The European Journal of Public Health
Volume 25, Issue 6, 1 December 2015
http://eurpub.oxfordjournals.org/content/25/6

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Editorials
Categorizations of migrants and ethnic minorities—are they useful for decisions on public health interventions?
Allan Krasnik
DOI: http://dx.doi.org/10.1093/eurpub/ckv177 907
Extract
Decisions regarding population-based preventive interventions require convincing measures of health and risks. Is it justified to initiate special community programs on diabetes prevention among migrants on the basis of a higher prevalence of diabetes than in the non-migrant population? Even as we know that diabetes is not a problem for the majority of the migrants? And that diabetes is also a problem for many non-migrants—however less prevalent? Relative risks and differences in prevalence of risks and diseases between groups are often used to justify such new programs for selected groups and communities based on certain characteristics such as ethnicity, migrant status, family situation or socio-economic position.
Mulinari et al.1 question the use of broad categorizations as instruments for predicting individual health problems using the area of ethnicity, migration and health as an example, and warn against the practice of only including measures of association in the consideration of public health interventions. Instead, these kinds of measures should always be reported together with measures of discriminatory accuracy…

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Editor’s Choice
Questioning the discriminatory accuracy of broad migrant categories in public health: self-rated health in Sweden
Shai Mulinari, Anna Bredström, Juan Merlo
DOI: http://dx.doi.org/10.1093/eurpub/ckv099 911-917
Abstract
Background: Differences between natives and migrants in average risk for poor self-rated health (SRH) are well documented, which has lent support to proposals for interventions targeting disadvantaged minority groups. However, such proposals are based on measures of association that neglect individual heterogeneity around group averages and thereby the discriminatory accuracy (DA) of the categories used (i.e. their ability to discriminate the individuals with poor and good SRH, respectively). Therefore, applying DA measures rather than only measures of association our study revisits the value of broad native and migrant categorizations for predicting SRH.
Design, setting and participants: We analyzed 27 723 individuals aged 18–80 who responded to a 2008 Swedish public health survey. We performed logistic regressions to estimate odds ratios (ORs), predicted risks and the area under the receiver operating characteristic curve (AU-ROC) as a measure of epidemiological DA.
Results: Being born abroad was associated with higher odds of poor SRH (OR = 1.75), but the AU-ROC of this variable only added 0.02 units to the AU-ROC for age alone (from 0.53 to 0.55). The AU-ROC increased, but remained unsatisfactorily low (0.62), when available social and demographic variables were included.
Conclusions: Our results question the use of broad native/migrant categorizations as instruments for forecasting individual SRH. Such simple categorizations have a very low DA and should be abandoned in public health practice. Measures of association and DA should be reported together whenever an intervention is being considered, especially in the area of ethnicity, migration and health.

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How do economic crises affect migrants’ risk of infectious disease? A systematic-narrative review
Alexander Kentikelenis, Marina Karanikolos, Gemma Williams, Philipa Mladovsky, Lawrence King, Anastasia Pharris, Jonathan E. Suk, Angelos Hatzakis, Martin McKee, Teymur Noori, David Stuckler
DOI: http://dx.doi.org/10.1093/eurpub/ckv151 937-944 First published online: 28 August 2015
Abstract
Background: It is not well understood how economic crises affect infectious disease incidence and prevalence, particularly among vulnerable groups. Using a susceptible-infected-recovered framework, we systematically reviewed literature on the impact of the economic crises on infectious disease risks in migrants in Europe, focusing principally on HIV, TB, hepatitis and other STIs.
Methods: We conducted two searches in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar, websites of key organizations and grey literature to identify how economic changes affect migrant populations and infectious disease. We perform a narrative synthesis in order to map critical pathways and identify hypotheses for subsequent research.
Results: The systematic review on links between economic crises and migrant health identified 653 studies through database searching; only seven met the inclusion criteria. Fourteen items were identified through further searches. The systematic review on links between economic crises and infectious disease identified 480 studies through database searching; 19 met the inclusion criteria. Eight items were identified through further searches. The reviews show that migrant populations in Europe appear disproportionately at risk of specific infectious diseases, and that economic crises and subsequent responses have tended to exacerbate such risks. Recessions lead to unemployment, impoverishment and other risk factors that can be linked to the transmissibility of disease among migrants. Austerity measures that lead to cuts in prevention and treatment programmes further exacerbate infectious disease risks among migrants. Non-governmental health service providers occasionally stepped in to cater to specific populations that include migrants.
Conclusions: There is evidence that migrants are especially vulnerable to infectious disease during economic crises. Ring-fenced funding of prevention programs, including screening and treatment, is important for addressing this vulnerability.

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Effect of Human Papillomavirus vaccination of daughters on the cervical screening uptake of their non-vaccinated mothers
Angela M. Spencer, Stephen A. Roberts, Arpana Verma, Julietta Patnick, Peter Elton, Loretta Brabin Eur J Public Health (2015) 25 (6): 1097-1100 DOI: http://dx.doi.org/10.1093/eurpub/ckv146 First published online: 8 August 2015 (4 pages)