Public health officials have had to take on lots to combat the COVID-19 pandemic. They needed to be able to offer both non-pharmaceutical and pharmaceutical interventions to prevent hospitalizations, death, and severe illness. Although these interventions have proved extremely effective in keeping the general public aware of the consequences and negative consequences of not adhering to existing protocols, immigrant communities from different countries have not benefited significantly.
Study: Uptake of Covid-19 preventive measures among ethnic minorities of 10 immigrants in Norway. Image Credit: Maridav/Shutterstock
Research across Scandinavian countries has revealed striking differences in the pre-existing socio and health disparities that exist between non-immigrants and immigrants who were diagnosed, hospitalized, or died from COVID-19. The data available point to the deleterious consequences of social determinants that are ubiquitous such as poor working and living conditions as well as linguistic and cultural barriers, poor knowledge, and limited social networks limiting migrants’ adequate health literacy and awareness. As a way to reduce COVID-19-related adversities among migrants it is crucial to address the underlying socio-economic conditions that immigrants face.
A Norwegian study revealed the rate of hospitalization and notification of 251 and 21 per 100,000 for non-immigrants, respectively, compared to 567 and 61 for 100,000 for immigrants. This indicates a higher chance of being hospitalized among immigrants. The highest rate of notification was among immigrants from Somalia (2057), Pakistan (1868), Iraq (1616), and Afghanistan (1391). However, it is not certain if there is any qualitative evidence of the impact of socioeconomic and socio-cultural factors on immigrants’ acceptance of COVID-19 preventive measures in Norway.
Norwegian public health researchers have published an article in the preprint server medRxiv* which addresses this issue and trying to determine the exact causes that make immigrants more susceptible to COVID-19-related fatalities.
About the study
Researchers from the Norwegian Institute of Public Health and Opinion which is a research consulting firm, sought out participants using snowballing and purposive methods. A diverse group of immigrants was selected to ensure an unbiased study. The criteria used to select participants included education and occupation, age and length of stay in Norway. A total of 88 people from 10 different ethnic groups from Somalia, Iraq, Pakistan, Afghanistan, Poland, Sri Lanka, Turkey, Bosnia/Serbia Eritrea and Syria were selected for this study.
Of the 88 participants of the 88, 49 were females and 39 were males, with their age range ranging from 19 to 78 years old. The majority of participants had lived in Norway for at least 15 years, some of them had recently immigrated to Norway, while others were born there. 38 percent of those who reported their education had a degree from a university, while others had a secondary degree or less.
Participants were asked questions on the excessive number of immigrants among people infected by the coronavirus as well as those who were who were hospitalized because of COVID-19. Participants agreed that the primary factors contributing to higher rates of infection in their communities was overcrowding front-line jobs, and the lack of education.
The majority of immigrants’ families resided in extreme or borderline poverty, forcing them to reside in smaller, constrained areas, which made them more vulnerable to infection because of the lack of social separation. It was challenging to care for infected family members and isolate them. This could have contributed to the increase in hospitalizations and deaths. The disease burden was only increased by frequent visits to relatives and friends.
Front-line workers that comprised the majority of immigrants’ communities were exposed to cases in the first place that could lead to infections and hospitalization. Their earnings were also low, making it difficult for them to receive the proper care. Poor health literacy, insufficient education, and a lack of knowledge among peers were major causes of the rising burden of disease. Although some believed the virus wasn’t contagious some believed that the virus only affected people from particular religions or beliefs that was a result of lack of education and knowledge.
Participants also claimed that the religious fatalism, which is the idea that preventing disease is beyond our control, played a crucial role in the spread. Others stated that cultural boundaries made it impossible for people to hug, kiss or shake hands with one other.
Other reasons that immigrants cited were inadequate risk perception as well as a lack of authoritarian rule and fear of stigma. However despite all this it was evident that immigrant communities had become aware of their own inadequacy which could have led to worse outcomes with time.
Implications
This study found that despite the improved knowledge of patients about the health risks and outcomes due to lack of adherence to COVID-19 guidelines There were two major factors that contribute to higher rates of infection among immigrants – socio-economic and socio-cultural.
The stark contrast in numbers for COVID-19-related deaths among immigrants only highlights the ever-existing gap that divides healthcare access for immigrants based on stigma and discrimination. Despite the constant outbreaks studies like these should be used to create specific policies and interventions that can aid in balancing the social and health factors that affect health between immigrants and natives.
*Important notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
