Migration trajectories, natural experiments and effects of small-area contexts on health: a privacy-preserving linkage study of routine and primary data among resettlement refugees

Introduction

The health effects of the migration trajectory, from pre- to post-migration in new environments, have yet been poorly studied. Methodological challenges and selection effects limit the possibilities for causal inferences on how differences in social, economic, or political factors at small-area level affect variation in health among migrants (e.g. differential mortality or self-reported health).

Importance of Knowledge

Knowledge about such relations would not only inform better health and integration policies for migrants. Considering migrants as humans in new environments (not as singularities) may allow us to conclude on the relationship between context and health more generally, and inform public health beyond immigration.

Challenges in Research

However, randomisation of individuals into new contexts is not possible, and the establishment of prospective cohorts (from pre- to post-migration settings) is challenging, resource-intensive, and prone to selection bias.

Aim of INTERSECT

The aim of INTERSECT is to study human mobility and health consequences of different social, economic, and policy environments at small-area level. To this end, INTERSECT builds on three innovations:

1. It reconstructs the migration trajectory by using existing data among German-bound resettlement refugees through data-linkage or distributed computation techniques.
2. It capitalises on mandatory dispersal as a natural experiment to minimise selective migration into contexts.
3. It prospectively collects primary data on the health of resettlement refugees and combines these with administrative and contextual data.

Research Infrastructure

Using these methodological innovations, INTERSECT creates a unique research infrastructure that allows answering important research questions on social, economic, and political factors at small-area level which causally explain:

A) Mortality differences among refugees while considering baseline health status;
B) Changes in self-reported health status depending on changes in contexts; and
C) Individual and/or contextual factors moderating such effects.