Showing papers by "Oliver Razum published in 2004"

Deteriorating health satisfaction among immigrants from Eastern Europe to Germany

Abstract: Migrants from Eastern Europe constitute more than 5% of Germany's population. Since population health in their countries of origin is poor their health status upon arrival may be worse than that of the native-born German population (hypothesis H1). As a minority, they may be socio-economically disadvantaged (H2), and their health status may deteriorate quickly (H3). We compared data from 1995 and 2000 for immigrants from Eastern Europe (n = 353) and a random sample of age-matched Germans (n = 2, 824) from the German Socioeconomic Panel. We tested H1-3 using health satisfaction, as a proxy for health status, and socioeconomic indicators. We compared changes over time within groups, and between immigrants and Germans. We assessed effects of socio-economic status and being a migrant on declining health satisfaction in a regression model. In 1995, immigrants under 55 years had a significantly higher health satisfaction than Germans. Above age 54, health satisfaction did not differ. By 2000, immigrants' health satisfaction had declined to German levels. Whereas in 1995 immigrants had a significantly lower SES, differences five years later had declined. In the regression model, immigrant status was much stronger associated with declining health satisfaction than low SES. In contrast to H1, younger immigrants had an initial health advantage. Immigrants were initially socio-economically disadvantaged (H2), but their SES improved over time. The decrease in health satisfaction was much steeper in immigrants and this was not associated with differences in SES (H3). Immigrants from Eastern Europe have a high risk of deteriorating health, in spite of socio-economic improvements.

Self-help: What future role in health care for low and middle-income countries?

Abstract: In the debate on 'Third options' for health care delivery in low- and middle-income countries it is proposed that self-help should play a larger role. Self-help is expected to contribute towards improving population health outcomes and reducing government health care expenditure. We review scope and limitations of self-help groups in Europe and South Asia and assess their potential role in health care within the context of health sector reform. Self-help groups are voluntary unions of peers, formed for mutual assistance in accomplishing a health-related purpose. In Europe, self-help groups developed out of dissatisfaction with a depersonalised health care system. They successfully complement existing social and health services but cannot be instrumentalized to improve health outcomes while reducing health expenditure. In South Asia, with its hierarchical society, instrumental approaches towards self-help prevail in Non-governmental Organizations and government. The utility of this approach is limited as selfhelp groups are unlikely to be sustainable and effective when steered from outside. Self-help groups are typical for individualistic societies with developed health care systems – they are less suitable for hierarchical societies with unmet demand for regulated health care. We conclude that self-help groups can help to achieve some degree of synergy between health care providers and users but cannot be prescribed to partially replace government health services in low-income countries, thereby reducing health care expenditure and ensuring equity in health care.

Suizidsterblichkeit unter Türkinnen und Türken in Deutschland

Abstract: Die Suizidsterblichkeit liegt weltweit unter Mannern meist hoher als unter Frauen. In sozial benachteiligten Gruppen kann sich das Verhaltnis umkehren. Wir untersuchten, ob dies bei in Deutschland lebenden Turkinnen und Turken der Fall ist. Wir berechneten alters- und geschlechtsspezifische Suizidraten fur in (West-)Deutschland lebende turkische Staatsburger (1.186 Suizide) und fur Deutsche unter 65 Jahren anhand einer Sonderauswertung der Todesursachenstatistik 1980–1997. Die altersadjustierten Suizidraten lagen bei Turken niedriger als bei Deutschen (relatives Risiko 0,3). Bei turkischen Madchen und jungen Frauen unter 18 Jahren betrug das relative Risiko jedoch 1,8 (95% KI: 1,4–2,3) gegenuber gleichaltrigen Deutschen. Das Verhaltnis der Suizidraten von Mannern gegenuber Frauen betragt in dieser Altersgruppe bei Deutschen 3,2, bei Turken 0,6. In Deutschland lebende Turken haben insgesamt eine niedrigere Suizidsterblichkeit als Deutsche. Mogliche Erklarungen sind eine ausgepragte soziale Koharenz und religiose Verbote. Die hohe Suizidrate unter jungen Turkinnen konnte auf sozial oder kulturell bedingte Konfliktsituationen hinweisen.

Suicide mortality among Turks in Germany

Abstract: BACKGROUND. Suicide mortality is usually higher among men than among women. In socially disadvantaged groups, this relationship can be reversed. We investigated whether this is the case among Turkish migrants in Germany. MATERIAL AND METHODS. We calculated age- and sex-specific suicide rates for Turkish nationals residing in (West) Germany (1186 suicides) and for Germans aged below 65 years based on death registration data covering the period 1980-1997. RESULTS. Age-adjusted suicide rates among Turks were lower than among Germans (relative risk 0.3). Among Turkish girls and young women under 18 years, however, the relative risk compared to Germans was 1.8 (95% confidence interval 1.4-2.3). The male-to-female ratio in this age group was 3.2 among Germans and 0.6 among Turks. DISCUSSION. Overall, Turks living in Germany have a lower suicide mortality than Germans. Possible explanations include a high level of social coherence in the Turkish community and religious prohibitions. The high suicide rate among Turkish girls and young women could indicate the presence of social or cultural conflict situations.

Community effectiveness of chloroquine and traditional remedies in the treatment of young children with falciparum malaria in rural Burkina Faso

Abstract: Background: There is little information on the effectiveness of modern compared to traditional malaria treatment from the rural areas of Africa. Methods: Follow-up of 402 episodes of clinical malaria among pre-school children in Nouna Health District, northwestern Burkina Faso. The exposure of interest was the type of treatment (chloroquine versus traditional); the outcome was clinical response to treatment. Results: Out of the 402 observed malaria episodes, 87% were treated with chloroquine and 13% with traditional remedies. Overall, community effectiveness was 67% with chloroquine and 54% with traditional treatment. Chloroquine effectiveness was associated with age and ethnicity. An additional interview survey demonstrated wide variations in the dosages of chloroquine given to young children in this community. Conclusions: The effectiveness of chloroquine, when used within the community, was significantly lower in this study than its known efficacy in the study area. This concerns, in particular, the very young children. These findings demonstrate the need for better education of parents about correct dosage of first-line malaria drugs, and for particular attention in the treatment of very young children.

Large-scale, population-based epidemiological studies with record linkage can be done in Germany.

Abstract: Record linkage is an invaluable tool for many epidemiological studies. So far, however, in Europe it has mainly been used in Scandinavian countries with nationwide registration systems. Using the example of a large retrospective cohort study among migrants, we show that this method is also feasible in Germany, a country without central registries and unique identification numbers for citizens.

Inequity, acculturation and the ‘Mediterranean paradox’

Abstract: Sirs—Khlat and Darmon 1 extend the ‘Hispanic Paradox’, the low all-cause mortality that Hispanics experience in the US in spite of a low socioeconomic status, to Mediterranean migrant populations in Europe. They analyse the role that a ‘salmon bias’ (the re-migration of ill migrants to their country of origin) and a ‘healthy migrant effect’ (a selection of healthy individuals at the time of immigration) might play. One of the key questions they raise is why a mortality advantage of migrants would persist over decades. In view of low socioeconomic status and poor working conditions, as well as presumably deteriorating health behaviours with acculturation, any mortality advantage that migrants experience would be expected to disappear quickly with time spent in the host country. We believe this is not always the case. Acculturation may lead to improving health behaviours and thereby declining mortality, even in the presence of socioeconomic and health inequalities that migrants face. Moving from one’s own country to another can bring substantial benefits to individuals and their families in terms of better access to effective medical care. Moreover, inequalities in access to care which migrants face may lessen with increasing length of time the respective migrant group has been established in the host country. We illustrate this by examining maternal mortality (International Classification of Diseases, Ninth Revision [ICD-9]: 630‐676), a particularly sensitive indicator of inequity, 2 and one that is unlikely to be affected by salmon bias or healthy migrant effect. Obstetric complications will not usually lead to a maternal death if prompt, adequate treatment is available. We assessed trends in maternal mortality among German women and among women of Turkish nationality residing in former West Germany, based on routine death registration data for 1980‐1997. Two million people of Turkish nationality reside in Germany, constituting the largest migrant group. Many came as work migrants in the 1960s and 1970s or followed later as family members. They often hold low-paid jobs in cleaning and construction, are exposed to numerous health risks, and may face cultural and language barriers when accessing health care. For comparison with the population of origin, we present estimates of maternal mortality in Turkey. 2‐4 In the study period, 713 364 live births and 106 maternal deaths among Turkish women in West Germany were reported. The Figure shows that their crude maternal mortality ratio (maternal deaths per 100 000 live births) over time converged upon that of German women. The maternal mortality ratio of Turkish women in Germany, standardized to the age distribution of German mothers, declined from 33.9 (95% CI: 25.0, 42.8) in the period 1980‐1985 to 6.3 (95%CI: 2.6, 9.9) in 1992‐1997. Mortality from abortion and ectopic pregnancy (ICD-9: 630‐639), conditions that require immediate access to emergency care, showed a particularly steep decline. The horizontal bars in the Figure 1 represent the—considerably higher—estimates of maternal mortality ratio for Turkey as a whole. Firstly, our findings illustrate an aspect of health inequality between countries. After migration to affluent nations, regular (documented) migrants from lower-income countries may experience substantial health advantages, relative to their populations of origin, as far as avoidable causes of mortality are concerned. 5 More importantly, our findings suggest that access to, and utilization of, health services is not only determined by an individual migrant’s length of stay. It appears to improve with the length of time a migrant population has been established in the host country, an—albeit crude—proxy of acculturation. The observed decline in maternal mortality thus is an active achievement, not only by the health services, but also by the migrant women and their families. 6 Given the complexity of the association between migration and mortality experience, future epidemiological research on this topic should be model-driven (for example, based on a better model of the healthy migrant effect), rather than engaging in attempts to explain puzzling empirical evidence post hoc.

[Breast cancer among Turkish women in Germany - epidemiology and research agenda].

Abstract: Breast cancer is the leading cause of cancer death and morbidity among women worldwide. In Germany an estimated 46,000 women are diagnosed with breast cancer every year, and 18,000 die of the disease. So far, limited information is available on possible epidemiological and clinical differences between women of German origin and other ethnic or national groups in Germany. Such differences between migrants and the general population could hint to underlying causes of disease and to differential access to medical care. In this paper we present epidemiological information on breast cancer among Turkish women in Germany and describe a future research agenda addressing these questions.

Cigarette smoking among school teachers in Tobago.

Abstract: Tobago, until lately, was considered a society with a low prevalence of cigarette smoking. Recent surveys, however, showed an increasing smoking prevalence among school children. To assess whether teachers in Tobago can be credible role models for their pupils, we carried out a cross-sectional survey on their smoking-related attitudes and behaviour in 2002. We distributed anonymous, structured questionnaires to teachers of all 52 primary and secondary schools in the island and conducted structured observations in schools. Of 579 teachers present during the survey, 559 (97%) returned a completed questionnaire; 8.6% of the male and 2.4% of the female teachers reported to be current cigarette smokers; slightly higher proportions had ever been daily smokers. Teachers were well aware of the harmful effects of smoking. Significantly more non-smokers than current smokers were in favour of strict school smoking regulations. The vast majority of the teachers perceived anti-smoking education as their duty. None of the schools had dedicated smoking rooms for teachers, and we found no cigarette butts in or around teachers' rooms. In Tobago, teachers have a lower reported prevalence of cigarette smoking than their pupils. Thus, most teachers can be credible role models with regard to smoking prevention and should be encouraged to become more active in school-based preventive activities.