BMJ Global Health: More research needed to understand non-communicable disease risks and outcomes for internal migrants in China
New research concludes more evidence is needed to understand the non-communicable disease (NCD) risks, treatment, management and health outcomes for internal migrants in China as compared with their non-migrant counterparts.
Researchers conducted a systematic review of medical, public health, and health economic literature dating from 2000 to 2020 to analyse behavioural risk factors (including tobacco use, unhealthy diet, and physical inactivity), metabolic risk factors (such as overweight and high blood pressure), and NCD outcomes with the aim of assessing differences between migrants and non-migrants groups.
Internal migrants are people who move within their own country to establish temporary or permanent residence, with China having the largest number of internal migrants of any country globally. In 2019, the number of internal migrants in China reached 290.8 million (accounting for more than one-fifth of the population).
In recent decades China has also experienced a shift of disease burden from infectious diseases to NCDs. This rising NCD prevalence, coupled with poor quality of care outcomes for chronic diseases, pose a major challenge to sustainable development and attainment of the Healthy China 2030 goal of reducing premature mortality from NCDs by one-third by 2030.
Dr Yang (William) Zhao, Senior Research Fellow at The George Institute for Global Health, Honorary Research Fellow at the University of Melbourne, and author on the paper said:
“NCD prevention for internal migrant populations is likely to remain the top priority of public health policy in China. Further research is essential to understand health-seeking behaviours of migrant populations, including implications of such behaviours and management of NCDs for health outcomes and long-term healthcare costs among internal migrants in China.”
While further evidence is needed, the study researchers suggest that internal migrants may have worse NCD diagnoses, treatment, and control than their non-migrant counterparts, which may be a result of inadequate access to healthcare and delays in seeking treatment.
Lead author Cynthia Qian, MPH candidate at the Department of Epidemiology, Harvard School of Public Health said:
“Internal migrants in China are less likely to seek timely treatment for their NCDs than non-migrant counterparts. This may be due to barriers such as healthcare costs associated with insufficient health insurance coverage among internal migrants in China who are excluded from the welfare and social security systems of cities.”
The study authors highlight the need for further research to understand the health-seeking behaviours of migrants and recommend reforming social health insurance to consolidate rural and urban schemes to allow greater portability for all people, including migrants, as well as addressing possible barriers to migrants accessing healthcare in their new city of residence.
Dr John Lee, Senior Lecturer from The Nossal Institute for Global Health at the University of Melbourne, Australia and senior author on the paper said:
“Optimising the health insurance system can play an important role in improving access to healthcare services and provide financial risk protection.”
The research is available in BMJ Global Health here: http://dx.doi.org/10.1136/bmjgh-2020-003324