Care facilities specifically targeted at older migrants can help close the health gap. However, such facilities have gone ‘out of fashion’, as the municipalities are responsible for elderly care. This is demonstrated by researcher Hanna Carlsson in her recently published dissertation, for which she did fieldwork in Nijmegen and The Hague.
The problem has been known for some time: Elderly people with a migration background make less use of care and have poorer health than their peers of Dutch origin. There are several reasons for this health gap, Carlsson explains. ‘Many older migrants have done heavy physical work. They often have a low income and a low education. This also applies to some Dutch elderly people, but even if you check for income and education, older migrants have poorer health. ‘
Carlsson: ‘That difference can be attributed, among other things, to poorer living conditions, social isolation and migration-related stress. But discrimination and cultural differences also play a role. Bad experiences with the care system lead to care avoidance. And if you do not speak the language well, it is harder to be well understood by a healthcare provider. For example, dementia is often found late in older migrants. ‘
“The idea was: If it’s close, it’s available.”
In his dissertation, Carlsson examines the effects of two recent trends in Dutch health policy: localization and post-multiculturalism. This first development, which started around 2010, meant that care was increasingly organized at the neighborhood level. The decentralization of the Social Assistance Act in 2015 reinforced this movement. Working neighborhood-oriented was the new starting point. In addition, thinking about the multicultural society changed from the turn of the century. Special facilities for migrant groups hampered integration, it was thought. ‘Now the municipalities prefer to talk about inclusiveness’, says Carlsson.
In other words, care provision was no longer target-oriented, but district-oriented. “The idea was that if it’s close, it’s available,” Carlsson said. “But it’s too easy to think. If you create something for the whole district, there will often be only one group. That usual suspects† The rest do not feel welcome. ‘
‘Stamppot and André Hazes are also very culture-specific.’
The facilities specifically targeted at a migrant group are able to reach the elderly who would otherwise remain out of the picture, Carlsson noted during his research. “An atmosphere is created where people recognize things from their own environment. It can be simple things like music or food that make people feel welcome. And it also lowers the threshold for other facilities.
Such facilities are called ‘culture-specific’, but this actually applies to all facilities, notes Carlsson, who himself comes from Sweden. ‘For example, I was with a Dutch group where the stew was eaten and André Hazes played. For me as a Swede, it also felt very culture-specific. ‘
Carlsson advises municipalities to map which groups are reached and which are not. This is not only related to ethnicity, language or culture, but also to the local community, Carlsson noted in his fieldwork. ‘It can be difficult for people of Chinese descent in Nijmegen to find care facilities. But that’s how it is in The Hague. There are so many people there with that background: Even if you do not speak Dutch, there are plenty of people who can help you. ‘
‘Migration-related diversity is not just an issue.’
In addition, Carlsson is in favor of a more forward-looking view of the health system. Health inequalities are now often seen as a short-term problem, mainly related to the disadvantages of the current generation of older working immigrants. But the population is only getting more diverse: by 2050, 24 percent of those over 65 will be people with a migration background, compared to 14 percent today. In the larger cities, it’s even 1 in 3 by 2030. And that’s it wishful thinking to believe that future migrants will have less need for culture-specific care, Carlsson says. ‘We have to accept that we still have migrant groups that are at a great distance from the health care system.’
The policy towards older migrants could also assume a more positive tone, Carlsson believes. ‘This means that we recognize that migration-related diversity is not just a problem. It is also a source of meaning in the lives of many seniors. Also for older people who are “well integrated” and who e.g. speaks the Dutch language well. ‘