IHMT-NOVA’s full professor, Maria do Rosário de Oliveira Martins, was interviewed by the newspaper Diário de Notícias, in an article published on September 5 with the title “Effects of the pandemic penalizing immigrants more, also in Portugal”, within the scope of study “Response to the Covid-19 pandemic in a context of social inequalities in health: a cross-sectional study in the native and immigrant population of Amadora”. Read the DN article.
This study was selected for funding by FCT under Research 4 Covid-19- Special support for rapid implementation projects for innovative solutions to respond to the COVID-19 pandemic.
Principal Investigator: M Rosário Oliveira Marins, Full Professor, Institute of Hygiene and Tropical Medicine, Universidade NOVA de Lisboa
Research Center: Global Health and Tropical Medicine
Partners: ACES Amadora and AJPAS (NGO)
We know from studies in other countries that Covid-19 is cruelly exposing the existing and persistent health inequalities in our society. In this context, health systems must be prepared for the needs arising from the economic and social changes caused by the pandemic. The concern about Leaving No One Behind in times of a pandemic requires that immigrants and their needs be explicitly included in public health responses to Covid-19.
A previous study, funded by the FAMI program (Fund for Asylum, Migration and Integration) and carried out by IHMT-UNL in collaboration with ACES Amadora and Hospital Amadora Sintra, that is following , since 2018, a cohort of 420 native and immigrant families from Amadora, showed, among others, that immigrant families (mostly from Cape-Verde, Angola, Brazil, Guinea-Bissau and São Tomé and Príncipe) are more exposed to job insecurity, have lower median incomes, lower health expenditures, and live in homes more overcrowded than natives.
Since there is no evidence on how the pandemic is affecting immigrant population in Portugal, the aim of this study was to analyze, the socioeconomic dynamics, apprehensions and difficulties in accessing health care for these 420 families (of which 217 are immigrants) during the month of July 2020.
HOW WAS THE STUDY CARRIED OUT?
Telephone interviews were conducted through a questionnaire with closed questions divided into 3 sections: changes in material deprivation, income and employment; difficulties in social confinement; increased difficulties in accessing health care due to the pandemic. The team of the study included: seven interviewers, health professionals from Portugal, Brazil, Cape Verde, Guinea-Bissau and S. Tomé and Príncipe (Master and PhD students at IHMT-UNL), three researchers from IHMT, a public health doctor from ACES Amadora and several members of ONJ AJPAS.
WHO PARTICIPATED AND WHEN?
Participants include members from a cohort of 420 families (217 immigrants and 203 natives) living in Amadora Municipality, in Lisbon area. Of the 217 immigrant families, 80 are from Cape Verde, 35 from Angola, 33 from Brazil, 27 from Guinea-Bissau, 21 from S. Tomé and Príncipe, 4 from Mozambique, and 17 families from other countries.
The interviews were conducted between June 26 and July 31, 2020.
WHAT TYPE OF INTERVENTION WAS MADE IN THE SHORT-TERM?
Whenever access difficulties were identified, these were reported to ACES who tried within the existing restrictions to solve the situation.
Whenever worrying social cases were identified, they were reported to AJPAS who directly contacted the families and proposing solutions.
Whenever cases of patients with covid-19 with a complex socioeconomic situation were identified, these were reported to the ACES Amadora public health unit for a direct homebased intervention.
The response rate was around 70% both for immigrant and native’s participants.
1. Changes in material deprivation, income and employment caused by the pandemic
Of the total of respondents who had a job before the pandemic, 46% remain without work and without receiving wages or part of wages for some time during the pandemic; this percentage being considerably higher in immigrants (57% versus 35% in natives); more than a half of respondents refer that household’s monthly income decreased due to the pandemic, and this cut was more prominent in immigrants (72%) than natives (49%).
As a consequence of the pandemic situation, about 30% of participants stated they had to postpone rent payments, credit provision or current expenses (water, gas and electricity bills), with immigrants reporting higher figure than natives (39% versus 23%).
2. Experiences during in social lockdown
Regarding the difficulties during social confinement, about half of the respondent report that their children had distance/online classes; however, more immigrants (20% versus 0%) mentioned they do not have a place at home where their children can have online classes; about 8% of immigrants and 3% of natives indicated that their children had to go to school for having a meal.
About 70% of the immigrants interviewed in this study report that in the last month they felt more nervous / anxious, against 62% of the natives.
3. Increased difficulties in accessing health care due to pandemic
About half of the participants reported that someone in their household had to go to the health center since the beginning of the pandemic and, 35% of these, had greater difficulties in accessing health care due to the situation of the covid19 (without differences between natives and immigrants); However, more immigrants reported that someone in their family had to go to the emergency room in the last month (32% vs 27%); as for the difficulties of access, of the immigrants who went to the emergency room, almost half (46%) revealed having had more difficulties due to the pandemic, a figure considerably higher than that of the natives (12%).
The very serious social cases identified by the study were much more frequent in the families of immigrants, especially those from Portuguese-speaking African countries.
This is the first study in Portugal that provides evidence on how the pandemic has affected and is affecting immigrant families when compared to native ones; the results on the social and economic impact of the pandemic on families are similar to those already found in other studies in Portugal (namely on the barometers): more unemployment, lower income, difficulties in paying rent, provision of credit or current expenses, greater difficulties in accessing care of health.
However, this study adds a very important dimension to the already published results for Portugal, by considering immigration as a social determinant of health. Results suggested that in immigrant households, the economic and social effects of the pandemic are exacerbated: for example, in every 20 of the immigrant respondents 12 report having been without work and without wages or part of wages, versus only 7 on 20 of the natives; on the other hand, 15 out of 20 immigrant households saw their monthly income decrease, versus 10 out of 20 natives.
Knowing the importance that social and economic determinants have on the health of populations, health systems in the near future must be prepared not only to receive the growing cases of covid-19 but also to face the needs arising from the economic and social transformations caused by the pandemic, in particular in the immigration population group.
The data collected will be further analyzed using multivariate statistical techniques based on which scores of increased social risk in time and pandemic will be created. It is essential to continue to monitor these families with the support of NGOs so that the effects of this economic and social crisis can be mitigated, intervening early both at the adult and child level.