategies to meet the health needs expressed by older migrants, beyond the successes of individual integration pathways and people's ability to adapt. Equity in health care can be achieved by promoting policies that are sensitive to diversity, inclusive, and adapted to a vulnerable ageing population that lacks the support of social networks that are so important for the native population. To this end, a collaborative approach bringing together policymakers, health and social workers, third-sector organisations, and migrant organisations is recommended. Based on the literature reviewed, the following contextual issues are highlighted as starting points for specific policy actions:
Over the past three months, our team has formulated a comprehensive theoretical framework to underpin our investigation into the intersection of migration, ageing and its multifaceted impacts on health. This framework delineates the critical variables and factors that shape our understanding, emphasising the well-being of older migrants. Our analysis integrates key concepts such as the "healthy migrant effect," the “health paradox”, and the dynamics of migration and mortality, with particular attention to selection effects, distortions, and the salmon bias.
The study disaggregates the migration experience into three distinct phases:
Older migrants are categorised by age at arrival:
Key determinants influencing the well-being of older migrants include educational attainment, marital status (e.g., divorce or widowhood), living arrangements, family support, and the prevalence of chronic health conditions. Health status will be analysed using a nuanced framework ranging from vulnerable health (characterised by poor physical and mental well-being) to robust health. Gender-specific issues, such as experiences of abuse, neglect, stigma, and shifts in societal roles, will also be explored.
Through primary and secondary data, the research will investigate themes including self-rated health, chronic illnesses, mental health challenges (e.g., anxiety, depression, dementia), loneliness, the impact of virtual care, and the significance of health literacy.
Policy, Industrial, and Scientific Implications
The findings emphasise critical considerations for policymakers and the academic community. Specifically:
Health promotion strategies must prioritise enabling individuals. This approach necessitates a shift from disease-centric definitions of health toward functionality-centered paradigms, acknowledging the interplay between personal capabilities and environmental determinants.
Capturing the heterogeneity of ageing experiences among migrants requires sophisticated theoretical and methodological approaches that extend beyond simplistic categorisations of immigrant status or age, incorporating the complex interplay of factors contributing to their lived realities.
Policymakers should acknowledge the persistent nature of migration and the unique challenges ageing migrants face, many of whom have acquired citizenship. Addressing these challenges requires community programs and support networks that cater to the needs of ageing immigrants. Additionally, the progressive dismantling of reception systems is poised to disproportionately impact elderly migrants in the coming years, underscoring the urgency of targeted policy responses.
Patrizia Farina, Daniela Carrillo “Immigrant presence in the Italian Health System. History of a Slow Discovery”, Paper at Convegno Age-It - Ca’ Foscari University of Venice, May 2024, 20th-22th
Elisa Barbiano di Belgiojoso, Eralba Cela, Patrizia Farina, Daniela Carrillo and Stefania Maria Lorenza Rimoldi "Migration and Health: Evidence and Challenges in the Italian Context" Paper presented at 2nd SIS Meeting, Bari, June 2024, 17th -20th [link: https://link.springer.com/book/9783031644467#about-this-book].