title: Migration as a social determinant of health for irregular migrants: Israel as case study.
abstract: More than 150,000 irregular migrants reside in Israel, yet data regarding their utilization of and perceived barriers to health care services are limited. Drawing on semi-structured interviews conducted with 35 irregular migrant adults between January and September 2012, this article analyzes the role of migration as a social determinant of health for irregular migrants, and especially asylum seekers. We analyze two kinds of barriers faced by migrants when they attempt to access health care services: barriers resulting directly from their migration status, and barriers that are common among low-income communities but exacerbated by this status. Migration-related barriers included a lack of clear or consistent legislation; the threat of deportation; the inability to obtain work permits and resulting poverty and harsh living and working conditions; and discrimination. Barriers exacerbated by migrant status included prohibitive cost; poor and confusing organization of services; language barriers; perceived low quality of care; and social isolation. These findings support recent arguments that migrant status itself constitutes a social determinant of health that can intersect with other determinants to adversely affect health care access and health outcomes. Findings suggest that any meaningful effort to improve migrants' health will depend on the willingness of clinicians, public health officials, and policymakers to address the complex array of upstream political and socio-economic factors that affect migrants' health rather than focusing on narrower questions of access to health care.
authors.affiliation: Public Health Services, Ministry of Health, Jerusalem, Israel. Electronic address: yonina.fleischman@gmail.com.
authors.forename: Yonina
authors.initials: Y
authors.lastname: Fleischman
authors.affiliation: Department of Anthropology, University of Connecticut, USA. Electronic address: sarah.willen@uconn.edu.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Willen
authors.affiliation: Department of Health Systems Management, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel. Electronic address: nadavd@bgu.ac.il.
authors.forename: Nadav
authors.initials: N
authors.lastname: Davidovitch
authors.affiliation: Ramla Department of Health, Ministry of Health, Ramla, Israel. Electronic address: zohar.mor@rml.health.gov.il.
authors.forename: Zohar
authors.initials: Z
authors.lastname: Mor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003144:Communication Barriers; D004641:Emigration and Immigration / Q000331:legislation & jurisprudence*; D005260:Female; D066296:Grounded Theory; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012036:Refugees / Q000331:legislation & jurisprudence; D064890:Social Determinants of Health / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Asylum seekers; Barriers to health care; Irregular migrants; Israel; Migrant health; Migration; Social determinants of health; Structural vulnerability