DOI: 10.1186/s12939-019-0970-x
Health equity remains a significant concern globally, particularly amongst vulnerable populations such as migrants who often encounter barriers in accessing health services. A recent systematic review by Jirawit et al. (2019) delves into evaluating the effectiveness of health interventions on reducing inequity among migrant populations.
Background: The Migrant Health Inequity Issue
In today’s society, health equity is a fundamental human right. Nonetheless, significant disparities continue to exist, notably among migrant populations. Migrants often face hurdles including linguistic, cultural, economic, and systemic obstacles that impede their access to healthcare and financial protection in health. International organizations, including the World Health Organization (WHO) and the International Organization for Migration (IOM), recognize the importance of addressing these inequalities to achieve sustainable development goals (SDGs).
Study Design: A Two-Stage Systematic Review
The systematic review, published in the International Journal for Equity in Health on May 6, 2019, adopts a two-stage approach to explore interventions aimed at improving the health of migrant populations. Initially, reviews focusing on interventions for migrants were extracted from five databases. Subsequently, primary studies included in the identified reviews were further analyzed to determine if they incorporated equity aspects in their outcome measurements, based on PROGRESS-Plus factors. PROGRESS-Plus stands for place of residence, race/ethnicity, occupation, gender, religion, education, socio-economic status, social capital, and others, constituting determinants that can influence health inequities.
Results of the Review
After a comprehensive screening process, 49 reviews encompassing 1145 primary studies were included in the first stage. The second stage involved a rigorous assessment of 381 experimental studies, of which only 13 (3.41%) included equity attributes as part of their outcome measurement. Notably, none of these studies demonstrated a significant impact on reducing inequity. Furthermore, these studies were predominantly conducted in high-income countries and involved interventions such as individual-based strategies, community education, and peer navigator programs.
Implications for Research and Policy
The review’s findings highlight a glaring gap in health interventions for migrant populations, revealing that equity has not been a focal point. This lack of focus on equity has significant implications for both research and policy. For research, it demonstrates the need for a more strategic and equity-focused approach to intervention design and outcome assessment. For policymakers, it stresses the importance of considering equity attributes when making decisions that impact migrants’ health and well-being.
Recommendations and Future Directions
Jirawit et al. (2019) recommend that future interventions should prioritize equity-oriented outcomes to better address the unique needs of migrant populations. Such interventions could involve culturally-tailored strategies and the inclusion of equity attributes in outcome measures. Additionally, the authors suggest extending research beyond high-income countries to obtain a more global perspective on effective interventions.
Conclusion: A Call for Equity-Focused Health Interventions
The review by Jirawit et al. (2019) serves as a reminder that achieving health equity for migrants requires comprehensive strategies that consider the multifaceted aspects of equity. It is only through intentional and targeted interventions that we can aim to reduce the health disparities experienced by migrant populations, thereby advancing global health equity.
References
1. Jirawit Y, Bangpan M, Thavorn K, Welch V, Tugwell P, Chaiyakunapruk N. Assessing evidence of interventions addressing inequity among migrant populations: a two-stage systematic review. Int J Equity Health. 2019 May 6;18(1):64. doi: 10.1186/s12939-019-0970-x.
2. World Health Organization. Constitution of the World Health Organization. Geneva: World Health Organization; 1948.
3. International Organization for Migration. World migration report 2018.
4. Welch V, Petticrew M, Tugwell P, Moher D, O’Neill J, Waters E, et al. PRISMA-equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity. PLoS Med. 2012;9(10):e1001333. doi: 10.1371/journal.pmed.1001333.
5. O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67:56–64. doi: 10.1016/j.jclinepi.2013.08.005.
Keywords
1. Migrant health inequity
2. Equity-focused health interventions
3. Health disparities in migrants
4. PROGRESS-Plus factors in health
5. Systematic review on migrant health