The general and mental health of movers to more- and less-disadvantaged socio-economic and physical environments within the UK
Introduction
Selective migration is commonly believed to have an important influence upon both individual health, by determining individual exposures to environments, and area health, by shaping area population composition (Boyle, 2004, Rogerson and Han, 2002, Spallek et al., 2011). However, research regarding the health of migrants, and how their selection relates to the characteristics of areas they move between, has neglected some types of health outcomes and environments. This study uses British Household Panel Survey (BHPS) data to describe the relationship between individual health and residential mobility between neighbourhoods in UK. The analysis builds upon previous research in the UK firstly, by comparing the general and mental health of migrants of different ages and secondly, by assessing moves between neighbourhoods with different levels of both socio-economic and physical environment deprivation.
‘Healthy migrant theory’ suggests migrants have better health than non-movers (Urquia and Gagnon, 2011). Much of the evidence supporting this healthy migrant effect has originated from research into the health of international migrants. For example, a number of studies have demonstrated that immigrants of Latino origin in the United States, and Turkish and Moroccan origin in France and Germany, have low death rates compared to native-born populations, despite their low levels of education and income (Khlat and Darmon, 2003, Ruiz et al., 2013). It has been proposed that this occurs in part due to selection; both direct health selection if health status itself supports the ability to move and/or indirect selection if material, educational and occupational circumstances required to make a move are associated with better health. However, research that has compared the health of international immigrants to populations in their country of origin has produced mixed results (Landale et al., 2006, Marmot et al., 1984, Rubalcava et al., 2008, Salmond et al., 1985).
Studies of internal migrants further emphasise a complex picture of migrant health. Whilst movers as a whole within the UK have better health than non-movers (Champion, 2005) research completed in developed countries indicates that a number of types of movers have poor health (Bentham, 1988, Cole et al., 2006, Evandrou et al., 2010, Jelleyman and Spencer, 2008, Larson et al., 2004, Martikainen et al., 2008, Norman et al., 2005, Tunstall et al., 2012, Tunstall et al., 2010, Verheij et al., 1998). These groups include pregnant women, mothers and their infants and young children, people in mid-life and old age, frequent movers, people moving short distances, and those moving due to negative life circumstances.
The relationship between propensity to migrate, health and age may be particularly important in understanding the healthy migrant effect. In the UK, young adults are much more likely than other age groups to have moved within the country in the previous year, and then rates of mobility among adults decline through mid-life to reach their lowest levels in old age (Bailey and Livingston, 2005, Champion, 2005). Most studies from Europe, Australia and USA indicate that young adult movers are more likely to have good health than those who do not migrate, but by midlife or older ages movers are more likely to have worse health than non-movers (Bentham, 1988, Evandrou et al., 2010, Larson et al., 2004, Martikainen et al., 2008, Norman et al., 2005, Verheij et al., 1998).
The relatively good health of movers at younger ages may reflect their socio-economic characteristics rather than a direct relationship with health status. In the UK, exceptionally high rates of mobility among young adults are driven, in part, by moves related to higher education, which remains selective for higher socio-economic position (Bailey and Livingston, 2005, Champion, 2005). In contrast, research assessing mothers and their infants and children has found both lower socio-economic status and poorer health among those that were more residentially mobile (Jelleyman and Spencer, 2008, Tunstall et al., 2012, Tunstall et al., 2010). It has been suggested that the socio-demographic characteristics of younger movers can explain virtually all differences in their health (Jongeneel-Grimen et al., 2011). In contrast, the possibility that poor health is directly related to mobility in mid-life and old age has been supported by studies which have found that this association persists after adjustment for socio-demographic factors (Evandrou et al., 2010, Halliday and Kimmitt, 2008, Larson et al., 2004).
Research that has assessed how change in health status is related to mobility may provide stronger evidence of direct health selection. A longitudinal study of migrant health in the USA demonstrated that changes in health conditions were unrelated to propensity to move at ages under 45 years, but at older ages the advent of poor health was associated with mobility (Findley, 1988). A UK study of people aged over 50 years found rates of migration were elevated among people experiencing both improvements and declines in general health status (Evandrou et al., 2010). The relationship between migration and health status is however likely to vary between health outcomes. New acute health problems may increase propensity to move while some chronic health problems could discourage mobility (Boyle et al., 2002). Most studies of the health characteristics of movers within the UK have only considered broad measures of morbidity and mortality (Bentham, 1988, Connolly and O'Reilly, 2007, Norman et al., 2005). Notably, studies that have considered mental health have indicated that there are high rates of mobility among people with severe mental illness (Tulloch et al., 2011, Tulloch et al., 2010). Analysis of psychiatric inpatients in the UK has found residential moves were concentrated in the time period immediately following discharge indicating that severe mental illness can be a direct cause of residential instability (Tulloch et al., 2011).
Overall, this evidence has led to the suggestion that the image of migrants as healthy adults moving to take advantage of opportunities may largely represent a ‘myth’ which is unrepresentative of the experience of many internal migrants (Larson et al., 2004). Evidence for direct health selection of internal migrants is stronger among older age groups. However, amongst these groups internal migration may be associated with poor health. For the population as a whole, evidence that direct selection for good health underlies the propensity to move is quite weak. This suggests therefore that a central part of the healthy migrant hypothesis may not apply to migration within countries (Urquia and Gagnon, 2011).
Migration itself may affect individual health by shaping exposure to relatively better or worse social and physical environments (Spallek et al., 2011). Residential moves within the UK have in recent decades been disproportionately towards more socio-economically advantaged and rural environments, except among young adults (Bailey and Livingston, 2007, Champion, 2001). There are also associations between the characteristics of migrants and their environments of origin and destination. Migrants in the UK and Europe who move towards more socio-economically deprived neighbourhoods generally have worse self-rated heath and health-related behaviour and higher mortality than those moving towards less deprived areas (Connolly and O'Reilly, 2007, Martikainen et al., 2008, Norman et al., 2005, Tunstall et al., 2012, van Lenthe et al., 2007). The limited research that has compared indicators of mental distress and illness to those of general and physical health, analysing mothers of young children in the UK (Tunstall et al., 2012) and adults aged 16–54 years in Canada (Curtis et al., 2009), has indicated that poor mental health may be particularly strongly associated with moves to more socio-economically deprived areas.
These socio-spatial patterns suggest that migration may contribute to the accumulation of poor health among unhealthy individuals. However, there is evidence that the relationship between neighbourhood health, area socio-economic deprivation and migration may vary with degree of deprivation and individual age (Connolly and O'Reilly, 2007, Jongeneel-Grimen et al., 2013, Martikainen et al., 2008, Norman and Boyle, 2014, Norman et al., 2005, Tunstall et al., 2012, van Lenthe et al., 2007). In addition, research exploring the relationships between migration, health and the characteristics of the origin and destination area has largely focused on area socio-economic status. Other area characteristics have rarely been considered, in particular, physical environment, despite a wealth of evidence that factors such as climate, air pollution, and proximity to polluting industry may affect health (Richardson et al., 2010a).
Environmental justice research has focused upon assessing the greater exposure of disadvantaged populations to hazardous physical environments (Been and Gupta, 1997). However, relatively few studies have explored whether socially selective migration can account for these disproportionate environmental burdens. Longitudinal analyses that has assessed changes in the aggregate social composition of populations following the siting of hazardous waste storage and disposal facilities have mostly found little evidence of increases in social inequalities (Been and Gupta, 1997, Cameron and McConnaha, 2006, Morello-Frosch et al., 2002, Oakes et al., 1996, Pastor et al., 2001, Richardson et al., 2010b, Shaikh and Loomis, 1999). However, recent studies that have directly assessed patterns of migration have produced stronger evidence that selective mobility increases social inequalities in exposure to environmental hazards (Banzhaf and Walsh, 2008, Crowder and Downey, 2010, Depro et al., 2012, Gawande et al., 2000, Shumway et al., 2014).
In summary, evidence suggests that people moving within a country have distinctive health characteristics but relationships between health, migration and the characteristics of places of origin and destination may vary by age and health outcome. There is evidence that people in poor health, especially poor mental health, are more likely to move to socio-economically deprived areas, which may contribute to the accumulation of further heath disadvantage. However, there is currently little evidence about relationships between migrant health and the physical environmental characteristics of their areas of origin and destination. This study sought to address these gaps in our understanding.
We had the following research questions:
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Are there differences in the general and mental health status of movers and non-movers?
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How does health status vary between people that move to more and less deprived neighbourhoods?
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How do these relationships vary between socio-economically and physical environmentally disadvantaged neighbourhoods?
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Do differences in the health status of mover groups reflect their individual socio-demographic characteristics?
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How do these relationships vary with age?
Section snippets
British Household Panel Survey (BHPS)
The analysis used data from the BHPS, an annual longitudinal survey, completed 1991–2008, which described the socio-demographic characteristics, economic activity and personal relationships of adult residents in the UK (Taylor et al., 2010). The survey also contains a range of health and residential mobility outcomes. The ‘original sample’ of the BHPS included approximately 5500 private households in England, Wales and Scotland containing 10,000 individuals. The survey was expanded to include
Results
‘Case’ numbers describe total observations in the pooled dataset 1996–2006. Among the 138,109 BHPS respondents at Time 1, 125,916 (91.2%) also participated at the next wave at Time 2. From this group of cases 3346 were excluded because of missing data for age (N = 5), marital status (N = 26), general health status (N = 320), mental health problems (N = 831), weights (N = 1627), CAS ward at Time 1 (N = 184), CAS ward at Time 2 (N = 200) or because of inconsistent data for movers status and CAS
Discussion
This study extends understanding of the health status of migrants by comparing the general and mental health of movers and non-movers of different ages, and by characterising the level of deprivation in origin and destination areas in two ways: socio-economically and physically. The study found little evidence of the ‘healthy migrant effect’ indicating instead that, in general, movers had similar or higher rates of poor health than non-movers. Mental health problems were more elevated among
Conclusion
This study indicated that young and old movers within the UK may be at risk of poor health. It showed that mental health problems are elevated among movers to more socio-economically deprived areas. Residential mobility may therefore contribute to the processes through which health and socio-economic disadvantage are reinforced and accumulate across the life course. The implication of these patterns of migration for health may be particularly pertinent to European countries experiencing new
Acknowledgements
This work was supported by the European Research Council [ERC-2010-StG Grant 263501]. The data and tabulations used in this publication were made available through The ESRC Data Archive. The data were originally collected by the ESRC Research Centre on Micro-Social Change at the University of Essex (now incorporated within the Institute for Social and Economic Research). Neither the original collectors of the data nor the Archive bear any responsibility for the analyses or interpretations
References (70)
Migration and morbidity: implications for geographical studies of disease
Soc. Sci. Med.
(1988)- et al.
Does migration exaggerate the relationship between deprivation and limiting long-term illness? A Scottish analysis
Soc. Sci. Med.
(2002) - et al.
The contribution of migration to changes in the distribution of health over time: five-year follow-up study in Northern Ireland
Soc. Sci. Med.
(2007) - et al.
Socio-geographic mobility and health status: a longitudinal analysis using the National Population Health Survey of Canada
Soc. Sci. Med.
(2009) - et al.
Internal migration and the environmental Kuznets curve for US hazardous waste sites
Ecol. Econ.
(2000) - et al.
Migration does not enlarge inequalities in health between rich and poor neighbourhoods in The Netherlands
Health Place
(2011) - et al.
Clarifying the relationships between health and residential mobility
Soc. Sci. Med.
(2004) - et al.
Lessons from the study of immigrant mortality
Lancet
(1984) - et al.
The effects of migration on the relationship between area socioeconomic structure and mortality
Health Place
(2008) - et al.
Are health inequalities between differently deprived areas evident at different ages? A longitudinal study of census records in England and Wales, 1991–2001
Health Place
(2014)
Selective migration, health and deprivation: a longitudinal analysis
Soc. Sci. Med.
A longitudinal analysis of environmental equity in communities with hazardous waste facilities
Soc. Sci. Res.
The Scottish excess in mortality compared to the English and Welsh. Is it a country of residence or country of birth excess?
Health Place
Residential mobility within England and urban-rural inequalities in mortality
Soc. Sci. Med.
The effects of migration on the detection of geographic differences in disease risk
Soc. Sci. Med.
An investigation into the presence and causes of environmental inequity in Denver, Colorado
Soc. Sci. J.
Residential mobility among patients admitted to acute psychiatric wards
Health Place
The characteristics of mobile families with young children in England and the impact of their moves on neighbourhood inequalities in maternal and child health
Health Place
Residential mobility in the UK during pregnancy and infancy: are pregnant women, new mothers and infants ‘unhealthy migrants’?
Soc. Sci. Med.
Neighbourhood inequalities in health and health-related behaviour: results of selective migration?
Health Place
How spatial segregation changes over time: sorting out the sorting processes
Environ. Plan. Part A
Determinants of Individual Migration: an Analysis of SARs Data
Population Turnover and Area Deprivation
Do people vote with their feet? An empirical test of Tiebout's mechanism
Am. Econ. Rev.
Coming to the nuisance or going to the barrios? A longitudinal analysis of environmental justice claims
Ecol. Law Q.
Population geography: migration and inequalities in mortality and morbidity
Prog. Hum. Geogr.
Using panel surveys to study migration and residential mobility
Evidence of environmental migration
Land Econ.
Deprivation and mortality – an alternative to social-class
Community Med.
The continuing urban-rural population movement in Britain: trends, patterns, significance
Espace Popul. Soc.
Population movement within the UK
Focus on People and Migration
A Review of the Evidence Base on Frequent Moving Among Disadvantaged Group. A Report to the Social Exclusion Unit
The dynamics of health in the British household panel survey
J. Appl. Econ.
Interneighborhood migration, race, and environmental hazards: modeling microlevel processes of environmental inequality
Am. J. Sociol.
Meeting Urban Housing Needs: Do People Really Come to the Nuisance?
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