By Helena Tunstall
New research just published by CRESH in the European Journal of Public Health suggests there is a strong correlation between net migration, 2000-2010, and age- and sex- standardised death rates, 2008-2010 among the regions of Europe (Figure 1). The recent ‘migrant crisis’ in Europe has ensured that European political debate about migration, long centred on immigration, has continued to focus upon areas receiving migrants. This analysis suggests however that difficulties associated with immigration are the problems of advantage. Regions of Europe which experienced significant population growth through migration, were found mostly in Western countries with higher incomes and lower death rates. In contrast, Europe regions with net out-migration, predominantly located in the East, are burdened by the combined problems of low incomes, high death rates and population decline.
Previous analysis has suggested that patterns of migration within countries can influence the death rates in areas. We assessed the relationship between migration and death rates across the whole of Europe analysing 250 regions in 26 European countries using ‘NUTS2’ data from EUROSTAT. Areas with the lowest death rates were found in Western Europe predominantly in regions of Spain, France and Italy. The greatest gains in population though migration were also found in these countries in eastern Spain, southern France and northern Italy. In contrast, the highest regional death rates were concentrated in East European countries, in particular Bulgaria and Romania. The highest rates of population loss from migration were again in regions of Bulgaria and Romania and in the former German Democratic Republic and Northern France.
Socio-economic status could underlie the association between migration and death rates, as more economically advantaged areas may have better health and attract migrants. We used regression models to assess whether an association between migration and death rates remained after adjusting for household income in 2005. We found a significant relationship persisted after adjusting for income when all regions in Europe where assessed, and when regions in Western countries were analysed separately, but not among the groups of Eastern regions.
Causal inferences cannot be drawn from this simple cross-sectional analysis, so we cannot be certain whether migration influences death rates across Europe. It is possible that regions experiencing population significant in-migration could have relatively good health in part because they are gaining ‘healthy migrants’. While population decline may damage social relationships and services that support well-being. The regression analysis suggests low income drives poor health in Eastern European countries. Low income in these areas may also encourage population loss, which in turn could have important social and economic consequences for health.
The time period of migration considered in this analysis, 2000-2010, encompassed the largest single expansion of the European Union (EU) population. In 2004, the EU grew from 15 to 25 member states with the accession of seven former Eastern Bloc countries, plus Cyprus, Malta and Slovenia. This substantially increased right to free movement within Europe. However, the decade analysed will not have captured longer term migration that be important for health. In particular, some Eastern European countries have experienced population decline since the end of communism in the early 1990s.
The ‘migrant crisis’ in 2015 has also brought new patterns of migration as large numbers of refugees have arrived in Europe from conflict-ridden countries. These immigrants could have important new influences on the geography of death rates in Europe. It is likely though that the worst health in Europe will continue to be concentrated in regions experiencing socio-economic disadvantage and population loss through out-migration.