Abstract
Introduction: Many aspects of health differ significantly between men and women, including mental health where there are pronounced differences. Women are more likely than men to seek treatment for psychological problems and depression.
Main Body: In the literature, two broad explanations are offered for these gender differences. On the one hand, socioeconomic factors such as the position in the labor market are highlighted. On the other hand, differences in mental health are associated with aspects of social capital, such as the support individuals receive from others. Immigrant populations are ideal to study these mechanisms, as they display great variance in both dimensions. Here we show that both mechanisms contribute to reported mental health.
Discussion: Statistically speaking, socioeconomic factors and the perception that one is in control of one’s life can explain substantial parts of the gender differences in mental health. Of the socioeconomic variables, the most important covariates are the level of education and labor market status. Indeed, there does not appear to be anything particular about immigrant populations as is sometimes suggested in migration studies.
Implications: These results follow that policies to alleviate the gender gap in mental health will probably be most successful if they focus on improving health and well-being generally rather than focusing on gender or being of immigrant origin. For immigrants and nonimmigrants alike, this means facilitating labor force participation such as by aiding reintegration and training for low-skilled women.
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Acknowledgement
The research leading to these results has received funding from the Swiss Federal Office of Public Health.
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Response Section
What the Study Tells Us About Swiss Integration Policy
This study is interesting as it is trying to explain the reasons and possible factors for the gender gap in immigrants’ mental health in Switzerland. In addition, from the point of view of a specialist on migration and health topics, working to promote the National Programme on Migration and Health within the Federal Office of Public Health, this study invites us to reflect on, and question, the achievements of Swiss integration policy.
In that regard, after a short overview of the main domains of integration promoted in Switzerland, I will use the results of the study to point out a few questions and challenges to consider in regard to integration policy.
Swiss Integration Policy
Integration is, first and foremost, to be achieved within existing structures such as schools, vocational training institutions, businesses, or institutions of the public health system. It is implemented at the three political levels, namely, the Confederation, the cantons, and the communes. At the federal level, both the Federal Office for Migration and the Federal Office of Public Health initiate and coordinate activities in order to promote integration.
With the National Programme on Migration and Health 2014–2017, the Federal Office of Public Health aims to promote the health of the migrant population in Switzerland and thus to contribute to equal opportunities in health. Measures are implemented in the following areas: health promotion and prevention of illness, health care provision and education, community interpreting and research and knowledge management.
The Federal Office for Migration provides—besides the efforts via the ordinary structures—financial support to the cantons to promote specific integration defined in the three following pillars: (1) information and advice, (2) training and employment, and (3) communication and social integration.
Integration Policy in Regard to the Study Results
The study brings us a step closer to understanding the gender gap in mental health between immigrants in Switzerland with two main explanatory factors:
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The socioeconomic factor, which stresses that the level of education, the effective access to the labor market, as well as the capacity of the immigrants to speak a local language are decisive.
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The feeling of being in control of one’s life: beside having a job and being in a position to be understood (language skills, interpreting services) having relationships and a support network—what the authors also call social capital—is another key explanatory variable.
Does that tell us anything about the relevance of the integration policy?
In my opinion, the results of the study and the variables explaining the gender gap in mental health between immigrants confirm that the domains promoted in Switzerland, also called pillars of integration, are important and need to be addressed.
The socioeconomic factor indeed gives importance and legitimacy to the education, employment, and language knowledge domains of integration promoted at the national and cantonal level. Education contributes to creation of job opportunities, social connections, and language learning. Employment as jobs—besides the financial support they provide and the financial autonomy—contributes to establishing a valued social role, developing language skills, and broader understanding of the host community and establishing social connections. Language skills facilitate social connections and quality interactions with other communities as well as with state agencies or institutions.
The second factor stresses the importance of having a social support network and thus gives the social connections or social integration domain particular value. Being able to create bridges to the host community or to other communities, as well as to engage with local authorities and services are decisive steps for avoiding isolation and exclusion. Being socially connected is also decisive in fulfilling the “two-way” process of integration which is at the heart of the Swiss definition of integration.
Regarding this domain of integration, the integration policy and its social integration pillar is focusing and pushing the cantons in the right direction. However, looking at the goal of this pillar (migrants are expected to participate in the social life of their neighborhood and become active in civil society organizations), one could think that the expected dynamic to achieve is the one coming from the immigrant’s side. What happened to the two-way integration process dynamic anchored in art. 4, Integration, of the Federal Act on Foreign Nationals, where it is explicitly mentioned that integration requires “Willingness on the part of the foreign nationals and openness on the part of the Swiss population”? Is that openness actually encouraged by the state and the cantons, and in which ways?
This example illustrates that if the domains of action mentioned here are relevant to the promotion of integration policy in theory, practitioners and policy makers need to keep a close eye on the content of policies in order to effectively succeed and achieve the declared two-way integration.
Challenges and Questions
I see at least three challenges to tackle linked to Swiss integration policy, in order to keep it relevant and accurate in the future:
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The research and assessment challenge
The domains of action of Swiss integration policy mentioned above are relevant as they answer effective neveds and problems of the migrant population. However, at the operational level, are things done the right way? Do implemented activities have the appropriate and expected impact? Could the gender gap mentioned in the study be reduced with specific measures? Do we effectively achieve a two-way process of integration? Does Swiss integration policy address all important domains of integration?
It certainly takes resources and time to set up and implement ambitious research and assessment processes. My conviction is, though, that we need to want to know more on that front to better achieve integration.
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The case management challenge
The study clearly shows that despite money having been invested in integration policy for years, problems remain at the beneficiaries’ level. Problems concern certain individuals or categories of individuals more than others. Can this difficulty be solved and how? Would case management focused on individual situations and problems be the solution to moving a step forward, and also reducing the aforementioned gender gap?
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The social integration challenge
Social integration is a declared priority for the authorities. It’s not the public face of integration as employment, housing, education, or health can be. But it is an important issue for people experiencing the integration challenge in their lives.
In a political context and climate which is quite critical towards migrants’ presence in the country, how can interaction be promoted between migrants and the host society at the individual level? Is this challenge realistic and what needs to be done to succeed?
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Moussa, J.S., Pecoraro, M., Ruedin, D., Houmard, S. (2015). The Gender Gap in Mental Health: Immigrants in Switzerland. In: Khanlou, N., Pilkington, F. (eds) Women's Mental Health. Advances in Mental Health and Addiction. Springer, Cham. https://doi.org/10.1007/978-3-319-17326-9_15
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DOI: https://doi.org/10.1007/978-3-319-17326-9_15
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