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Monitoring Migrants’ Health Risk Factors for Noncommunicable Diseases  

Stefano Campostrini

Noncommunicable diseases (NCDs) have become the first cause of morbidity and mortality around the world. These have been targeted by most governments because they are associated with well-known risk factors and modifiable behaviors. Migrants present, as any population subgroup, peculiarities with regard to NCDs and, more relevantly, need specific information on associated risk factors to appropriately target policies and interventions. The country of origin, assimilation process, and many other migrant health aspects well studied in the literature can be related to migrants’ health risk factors. In most countries, existing sources of information are not sufficient or should be revised, and new sources of data should be found. Existing survey systems can meet organizational difficulties in changing their questionnaires; moreover, the number of changes in the adopted questionnaire should be limited for the sake of brevity to avoid excessive burden on respondents. Nevertheless, a limited number of additional variables can offer a lot of information on migrant health. Migrant status, country of origin, time of arrival should be included in any survey concerned about migrant health. These, along with information on other Social Determinants of Health and access to health services, can offer fundamental information to better understand migrants’ health and its evolution as they live in their host countries. Migrants are often characterized by a better health status, in comparison with the native population, which typically is lost over the years. Public health and health promotion could have a relevant role in modifying, for the better, this evolution, but this action must be supported by timely and reliable information.


Health Information Systems and Migrant Health in Europe  

Louise Biddle, Kayvan Bozorgmehr, and Rosa Jahn

Ensuring the health of migrants and access to appropriate health services presents a challenge to health systems in the age of global migration. Reliable and timely information is key to decision-making in all sectors of the health system to ensure that health system goals are met. Such information is even more important among a mobile, sometimes rapidly changing, dynamic and heterogeneous migrant population. While health information systems (HIS) are crucial for effective functioning of other health system blocks as well as for evidence-informed decision-making, they are often sidelined in health system policy and development. Looking across the World Health Organization (WHO) European Region, HIS for migrants are deficient both in their overall availability and their integration into regular monitoring structures. Less than half of the 53 member states routinely report health data for refugees and migrants. Most of the routinely collected data on migrant and refugee health can be identified in countries with strong population-based records, with some good practice examples of well-integrated and high-quality health monitoring surveys, disease-specific registries, and “parallel” HIS in migrant-specific settings. Overall, however, HIS in the WHO European Region are not able to provide data of sufficient quality and comparability to be well integrated into regular health monitoring structures. The reasons for this can be highlighted by five key barriers to improved information systems for migrant health: barriers in recording data, standardizing data collection, harmonizing migrant indicators, producing high-quality data, and sharing information. Better integration can be achieved through increased multilateral collaboration for the harmonization of indicators, strengthening of governance frameworks for data-sharing and protection measures, and the increased use of currently underutilized data collection mechanisms, including health monitoring surveys and medical records from refugee reception facilities. These steps will remain essential for the adequate planning and provision of needs-based care for refugees and migrants.


Using Large Data Sets to Measure Health Status and Service Use of Older Adults  

Kimberly E. Lind and Magdalena Z. Raban

Commonly used data sources for measuring health status and service use of older adults include national surveys and secondary data analysis of electronic data sources including healthcare claims data and electronic health records (EHRs). Depending on how the data are generated in EHRs and medical claims, and depending on how long people are observed for, the ability to measure prevalence or incidence of chronic conditions and the ability to measure incidence or a history of acute conditions will vary. Various data types spanning standardized data (diagnostic codes, procedure codes), medication administered or prescribed, unstructured free text such as clinical notes, and clinical assessment data can all be used to measure health status and service use. Different data sources and types of variables have different benefits and limitations depending on how data are generated and the incentives for those recording data (i.e., healthcare providers and billing staff) to be complete. Testing assumptions and exploring the validity of measures can be accomplished by approaches such as comparing agreement of measures (e.g., disease prevalence) across data tables within a data source, comparing agreement with linked data sources, and comparing rates of disease or service use to rates in data sources that have similar populations. Future directions for administrative data such as data linkage and natural language processing will improve the utility of administrative data. The information and concepts are broadly applicable, but for illustrative purposes, examples of how these approaches have been applied to electronic data from administrative records including EHRs and claims data to fill important knowledge gaps and measure health status and quality of care from Australia and the United States are presented.