ED Sociétés, Politique, Santé Publique
Health status and access to preventive care of undocumented migrants in France: role of migration, living conditions in France and comparison with legal immigrants
by Sohela MOUSSAOUI (Bordeaux Population Health Research Center)
The defense will take place at 13h00 - Amphithéâtre 6 ISPED, Université de Bordeaux, Campus Carreire, 146 Rue Léo Saignat, 33000 Bordeaux
in front of the jury composed of
- Jérôme WITTWER - Professeur des universités - Université de Bordeaux - Directeur de these
- Julie DUPOUY - Professeure des universités - Université de Toulouse - Rapporteur
- Yves JACKSON - Professeur associé - Université de Genève - Rapporteur
- Maria MELCHIOR - Directrice de recherche - iPLesp , unité de Recherche ESSMA - Examinateur
Undocumented migrants (UM) in France represent a marginalized population whose health has been little studied. This thesis explores the health status, access to preventive care, and the link between pain and mental health among undocumented migrants, while analyzing the influence of social determinants of health (SDH), particularly living conditions, on these different aspects. This work was conducted using the Premiers Pas survey, which is a representative survey of UM in France, and a representative sample of documented migrants (DM) in France (EHIS). The first focus was on the general health status of UM. The indicators analyzed were depression, asthma, hypertension, diabetes, and perceived health status. High prevalences of depression and poor perceived health were found, with a strong influence of living conditions. After adjusting for several SDH, UM had a higher risk of depression and poor perceived health than DM. The second focus of focus was access to preventive care and tobacco and alcohol consumption. Between half and two-thirds of participants reported having had access to preventive care since arriving in France. Access to health insurance (Aide Médicale de l'Etat) and length of stay in France were contributing factors. Although lower than those of the general French population, the prevalence of substance use was significant. These patterns of use were more common among men and people of North African origin. Tobacco use rates were higher among UM than among DM. Finally, the third focus of analysis examined the association between pain and mental health among UM. Our results revealed a strong and persistent association between these two dimensions, even after adjusting for DSS. This result supports the systematic exploration of mental health among UM consulting for pain. Those different results provide new empirical data showing that the health of UM in France is strongly influenced by poor living conditions. The poorer health of UM, who arrived more recently, compared to DM, who have been in France for longer, raises the question of the application of known theories on migrant health, such as the “exhausted migrant effect”. Although the results of this thesis do not allow us to conclude that these theories do not apply to UM, they do suggest that for certain health indicators, the effect of poor living conditions on health may mitigate or even counterbalance the effects of migration theories. It is likely that within the UM population itself, the effect of living conditions has a different impact depending, for example, on the mode of entry into France (with or without a residence permit). In conclusion, the results of this study highlight the importance of structural determinants of health, such as public policies, in addressing issues related to living conditions. Measures such as legal access to the labor market, access to social housing, and regularization of administrative status are major factors in integration, enabling financial and administrative stability and potentially positively influencing the health status of UM. Although our results show that access to health insurance explains very little of the differences in health, public health policies also have an important role to play in the health and access to care of this population. Better integration of the specific needs, particularly the psychosocial factors, of UM could help promote their integration into the healthcare system.