The political determinants of the health of undocumented immigrants: a comparative analysis of mortality patterns in Switzerland

Abstract

Background The health of undocumented immigrants is an important concern in most societies. However, there is no conclusive evidence that inclusive health care policies lead to better outcomes for this group of the population. The aim of this study is to analyse whether there is an association between inclusive health care policies and the mortality patterns of undocumented immigrants, or the distribution of different causes of death among those who have died. Methods We analyse individual data concerning the deceased in Switzerland between 2011 and 2017. We proceed in two steps. First, we estimate and compare the patterns of mortality of Swiss citizens, documented immigrants, and undocumented immigrants. Second, we test whether there is an association between cantonal authorities’ policies and differing mortality patterns. We use logistic regressions and multinomial regressions to estimate the relationship between legal status and mortality patterns both in Switzerland and across different cantons. Results We find a difference in the patterns of mortality between undocumented immigrants and the other groups of the population. Specifically, death from circulatory system diseases is twice as frequent among undocumented immigrants compared to documented immigrants and Swiss citizens. However, this difference is smaller in the Swiss cantons that have more inclusive health care policies towards undocumented immigrants. Conclusions We interpret these results as an indication that policies that expand access to health services lead to better outcomes for undocumented immigrants. This finding has implications for research on civic stratification and public health. Further analysis is needed to evaluate the effects of extending public health care for undocumented immigrants in different contexts.

Impact of legal status regularization on undocumented migrants’ self-reported and mental health in Switzerland

“…In their systematic analysis, Vernice et al (2020) showed that mental health is linked to the configuration of immigration policies and whether access to healthcare is possible. Similarly, Piccoli and Wanner (2022) , emphasized that health of undocumented migrants differs between Swiss cantons depending on the level of inclusiveness of health policies. Our findings allow to nuance and point to the importance of taking stressors away from undocumented migrants.…”

“…Poorer self-reported health among undocumented migrants is associated with hardworking conditions, limited social interaction as well as precarious living conditions ( Ahonen et al, 2009 ; Fakhoury et al, 2021 ; Jolivet et al, 2012 ; Kumparatana et al, 2017 ; Pikhart et al, 2010 ; Sousa et al, 2010 ; Woodward et al, 2014 ). This could explain the higher mortality rates among undocumented migrants recently reported in Switzerland ( Piccoli & Wanner, 2022 ). However, scholars showed that the difference in health evaluations is not primarily due to the acquisition of a residence status, but results from better healthcare and socioeconomic opportunities once documented ( Cloos et al, 2020 ).…”

Learning from the COVID-19 pandemic response to strengthen undocumented migrant-sensitive health systems: case studies from four countries

“…These health policy differences reflect variation in other non-health policies targeting undocumented migrants and may contribute to the gradient in undocumented migrants' mortality across cantons. 17 As a Federal State with completely decentralized health system governance, regional COVID-19 response policy varied widely. Only few cantons adopted a proactive and inclusive strategy to alleviate financial and administrative barriers to testing, treatment, and vaccination for uninsured migrants.…”

The Challenge of Reaching Undocumented Migrants with COVID-19 Vaccination

“…Barriers to accessing health services are of particular concern in the case of undocumented migrants because past experiences and current situations often increase their susceptibility to disease and vulnerability to a range of health threats. These may arise from their living conditions, which may be overcrowded and lacking adequate sanitary facilities; from food insecurity, reliance on public transportation for mobility, absence of locally accessible medical services, communication barriers between physicians and im-migrant patients that limit access to health information and services (including key messages on COVID-19 prevention and health-seeking behaviour), and digital illiteracy and/or communication barriers that limit access to telemedicine [ 9 , 10 , 11 , 12 ]. Moreover, environmental factors, such as long-term average exposure to fine particulate matter having a diameter of less than 2.5 μm (PM2.5), may also influence COVID-19 outcomes [ 13 ].…”