Context, health and migration: a systematic review of natural experiments

Effect of area-level socioeconomic deprivation on mental and physical health: A longitudinal natural experiment among refugees in Germany

“…The results of this study confirm the existing evidence ( Diez Roux & Mair, 2010 ), including other natural experiments ( Biddle et al, 2023 ; Hamad et al, 2020 ; White et al, 2016 ), on the relationship between area-level socioeconomic deprivation and physical health. Area-level deprivation may have effects on the physical health status of residents through diminished neighbourhood resources such as access to green space, food availability, walkability and environmental pollution ( Diez Roux & Mair, 2010 ).…”

“…To overcome these issues, natural experiments are needed ( Biddle et al, 2023 ; Diez Roux & Mair, 2010 ). Since the place of residence is not readily amenable to experimentation, situations where individuals are (quasi-)randomly distributed into neighbourhoods provide an opportunity to study contextual effects on health ( Biddle et al, 2023 ).…”

“…To overcome these issues, natural experiments are needed ( Biddle et al, 2023 ; Diez Roux & Mair, 2010 ). Since the place of residence is not readily amenable to experimentation, situations where individuals are (quasi-)randomly distributed into neighbourhoods provide an opportunity to study contextual effects on health ( Biddle et al, 2023 ). The dispersal of refugees provides such opportunities, as it is organised in a quota-based system in several countries, allocating individuals to contexts at national or sub-national level based on factors such as population size or tax revenue, but independent of socio-demographic characteristics of the refugee population ( Dustmann et al, 2017 ).…”

“…In some countries, such dispersal policies are accompanied by residence requirements which oblige individuals to reside in the assigned region for the duration of their asylum claim or for several years following a successful asylum claim ( Brücker et al, 2019 ; Schikora, 2019 ). Existing studies from Denmark and Sweden which use refugee dispersal processes as natural experiments confirm the negative impacts of area-level socioeconomic deprivation on physical health, with mixed results for mental health ( Biddle et al, 2023 ). However, as these studies use register-based approaches with identification of refugees by nationality, they are subject to misclassification bias.…”

“…Refugee health is not a singularity and other marginalised populations may be subject to the same contextual exposures ( Biddle et al, 2023 ). Studying their health in natural experiments may thus serve as a lens, allowing us to explore the effects of area-level socioeconomic deprivation for the health of other population groups.…”