Addressing migration-related social and health inequalities in Australia: call for research funding priorities to recognise the needs of migrant populations
Andre Renzaho A E , Michael Polonsky B , David Mellor C and Sheila Cyril DA School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
B Deakin Business School, Department of Marketing, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email: michael.polonsky@deakin.edu.au
C School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email: david.mellor@deakin.edu.au
D School of Public Health and Preventive Medicine, Monash University, Level 3 Burnet Building, 89 Commercial Road, Melbourne, Vic. 3004, Australia. Email: sheila.cyril@monash.edu
E Corresponding author. Email: andre.renzaho@uws.edu.au
Australian Health Review 40(1) 3-10 https://doi.org/10.1071/AH14132
Submitted: 7 August 2014 Accepted: 15 May 2015 Published: 13 July 2015
Journal Compilation © AHHA 2016
Abstract
Objective Migrants constitute 26% of the total Australian population and, although disproportionately affected by chronic diseases, they are under-represented in health research. The aim of the present study was to describe trends in Australian Research Council (ARC)- and National Health and Medical Research Council (NHMRC)-funded initiatives from 2002 to 2011 with a key focus on migration-related research funding.
Methods Data on all NHMRC- and ARC-funded initiatives between 2002 and 2011 were collected from the research funding statistics and national competitive grants program data systems, respectively. The research funding expenditures within these two schemes were categorised into two major groups: (1) people focused (migrant-related and mainstream-related); and (2) basic science focused. Descriptive statistics were used to summarise the data and report the trends in NHMRC and ARC funding over the 10-year period.
Results Over 10 years, the ARC funded 15 354 initiatives worth A$5.5 billion, with 897 (5.8%) people-focused projects funded, worth A$254.4 million. Migrant-related research constituted 7.8% of all people-focused research. The NHMRC funded 12 399 initiatives worth A$5.6 billion, with 447 (3.6%) people-focused projects funded, worth A$207.2 million. Migrant-related research accounted for 6.2% of all people-focused initiatives.
Conclusions Although migrant groups are disproportionately affected by social and health inequalities, the findings of the present study show that migrant-related research is inadequately funded compared with mainstream-related research. Unless equitable research funding is achieved, it will be impossible to build a strong evidence base for planning effective measures to reduce these inequalities among migrants.
What is known about the topic? Immigration is on the rise in most developing countries, including Australia, and most migrants come from low- and middle-income countries. In Australia, migrants constitute 26% of the total Australian population and include refugee and asylum seeker population groups. Migrants are disproportionately affected by disease, yet they have been found to be under-represented in health research and public health interventions.
What does this paper add? This paper highlights the disproportions in research funding for research among migrants. Despite migrants being disproportionately affected by disease burden, research into their health conditions and risk factors is grossly underfunded compared with the mainstream population.
What are the implications for practitioners? Migrants represent a significant proportion of the Australian population and hence are capable of incurring high costs to the Australian health system. There are two major implications for practitioners. First, the migrant population is constantly growing, therefore integrating the needs of migrants into the development of health policy is important in ensuring equity across health service delivery and utilisation in Australia. Second, the health needs of migrants will only be uncovered when a clear picture of their true health status and other determinants of health, such as psychological, economic, social and cultural, are identified through empirical research studies. Unless equitable research funding is achieved, it will be impossible to build a strong evidence base for planning effective measures to reduce health and social inequalities among migrant communities.
Additional keywords: asylum seekers, Australian Research Council, equitable funding, low-and middle-income countries, National Medical Research Council, refugees, research advocacy.
References
[1] Organization for Economic Cooperation and Development (OECD). International migration outlook 2013. OECD Publishing. 2013. Available at: http://dx.doi.org/ 10.1787/migr_outlook-2012-en [verified 26 June 2014].[2] Australian Bureau of Statistics (ABS). Australian demographic statistics. Catalogue no. 3101.0. Canberra: ABS; 2012.
[3] Race Ethnicity and Genetics Working Group The use of racial, ethnic, and ancestral categories in human genetics research. Am J Hum Genet 2005; 77 519–32.
| The use of racial, ethnic, and ancestral categories in human genetics research.Crossref | GoogleScholarGoogle Scholar | 16175499PubMed |
[4] Hussain-Gambles M, Atkin K, Leese B. Why ethnic minority groups are under-represented in clinical trials: a review of the literature. Health Soc Care Community 2004; 12 382–8.
| Why ethnic minority groups are under-represented in clinical trials: a review of the literature.Crossref | GoogleScholarGoogle Scholar | 15373816PubMed |
[5] National Preventative Health Taskforce. Australia: the healthiest country by 2020. Canberra: Commonwealth of Australia; 2008.
[6] Renzaho AM, Halliday JA, Nowson C. Vitamin D, obesity, and obesity-related chronic disease among ethnic minorities: a systematic review. Nutrition 2011; 27 868–79.
| 1:CAS:528:DC%2BC3MXpvFCnt7s%3D&md5=6eb0c80f74439223bd7ad27e05efd3daCAS | 21704500PubMed |
[7] Abouzeid M, Philpot B, Janus ED, Coates MJ, Dunbar JA. Type 2 diabetes prevalence varies by socio-economic status within and between migrant groups: analysis and implications for Australia. BMC Public Health 2013; 13 252
| 23517376PubMed |
[8] Saleh A, Amanatidis S, Samman S. The effect of migration on dietary intake, type 2 diabetes and obesity: the Ghanaian Health and Nutrition Analysis in Sydney, Australia (GHANAISA). Ecol Food Nutr 2002; 41 255–70.
[9] Renzaho A, Swinburn B, Burns C. Maintenance of traditional cultural orientation is associated with lower rates of obesity and sedentary behaviours among African migrant children to developed countries. Int J Obesity 2008; 32 594–600.
| 1:STN:280:DC%2BD1c3ksV2nuw%3D%3D&md5=771339904a0137e9e5a00b6e5fd7dd5cCAS |
[10] Faskunger J, Eriksson U, Johansson S, Sundquist K, Sundquist J. Risk of obesity in immigrants compared with Swedes in two deprived neighbourhoods. BMC Public Health 2009; 9 [Epub ahead of print]
| 19698119PubMed |
[11] Singh M, de Looper M. Australian health inequalities: birthplace. Bulletin no. 2. Catalogue no. AUS 27. Canberra: Australian Institute of Health and Welfare; 2002.
[12] Abraído-Lanza A, Dohrenwend B, Ng-Mak D, Turner J. The Latino mortality paradox: a test of the ‘salmon-bias’ and healthy migrant hypotheses’. Am J Public Health 1999; 89 1543–8.
| The Latino mortality paradox: a test of the ‘salmon-bias’ and healthy migrant hypotheses’.Crossref | GoogleScholarGoogle Scholar | 10511837PubMed |
[13] Renzaho AM, Houng B, Oldroyd J, Nicholson JM, D’Esposito F, Oldenburg B. Stressful life events and the onset of chronic diseases among Australian adults: findings from a longitudinal survey. Eur J Public Health 2013; 24 57–62.
| Stressful life events and the onset of chronic diseases among Australian adults: findings from a longitudinal survey.Crossref | GoogleScholarGoogle Scholar | 23397581PubMed |
[14] Renzaho A, Oldroyd J, Burns C, Waters E, Riggs E, Renzaho C. Over and undernutrition in the children of Australian immigrants: assessing the influence of birthplace of primary carer and English language use at home on the nutritional status of 4–5 year olds. Int J Pediatr Obes 2009; 4 73–80.
| Over and undernutrition in the children of Australian immigrants: assessing the influence of birthplace of primary carer and English language use at home on the nutritional status of 4–5 year olds.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MzktFemsg%3D%3D&md5=3ea7f5afc27029332a665ca2ceac2474CAS | 18649162PubMed |
[15] Australian Bureau of Statistics (ABS). Reflecting a nation: stories from the 2011 census, 2012–2013. Catalogue no. 2071.0. Canberra: ABS; 2012.
[16] Garrett PW, Dickson HG, Whelan AK, Whyte L. Representations and coverage of non-English-speaking immigrants and multicultural issues in three major Australian health care publications. Aust New Zealand Health Policy 2010; 7 1–13.
| Representations and coverage of non-English-speaking immigrants and multicultural issues in three major Australian health care publications.Crossref | GoogleScholarGoogle Scholar | 20044938PubMed |
[17] Australian Bureau of Statistics (ABS). Cardiovascular disease in Australia: a snapshot, 2004–05. Catalogue no. 4821.0.55.001. Canberra: ABS; 2006.
[18] Saleh A, Amanatidis S, Samman S. The effect of migration on dietary intake, type 2 diabetes and obesity: the Ghanaian Health and Nutrition Analysis in Sydney, Australia (GHANAISA). Ecol Food Nutr 2002; 41 255–70.
| The effect of migration on dietary intake, type 2 diabetes and obesity: the Ghanaian Health and Nutrition Analysis in Sydney, Australia (GHANAISA).Crossref | GoogleScholarGoogle Scholar |
[19] Schweitzer RD, Brough M, Vromans L, Asic-Kobe M. Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience. Aust N Z J Psychiatry 2011; 45 299–307.
| Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience.Crossref | GoogleScholarGoogle Scholar | 21303193PubMed |
[20] Abouzeid M, Philpot B, Janus ED, Coates MJ, Dunbar JA. Type 2 diabetes prevalence varies by socio-economic status within and between migrant groups: analysis and implications for Australia. BMC Public Health 2013; 13 252–60.
| Type 2 diabetes prevalence varies by socio-economic status within and between migrant groups: analysis and implications for Australia.Crossref | GoogleScholarGoogle Scholar | 23517376PubMed |
[21] ABS. Catalogue 4719.0 - Overweight and Obesity in Adults, Australia, 2004-05. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4719.0Main%20Features32004-05?opendocument&tabname=Summary&prodno=4719.0&issue=2004-05&num=&view= [verified 7 April 2015].
[22] Correa-Velez I, Barnett AG, Gifford SM, Sackey D. Health status and use of health services among recently arrived men with refugee backgrounds: a comparative analysis of urban and regional settlement in south-east Queensland. Aust J Primary Health 2011; 17 66–71.
| Health status and use of health services among recently arrived men with refugee backgrounds: a comparative analysis of urban and regional settlement in south-east Queensland.Crossref | GoogleScholarGoogle Scholar |
[23] Johnston V, Smith L, Roydhouse H. The health of newly arrived refugees to the Top End of Australia: results of a clinical audit at the Darwin Refugee Health Service. Aust J Primary Health 2012; 18 242–7.
| The health of newly arrived refugees to the Top End of Australia: results of a clinical audit at the Darwin Refugee Health Service.Crossref | GoogleScholarGoogle Scholar |
[24] Ehntholt KA, Yule W. Practitioner review: assessment and treatment of refugee children and adolescents who have experienced war-related trauma. J Child Psychol Psychiatry 2006; 47 1197–210.
| Practitioner review: assessment and treatment of refugee children and adolescents who have experienced war-related trauma.Crossref | GoogleScholarGoogle Scholar | 17176375PubMed |
[25] Gagnon AJ, Joly MP, Bocking J. Aligning research to meet policy objectives for migrant families: an example from Canada. Health Res Policy Syst 2009; 7 15–21.
| Aligning research to meet policy objectives for migrant families: an example from Canada.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MvovFWmsw%3D%3D&md5=9f067a6207fb0e75e05cd32c09bca44fCAS | 19515260PubMed |
[26] Australian Institute of Health and Welfare (AIHW). Australia’s health 2008. Canberra: AIHW; 2008.
[27] Australian Government Department of Health and Ageing. Health Inequalities Research Collaboration (HIRC). 1999. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/hirc-index.htm [verified 12 August 2013].
[28] National Health Priority Action Council. National chronic disease strategy. Canberra: Australian Government Department of Health and Ageing; 2006.
[29] National Preventative Health Strategy. Australia: the healthiest country by 2020. The roadmap for action. Canberra: Commonwealth of Australia; 2009.
[30] Australian Human Rights Commission. Close the Gap: Indigenous health campaign. 2007. Available at http://www.humanrights.gov.au/close-gap-indigenous-health-campaign [verified 26 November 2013].
[31] Mills A. Health policy and systems research: defining the terrain; identifying the methods. Health Policy Plan 2012; 27 1–7.
| Health policy and systems research: defining the terrain; identifying the methods.Crossref | GoogleScholarGoogle Scholar | 21324972PubMed |
[32] Hetzel D, Glover JD. Is it working…together? Linking research, policy and practice in relation to children and health inequalities in South Australia. Occasional Paper Series No. 3. Public Health Information Development Unit, The University of Adelaide; 2003.
[33] Gross CP, Anderson GF, Powe NR. The relation between funding by the National Institutes of Health and the burden of disease. N Engl J Med 1999; 340 1881–7.
| The relation between funding by the National Institutes of Health and the burden of disease.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3otVSnsA%3D%3D&md5=8615ea8cdff25272cf4bf9013fd5375bCAS | 10369852PubMed |
[34] National Health and Medical Research Council. Research funding statistics and data. 2012. Available at: http://www.nhmrc.gov.au/grants/research-funding-statistics-and-data/funding-datasets [verified 26 November 2013].
[35] Australian Research Council. National competitive grants program (NCGP) dataset. 2013. Available at: http://www.arc.gov.au/general/searchable_data.htm [verified 20 March 2014].
[36] Renzaho A. Providing health services to migrants and refugees settling in Victoria, Australia: an analysis of the complexity, cost and policy implications for public health. Int J Migr Health Soc Care 2007; 3 31–43.
| Providing health services to migrants and refugees settling in Victoria, Australia: an analysis of the complexity, cost and policy implications for public health.Crossref | GoogleScholarGoogle Scholar |
[37] Renzaho AMN. Migrants getting fat in Australia: acculturation and its effects on the nutrition and physical activity of african migrants to developed countries. New York: Nova Science Publishers; 2007.
[38] Renzaho AMN. Immigration and social exclusion: examining health inequalities of immigrants through acculturation lenses. In: Taket A, Crisp B, Nevill A, Lamaro G, Graham M, Barter-Godfrey S, editors. Theorising Social Exclusion. Oxon: Routledge; 2009. pp. 117–126.
[39] Dong XS, Wang X, Largay J, Waddoups CJ, Fujimoto A. The impact of language barriers on healthcare utilization among Hispanic construction workers. In: Jackson TO, Evans KA, eds. Health disparities: epidemiology, racial/ethnic and socioeconomic risk factors and strategies for elimination. Las Vegas: NOVA Science; 2013. pp. 161–176.
[40] Aldrich R, Mooney G. Agenda-setting in health reform: the role of community. Aust Health Rev 2001; 24 161–5.
| Agenda-setting in health reform: the role of community.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3ms1Gluw%3D%3D&md5=9e3212a749adaf03f0bb35ec66169b76CAS | 11357732PubMed |
