Varda Soskolne School of Social Work, Bar-Ilan University, Ramat-Gan and Hadassah Medical Center, Jerusalem, Israel

1. Linking evidence for inequalities in physical and in psychological health by socioeconomic and immigration status: implications for health social work Varda Soskolne School of Social Work, Bar-Ilan University, Ramat-Gan and Hadassah Medical Center, Jerusalem, Israel

2. Health inequalities: immigrants Linkages between health inequalities by immigration status and socio-economic position A Case example of immigrants from the former Soviet Union to Israel Physical health vs. psychological distress Differences in utilization of health social work services Implications for social work interventions & policy Topics Dr. Varda Soskolne, Bar-Ilan Universiy

3. Diverse patterns of inequalities The “healthy immigrant” effect: better health than those that stay behind Poorer health than the native, non-immigrant population in the host country Health inequalities: immigrants Dr. Varda Soskolne, Bar-Ilan Universiy

4. BUT other examples: Japanese who migrated to USA - worse health status than counterparts in Japan but better than Americans Chinese in Australia - higher IHD and CVD rates than in China, but similar to the host population Over time - a decline of differences Health inequalities: immigrants Dr. Varda Soskolne, Bar-Ilan Universiy

5. Mental health General psychological distress – higher than the non-immigrants; variation between cultural groups Mental disease – no consistent indication for higher ‘caseness’ Health inequalities: immigrants Dr. Varda Soskolne, Bar-Ilan Universiy

6. Type of immigration: involuntary immigration or voluntary, single or in families, chain migration, legal status in the new country, etc. Risk factors from the country of origin persist, often for more than a generation Post-immigration factors: lower socio-economic position (SEP), limited psychosocial resources compared to non-immigrants Determinants ofimmigrants’health inequalities Dr. Varda Soskolne, Bar-Ilan Universiy

7. Social inequalities in health: Differences in health status by socio-economic position (SEP)The social gradient:With each decrease in SEP, there is an increase in morbidity and mortality rates Dr. Varda Soskolne, Bar-Ilan Universiy

8. Major explanations for social inequalities in health • Material deprivation • Psychosocial explanation: Individual-level Community-level • Life-course • Neo-materialist Dr. Varda Soskolne, Bar-Ilan Universiy

9. Immigrants from the former Soviet Union to Israel as a case example Dr. Varda Soskolne, Bar-Ilan Universiy

10. Research questions • Do socioeconomic factors explain the adverse health status of the immigrants? • Do psychosocial factors and health behavior further explain the adverse health status of immigrants? • Are the associations with immigration status different for physical health and psychological distress? Dr. Varda Soskolne, Bar-Ilan Universiy

11. Why study social inequalities in health in Israel? • National Health Insurance Law, committed to assure “the principles of justice, equality and reciprocity” • From previous research - evidence for social inequalities in health: higher mortality and morbidity rates in the more disadvantaged sectors Dr. Varda Soskolne, Bar-Ilan Universiy

12. In 1990 – 2000: close to one million Surveys in the early 1990’s: Social inequalities: Higher education level but lower income, occupation level Health inequalities: Poorer physical health status, higher psychological distress A higher proportion of elderly persons compared to the non-immigrants Recent immigrants from the former Soviet Union Dr. Varda Soskolne, Bar-Ilan Universiy

13. Methods • A national random sample of 1328 people, aged 30-70 years, from a variety of Jewish urban areas* • Interviewed at home • For this analysis 1274 respondents: 1050 veteran residents and 224 immigrants from the former Soviet Union * Manor & Soskolne, 2005 Dr. Varda Soskolne, Bar-Ilan Universiy

14. RESULTS* * Part of the following analysis is based on the MPH thesis of Dmitry Taran, The Hebrew University – Hadassah School of Public Health, Jerusalem, 2006 Dr. Varda Soskolne, Bar-Ilan Universiy

15. Mean years of residence in Israel - 8.64 (SD=3.84) • The immigrants did not differ from the non-immigrants in age, gender or marital status • SEP indicators: significant differences The immigrants (compared to non-immigrants) had • higher education • lower-level occupations • no cars in family • lower income Dr. Varda Soskolne, Bar-Ilan Universiy

16. Significant differences in Health measures ***p<0.001, #p=0.08 Dr. Varda Soskolne, Bar-Ilan Universiy

17. Research question 1:Do socioeconomic factors explain the adverse health status of the immigrants? Physical health: SEP indicators factors do not explain inequalities in self-rated health Depressive symptoms: Yes, current SEP indicators explain inequalities Dr. Varda Soskolne, Bar-Ilan Universiy

18. Research question 2:Do psychosocial factors further explain the adverse health status of the immigrants? Physical health: No (the poorer health status of the immigrants remains significant) Depressive symptoms: Small added explanation to that of current SEP indicators Dr. Varda Soskolne, Bar-Ilan Universiy

19. Research question 3:Are the associations with immigration status different for physical health and psychological distress? Yes. SEP indicators and psychosocial factors do not explain inequalities in self-rated health But, current SEP indicators and more psychosocial factors explain inequalities in depressive symptoms Dr. Varda Soskolne, Bar-Ilan Universiy

20. Despite the higher health needs: No difference in utilization of medical services between the immigrants and non-immigrants Utilization of health social work services was lower among immigrant patients compared to non-immigrant patients Different reasons for non-utilization Insights from a study on utilization of health services* * Auslander, Soskolne & Ben-Shahar, 2005 Dr. Varda Soskolne, Bar-Ilan Universiy

21. Conclusions • Effects of the ‘old’ countryon poorer physical health persist even a decade after immigration • Effects of the current SEP context, stressors and resources on inequalities in depressive symptoms • Utilization of social work services is highly influenced by perception from the Soviet Union • Relevance to immigrants from the former Soviet Union or from other East European countries Dr. Varda Soskolne, Bar-Ilan Universiy

22. Implications for social work • Use evidence-base to identify most vulnerable immigrants • Promote utilization of social work services (raise awareness; decrease suspicion; outreach) c) Better, culturally appropriate interventions, not necessarily more services; better interface with other services d) Be the voices about the determinants of health inequalities e) A greater involvement of social workers in health policy decision-making; the reduction of health inequalities should be a target of a national health policy Dr. Varda Soskolne, Bar-Ilan Universiy