Migrants, Refugees, Asylum Seekers: Use and Misuse of Labels in Public Health Research

  • Judith Wenner
  • Yudit Namer
  • Oliver Razum
Part of the Migration, Minorities and Modernity book series (MMMO, volume 4)


Public health researchers in Germany increasingly acknowledge refugees’ and other migrants’ right to access healthcare. In their decisions regarding the definition of population sub-groups, however, researchers face a dilemma. On the one hand, they need to differentiate between groups for thorough analysis of access barriers in order to identify and challenge health inequalities. On the other hand, they recognise that categories are constructed and may replicate discourses of “othering”, or a separation between “us” and “them”. This chapter firstly summarises Germany’s history of migration to describe the research field. Then it discusses the difficulties of categorising population sub-groups to research the health of migrants and refugees and their access to healthcare, while running the risk of “categorical fetishism”. To overcome this dilemma, three strategies are proposed: (1) caution toward politically defined categories through continuous reflection on constructs, variables and methods, taking the position of a “moral third”; (2) considering a life course approach to migrant health to account for the heterogeneity of life courses among migrants; (3) collecting and using data that allow for a detailed and not purely political differentiation between migrants and non-migrants as well as within the group of migrants.


  1. Apostolova, R. (2015). Of refugees and migrants: Stigma, politics, and boundary work at the borders of Europe. American Sociological Association Newsletter. Accessed February 16, 2018.
  2. Arnold, M., Razum, O., & Coebergh, J. W. (2010). Cancer risk diversity in non-western migrants to Europe: An overview of the literature. European Journal of Cancer, 46(14), 2647–2659.CrossRefGoogle Scholar
  3. Bade, K. J. (2007). Enzyklopädie Migration in Europa. Vom 17. Jahrhundert bis zur Gegenwart. Paderborn: Verlag Ferdinand Schöningh.Google Scholar
  4. Bade, K. J. (2017). Migration - Flucht - Integration: Kritische Politikbegleitung von der “Gastarbeiterfrage” bis zur “Flüchtlingskrise”. Erinnerungen und Beiträge. Karlsruhe: Von Loeper Literaturverlag.Google Scholar
  5. Ben-Shlomo, Y., & Kuh, D. (2002). A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology, 31(2), 285–293.CrossRefGoogle Scholar
  6. Benjamin, J. (1995). Like subjects, love objects: Essays on recognition and sexual difference. Yale University Press. Accessed February 16, 2018.
  7. Benjamin, J. (2014). The discarded and the dignified—From the failed witness to “you are the eyes of the world”. Accessed February 16, 2018.
  8. Bermejo, I., Nicolaus, L., Kriston, L., Hölzel, L., & Härter, M. (2012). Vergleichende Analyse psychosomatischer Beschwerden bei Personen mit spanischem, italienischem, turkischem und russischem Migrationshintergrund. Psychiatrische Praxis, 39(4), 157–163.CrossRefGoogle Scholar
  9. Bozorgmehr, K., Mohsenpour, A., Saure, D., Stock, C., Loerbroks, A., Joos, S., et al. (2016). Systematische Übersicht und „Mapping“ empirischer Studien des Gesundheitszustands und der medizinischen Versorgung von Flüchtlingen und Asylsuchenden in Deutschland (1990–2014). Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 59(5), 599–620.CrossRefGoogle Scholar
  10. Bozorgmehr, K., & Razum, O. (2015). Effect of restricting access to health care on health expenditures among asylum-seekers and refugees: A quasi-experimental study in Germany, 1994–2013. PLoS ONE, 10(7), e0131483.CrossRefGoogle Scholar
  11. Brückner, G. (2016). Bevölkerung mit Migrationshintergrund. In Statistisches Bundesamt & Wissenschaftszentrum Berlin für Sozialforschung, (Eds.) Datenreport 2016 - Ein Sozialbericht für die Bundesrepublik Deutschland (pp. 218–235). Bonn: Bundeszentrale für politische Bildung.Google Scholar
  12. Brzoska, P., Sauzet, O., Yilmaz-Aslan, Y., Widera, T., & Razum, O. (2016). Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: An exploratory cross-sectional study. BMC Health Services Research, 16(1), 105.CrossRefGoogle Scholar
  13. Brzoska, P., Voigtländer, S., Spallek, J., & Razum, O. (2010). Utilization and effectiveness of medical rehabilitation in foreign nationals residing in Germany. European Journal of Epidemiology, 25(9), 651–660.CrossRefGoogle Scholar
  14. Bundesamt für Migration und Flüchtlinge. (2017). Das Bundesamt in Zahlen 2016. Asyl.;jsessionid=261AB9147FAB7DF34E9DA9AF5C773649.2_cid294?nn=1694460. Accessed February 16, 2018.
  15. Castles, S. (2003). The international politics of forced migration. Development, 46(3), 11–20.CrossRefGoogle Scholar
  16. Cattacin, S., & Chimienti, M. (2007). From control policies to health policies as a tool for inclusion. International Journal of Public Health, 52(2), 73–74.CrossRefGoogle Scholar
  17. Classen, G. (2011). Das Asylbewerberleistungsgesetz und seine Novellen auf dem Prüfstand. In Heinrich-Böll-Stiftung (Ed.) Grenz- statt Menschenschutz? Asyl- und Flüchtlingspolitik in Europa (pp. 39–44). Berlin: Heinrich-Böll-Stiftung.Google Scholar
  18. Crawley, H., & Skleparis, D. (2018). Refugees, migrants, neither, both: Categorical fetishism and the politics of bounding in Europe’s “migration crisis”. Journal of Ethnic and Migration Studies, 44(1), 48–64.CrossRefGoogle Scholar
  19. David, M., Borde, T., Brenne, S., Ramsauer, B., Henrich, W., Breckenkamp, J., et al. (2014). Comparison of perinatal data of immigrant women of Turkish origin and German women—Results of a prospective study in Berlin. Geburtshilfe und Frauenheilkunde, 74(5), 441–448.CrossRefGoogle Scholar
  20. David, M., Brenne, S., Breckenkamp, J., Razum, O., & Borde, T. (2015). Postpartum contraception: A comparative study of Berlin women with and without immigration background. Geburtshilfe Frauenheilkunde, 75(9), 915–922.CrossRefGoogle Scholar
  21. Droste, M., Gün, A. K., Kiefer, H., Koch, E., Naimi, I., Wächter, M., & Wesselman, E. (2015). Das kultursensible Krankenhaus. Ansätze zur interkulturellen Öffnung. 3rd ed. F. und I. Beauftragte der Bundesregierung für Migration, (Ed.), Berlin.;jsessionid=E83D912161027EBA64EA6D0EB44103F7.s2t2?__blob=publicationFile&v=18. Accessed February 16, 2018.
  22. Feller, E. (2005). Refugees are not migrants. Refugee Survey Quarterly, 24(4), 27–35.CrossRefGoogle Scholar
  23. Frank, L., Yesil-Jürgens, R., Razum, O., Bozorgmehr, K., Schenk, L., Gilsdorf, A., et al. (2017). Gesundheit und gesundheitliche Versorgung von Asylsuchenden und Flüchtlingen in Deutschland. Journal of Health Monitoring, 2(1), 24–47.Google Scholar
  24. Gee, G. C., Walsemann, K. M., & Brondolo, E. (2012). A life course perspective on how racism may be related to health inequities. American Journal of Public Health, 102(5), 967–974.CrossRefGoogle Scholar
  25. Grove, N. J., & Zwi, A. B. (2006). Our health and theirs: Forced migration, othering, and public health. Social Science and Medicine, 62(8), 1931–1942.CrossRefGoogle Scholar
  26. International Lesbian Gay Bisexual Trans and Intersex Association. (2016). Protecting the rights of LGBTI asylum seekers and refugees in the reform of the Common European Asylum System. Accessed February 16, 2018.
  27. Johnson, J. L., Bottorff, J. L., Browne, A. J., Grewal, S., Hilton, B. A., & Clarke, H. (2004). Othering and being othered in the context of health care services. Health Communication, 16(2), 255–271.CrossRefGoogle Scholar
  28. Kuh, D., Ben-Shlomo, Y., Lynch, J., Hallqvist, J., & Power, C. (2003). Life course epidemiology. Glossary. Journal of Epidemiology and Community Health, 57(10), 778–783.CrossRefGoogle Scholar
  29. Lindert, J., Ehrenstein, O. S., Priebe, S., Mielck, A., & Brähler, E. (2009). Depression and anxiety in labor migrants and refugees—A systematic review and meta-analysis. Social Science and Medicine, 69(2), 246–257.CrossRefGoogle Scholar
  30. Marmot, M., Allen, J., Bell, R., Bloomer, E., & Goldblatt, P. (2012). WHO European review of social determinants of health and the health divide. Lancet, 380(9846), 1011–1029.CrossRefGoogle Scholar
  31. Mattes, M. (2001). Wirtschaftliche Rekonstruktion in der Bundesrepublik Deutschland und grenzüberschreitende Arbeitsmigration von den 1950er bis zu den 1970er Jahren. In J. Oltmer (Ed.), Handbuch Staat und Migration in Deutschland seit dem 17. Jahrhundert (pp. 815–852). Berlin, München, Boston: De Gruyter.Google Scholar
  32. Mulinari, S., Bredström, A., & Merlo, J. (2015). Questioning the discriminatory accuracy of broad migrant categories in public health: Self-rated health in Sweden. European Journal of Public Health, 25(6), 911–917.CrossRefGoogle Scholar
  33. Niedrig, H., & Seukwa, L. H. (2010). Die Ordnung des Diskurses in der Flüchtlingskonstruktion: Eine postkoloniale Re-Lektüre. Diskurs Kindheits- und Jugendforschung, 5(2), 181–193.Google Scholar
  34. Peck, J. (1995). Refugees as foreigners: The problem of becoming German and finding home. In D. Valentine & J. Knudsen (Eds.), Mistrusting refugees (pp. 102–125). Berkeley: University of California Press.Google Scholar
  35. Razum, O. (2006). Commentary: Of salmon and time travellers—Musing on the mystery of migrant mortality. International Journal of Epidemiology, 35(4), 919–921.CrossRefGoogle Scholar
  36. Razum, O., Zeeb, H., Meesmann, U., Schenk, L., Bredehorst, M., Brzoska, P., et al. (2008). Migration und Gesundheit. Robert Koch-Institute: Schwerpunktbericht der Gesundheitsberichterstattung des Bundes. Berlin.Google Scholar
  37. Razum, O., Bunte, A., Gilsdorf, A., Ziese, T., & Bozorgmehr, K. (2016a). Zu gesicherten Daten kommen. Deutsches Ärzteblatt, 113(4), 130–133.Google Scholar
  38. Razum, O., & Bozorgmehr, K. (2016). Restricted entitlements and access to health care for refugees and immigrants: The example of Germany. Global Social Policy, 16(3), 321–324.CrossRefGoogle Scholar
  39. Razum, O., Karrasch, L., & Spallek, J. (2015). Migration. Eine vernachlässigte Dimension gesundheitlicher Ungleichheit? Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 59(2), 259–265.CrossRefGoogle Scholar
  40. Razum, O., & Twardella, D. (2002). Time travel with Oliver Twist—Towards an explanation for a paradoxically low mortality among recent immigrants. Tropical Medicine & International Health, 7(1), 4–10.CrossRefGoogle Scholar
  41. Razum, O., & Wenner, J. (2016). Social and health epidemiology of immigrants in Germany: Past, present and future. Public Health Reviews, 37(1), 4.CrossRefGoogle Scholar
  42. Razum, O., Wenner, J., & Bozorgmehr, K. (2016b). Wenn Zufall über den Zugang zur Gesundheitsversorgung bestimmt: Geflüchtete in Deutschland. Das Gesundheitswesen, 78(11), 711–714.Google Scholar
  43. Schenk, L., Bau, A.-M., Borde, T., Butler, J., Lampter, T., Neuhauser, H., et al. (2006). Mindestindikatorensatz zur Erfassung des Migrationsstatus: Empfehlungen für die epidemiologische Praxis. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 49(9), 853–860.Google Scholar
  44. Schwentker, B. (2014). Da waren’s plötzlich noch mehr. Accessed February 16, 2018.
  45. Spallek, J., Zeeb, H., & Razum, O. (2011). What do we have to know from migrants’ past exposures to understand their health status? A life course approach. Emerging Themes in Epidemiology, 8(1), 6–13.CrossRefGoogle Scholar
  46. Statistisches Bundesamt. (2017). Bevölkerung mit Migrationshintergrund um 8.5% gestiegen. Accessed February 16, 2018.
  47. Süssmuth, R. (2001). Zuwanderung gestalten - Integration fördern. Bericht der Unabhängigen Kommission „Zuwanderung“. Accessed February 16, 2018.
  48. von Unger, H., Odukoya, D., & Scott, P. (2016). Kategorisierung  als  diskursive  Praktik: Die Erfindung der „Ausländer-Tuberkulose“. In S. Bosancic & R. Keller (Eds.), Perspektiven wissenssoziologischer Diskursforschung (pp. 157–176). Wiesbaden: Springer.CrossRefGoogle Scholar
  49. Wächter-Raquet, M. (2016). Einführung der Gesundheitskarte für Asylsuchende und Flüchtlinge. Der Umsetzungstand im Überblick der Bundesländer. Stand Mai 2016. Gütersloh: Bertelsmann Stiftung.Google Scholar
  50. Weis, L. (1995). Identity formation and the processes of “othering”: Unraveling sexual threads. Educational Foundations, 9(1), 17–33.Google Scholar
  51. Wingens, M., de Valk, H., Windzio, M., & Aybek, C. (2011). The sociological life course approach and research on migration and integration. In M. Wingens, H. de Valk, M. Windzio, & C. Aybek (Eds.), A life-course perspective on migration and integration (pp. 1–26). Heidelberg, London, New York: Springer.CrossRefGoogle Scholar
  52. Winnicott, D. W. (1971). Playing and reality. London: Tavistock Publications.Google Scholar
  53. Yano, H. (2001). Anwerbung und ärztliche Untersuchung von “Gastarbeitern” zwischen 1955 und 1965. In P. Marschalck & K. H. Wiedl (Eds.), Migration und Krankheit. IMIS Schriften 10 (pp. 65–86). Osnabrück: Verlag des Instituts für Migrationsforschung und Interkulturelle Studien.Google Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Epidemiology & International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany

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