Migration, Assimilation, and Chronic Disease Among Refugees in Belgium

Hadewijch Vandenheede, Vrije Universiteit Brussel
Solveig Cunningham, Emory University

Refugees and asylum-seekers tend to be even more disadvantaged than other immigrants, having lower levels of education, social connections, and poorer health. Research on foreign-born people, especially in North America, has shown deterioration in health with years since resettlement, most markedly in terms of diabetes, obesity, and cardiovascular diseases; research in Europe has also shown higher levels of diabetes-related mortality among foreign-born people. The origins of these risks are not well understood, but a leading explanation has been acculturation, a process through which immigrants adopt new products, values, and behaviors that may be detrimental to health. Whether these patterns also hold for refugees is unclear. This study examines how health-related behaviors change after resettlement in Belgium, a leading recipient of refugees and immigrants. We adapted previously-developed survey instruments for data collection about health behavior changes and health. We collected data in Brussels in 2017 in English or Arabic using venue-based sampling. The 60 adult respondents were from 23 countries and had lived in Belgium on average 8 years. Respondents had generally positive perceptions of their health; still, 5% reported having been diagnosed with diabetes, 5% with heart disease, and 12% with hypertension; 13% assessed themselves as underweight and 5% as obese. Respondents spent more than 2 hours per day being active, but also another two hours in inactive screen-viewing. About a third of respondents did not report any changes in diets since arrival; among the rest, Belgian street foods were the most commonly listed foods adopted after resettlement; many reported changes in the types of grains consumed; still, many people also reported having adopted some new healthy items - vegetables, fruits, pastas. The main considerations in changing food habits among refugee families have to do with ease of finding foods. Respondents demonstrated accurate knowledge of what is healthy and unhealthy.

There are over almost 16 million are refugees and asylum seekers worldwide, having been forced by conflict, violence and extreme social, economic or political hardship to flee abroad.(1, 2) Refugees and asylum-seekers arrive especially disadvantaged, having lower levels of education, fewer social networks, and poorer health than other migrants.(3-9)

Even though immigrants frequently have limited access to health care and preventative care,(10-17) they tend to be in better health than native-born individuals on arrival.(18-24) However, with duration of residence in the country of reception, immigrants’ health seems to deteriorate, most markedly in terms of diabetes, obesity, and some cardiovascular diseases.(24-31) The origins of these risks are not well understood, but a leading explanation has been acculturation, a process through which immigrants adopt new products, values, and behaviors that may be detrimental to health.(32, 33)

Whether these patterns also hold for refugees is unclear. Refugees are an immigrant group facing major inequalities. Prior to migration, due to poor living conditions, food scarcity and limited access to health care in communities or refugee camps, refugees often experience untreated health problems (8, 9). In their receiving communities, refugees’ access to health care varies and they may have undiagnosed chronic and infectious conditions(9, 34). The study we will describe examined how health behaviors and health risks change among refugee families upon resettlement in Belgium. European countries house almost 10% of the world’s refugees, and Belgium is the 6th leading recipient of refugees.4 It has some of the lowest rates of diabetes and obesity among Western countries, and thus offers a very different context of reception from studies of obesity and diabetes in the United States and other more obesogenic environments.

We previously developed, tested, and used survey instruments for data collection about health behavior change and health among refugees in the U.S.; for this project, we adapted and improved the survey instruments for the Brussels context. Questions pertained to migration history, demographic and socio-economic characteristics, differences in eating and physical activity before and after resettlement, and self-perceptions of wellbeing and body weight. We collected data in Brussels in June and July 2017 using venue-based sampling at locations with large proportions of immigrants throughout the city. Sixty foreign-born individuals arrived as refugees in Brussels gave informed consent and participated in 30-minute interviews in English or Arabic. Data analysis includes descriptive analysis of migration histories, self-perceptions, and beliefs and behaviors relating to eating, physical, and sedentary behaviors. We will also use t-tests and multivariate regression models as appropriate.

Respondents were from 23 countries, most commonly Afghanistan. Almost half of respondents had lived in refugee camps before arriving in Belgium. Average age was 35years; the majority were men and less than half were married.

Table 2 summarizes the differences identified by respondents between their current and pre-settlement diets, aggregated into broad categories. The most frequently listed foods that participants frequently consumed before arriving in Belgium. but do so no more are types of grains and specific ethnic dishes. Consistent with theories about adoption of unhealthy lifestyles after migration, the most commonly listed newly adopted items were street foods, especially frites. But the patterns are not as simple as the theories would suggest, because many respondents also named new fruits and vegetables and pasta and pizza. The most common food and drink items identified by respondents as Belgian were frites and potatoes, as well as what might be called Italian food – pastas, lasagnas, pizzas. As respondents thought about the things that they consume now which they had not consumed before arriving in Belgium, they reported that main considerations were that the items were easy to find in their new communities.

Levels of physical activity were fairly high, at 132 minutes per day on average; levels of screen-based activities were also high, at 127 minutes daily. Respondents had generally positive perceptions of their health, with almost 71% reporting that they were in very good or good health; still, 5% reported having been diagnosed with diabetes, 5% with heart disease, and 12% with hypertension. Respondents were asked about their weight using pictures, and 40% reported that they were in a normal-weight range; 13% assessed themselves to be underweight and 5% assessed themselves as obese.

Presented in Session 1079: International Migration and Migrant Populations