Description
Introduction:
Undocumented migrants living with noncommunicable diseases (NCDs) have multiple healthcare needs that are conditioned by the different contexts in which they have lived and worked.
Methods:
We conducted a scoping review to map the socioeconomic factors at the individual and structural levels along the migration journey - from the country of origin to transit, departure, and integration in the country(ies) of destination - that influence the healthcare needs of undocumented migrants living with NCDs.
The literature reviewed includes Medline, Embase, Web of Science, and Google Scholar between 2000 and 2022. We included scientific articles that described interventions, programs, or policies that address cardiovascular disease, cancer, chronic respiratory disease, and diabetes. The data were structured according to the Commission on Social Determinants of Health framework, differentiated along the migration journey. A new conceptual model emerged from data synthesis.
Results and discussion:
We included 22 studies out of 953 identified. They reported data from Italy, the United States, Spain, Switzerland, The Netherlands, France, Austria, and Sweden. There is no standard operational definition of undocumented migrants; they include irregular migration, individuals who are neither citizens nor legal residents, and self-reporting.
The new conceptual model emphasizes two categories: structural determinants including sociopolitical context and socioeconomic position, and intermediary determinants including individual and health system-related determinants. These categories are interrelated and may persist or change throughout the migration journey.
The structural determinants do not directly affect the healthcare needs, but rather they affect the availability of resources of the intermediary determinants. The sociopolitical context and socioeconomic position can be the root of differential exposure to heath-damaging conditions for undocumented migrants compared to documented migrants or native populations.
The intermediate determinants evolve throughout the migration journey and directly shape the healthcare needs. The individual determinants include material circumstances, biological or psychosocial factors, and health-related behaviors. Individual determinants are highly variable throughout the migration journey and are more influential in the country(ies) of destination. The health system-related determinants matter for access to early diagnosis, periodic follow-up, chronic medication, and prevention of complications.
Health system-related determinants and the sociopolitical context overlap and interact during the transit, departure, and integration in the country(ies) of destination. Finally, there is a feedback effect of the needs generated by living with NCDs on the structural determinants that operate through income, occupation, or policies based on the morbidity or mortality of chronic conditions.
Conclusion:
The elements that shape healthcare needs for NCDs in undocumented migrants are complex. Migrant health policies should aim to better respond to the NCD-related healthcare needs of undocumented migrants throughout the disease course and their migration journey, considering social, economic, and legal factors that underlie their health vulnerability.
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