Características principales de la materia prima

6.5.2.a) Literature and theory on migration as a determinant of health

It has been accepted that migration is a social determinant of health. As stated by Davies, Mosca and Frattini (2010), migrants are affected by social inequalities and are exposed to several experiences during the migration process that put their wellbeing at risk. National statistics in Chile show that immigration to the country is not large in numbers (1.6-1.8%

approximately, equal to 258-350 thousand persons), but it has had a positive impact on services’ innovation and economic growth (Departamento de Extranjeria y Migracion, 2007). Two key papers have showed quite similar results to the findings in this chapter.

Martinez (2003a), in a brief working paper on migration patterns in Chile from the latest Census 2002, and Acuña et al. (2003), gave population estimations and projections for the period 1950-2050. Martinez (2003a) highlighted the social context during which his paper was written. In the 1990’s, some academic groups started disseminating the idea that Chile had became a “pole of attraction” for international immigration and this received

considerable attention from the mass media, which made a connection between this apparent enormous flow of immigrants and a reduction of labour opportunities for the local

population. Stigma and discrimination issues emerged almost immediately, especially against those coming from Bolivia and Peru. These people were perceived as poor, “lower status” immigrants who came to the country to “steal” the jobs from the Chilean-born.

It is true that the 2002 Census shows the highest number of international immigrants in Chile since 1952, with just over 180 thousand people. Nonetheless, Chile had higher rates of international immigration during the first half of the 20^thcentury, up to 4% of the total population, then progressive decreases since the 1950’s. Even in 2002, the number of Chilean emigrants remains larger than the number of international immigrants living in the country, which gives a negative net migration ratio. Most Chilean emigrants live in

Argentina (220 thousand people), the US (85 thousand people), Canada (25 thousand people)

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small, compared to other countries like the US, Spain, Canada or the UK, and migration patterns probably do not significantly shape Chile’s current demography (Martinez, 2003a;

CELADE, 2003). Nonetheless, findings from this chapter suggest that a proportion of immigrants might be living in relatively poor conditions (as found among those living in poor areas) and the hypothesis of a gentrification process among a group of immigrants over years living in Chile versus changes in migration patterns should be further explored.

6.5.2.b) Literature and theory on demographic determinants of health among immigrants

There is some literature discussing demographic factors and how they interact with other Social Determinants of Health (SDH, e.g. Nazroo, 2003; Sacker et al., 2000). Some have been particularly interested in these relationships in the context of migration (e.g. Davies, Mosca and Frattini, 2010; Karl-Trummer, Novak-Zezula and Meltzer, 2010). With regards to age, immigrants in extreme age groups are the ones most strongly associated with mortality and morbidity, and differences in health widen in early life and with increasing age

(Williams and Collins, 1995). Gender, belonging to a minority ethnic group and living in rural versus urban areas do matter in the immigrant population. For instance, it has been stated that the relationship between women, poverty and migration is strong but complex and not completely understood (Williams and Collins, 1995). Of data on ethnic groups, mask important patterns of variation between subgroups and their health outcomes (Sorlie et al., 1993; Vega and Amaro 1994; Williams and Collins, 1995; Nazroo, 2003). Immigrant women and immigrant minority ethnic groups also face racism and different types of discrimination (e.g. Williams and Collins, 1995; Furino, 1992; Sorel et al., 1992; Nazroo, 2003; Rogers, 1992; Krieger et al., 1993; Karlsen and Nazroo, 2002).

Some of the results from this study are consistent with previous data from the Chilean Government. The “new immigration” patterns in Chile have been presented before in the literature review section (Chapter 2), and they highlighted the marked regional and especially Andean immigration and working age group immigrants coming to Chile, the progressive urbanization of immigrants who tend to concentrate in the capital, and a growing rate of women immigrants coming to work (Departamento de Extranjeria y Migracion, 2007;

Martinez, 2003a; Stefoni, 2001). In addition, a migration pattern slightly favouring female immigration to Chile since 1992 has also been reported before, in contrast to a historical male immigration to the country since 1952 (men:women ratio from 2002 Census was 0.91 among immigrants) (Martinez, 2003a; Stefoni, 2002). Female immigration influx is particularly relevant among Peruvian immigrants (Stefoni, 2002), and the reported

association with domestic service has created labour segmentation and a sense of intolerance

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this chapter continue to support the linkage between gender and migration in Chile. There are also results from this chapter that are new to the understanding of social determinants of international immigrants in Chile. Marital status, minority ethnic status, years living in the country, and subgroup analysis by country of origin, add knowledge to what has already been described on immigrants in Chile in the past. Results from this chapter show, on one hand, that immigrants are a unique group and quite different from the population in the host country in terms of their demographic characteristics; and on the other hand, there is great heterogeneity and complexity within the immigrant group in Chile. The relative importance of age indicated in previous studies, for example, is strongly supported by these results, as a selective group of working age are more likely to migrate to Chile. Ethnicity and country of origin appear to be relevant social determinants of the immigrant population in Chile and further understanding of the meaning and implications of both demographic determinants in terms of health among immigrants needs to be addressed. Some other key findings

concerning international immigrants’ demographic characteristics deserve more discussion in the Chilean context. These elements are presented here with the aim of stimulating hypothesis formulation for future research in this field (Table 6.4).

Table 6.4 Key findings concerning international immigrants’ demographic characteristics Key finding from this chapter Discussion

Relative higher rate of over 65 years old widowed immigrants compared to the Chilean-born

This finding suggests either migration during retirement for those whose partners died, or premature death of one of the couple while living in Chile together

Relative higher rate of immigrant women of working age than Chilean-born women

This finding suggests a gendered selection in the migration process and labour structure and opportunities in the country might merit further observation (see also 6.2.3).

Reduced number of immigrants in the Southern area of the country

This finding reflects the strong centralization of development and economic investment around the metropolitan region in the Central area (Oyarzo, 2000), even though this concentration was found in all the age-groups

Relatively higher proportion of immigrants belonging to a minority ethnic group, especially Aymara group, compared to Chilean-born

(1) There might be cultural reasons favouring migration among Aymara members in recent times, even though they have not been recognised as a traditionally nomadic group (Minority Rights Group International, 2008); (2) There could be socioeconomic explanations secondary to poverty and deprivation (no money to travel a farther distance);

(3) It could be chain migration among ethnic minorities and, through the push-and-pull explanation, the numbers tend to go up in a natural fashion if social ties with local members are maintained after migration and if the experience of migrating was positive for those who did it first (Martine, Hakkert and Guzman 2000; Easterlin, 1961; Faist 2000);

(4) There could be political issues in the countries of origin, where oppression, discrimination, poverty and social vulnerability threatening ethnic groups would encourage them to migrate to a new country despite the risks and challenges involved in such a journey;

(5) There could be a combination in the context of globalisation, in which poor people from ethnic groups might obtain manual occupations on the Chilean border (Martine, Hakkert and Guzman, 2000; Massey, 1999; Giddens, 1990);

(6) It could be due to a growing interest among immigrants in Chile’s health care system (Carrasco-Garrido et al., 2007; Cots et al., 2007;

Torres and Sanz, 2000).

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theory, chain migration theory and, indirectly, globalisation theory could support the idea that Chilean emigrants from the 1970’s (secondary to General Pinochet’s dictatorship) and their offspring might be returning to the country after several decades. Even though the return of Chilean emigrants to the country could explain part of the current migration pattern, this issue is almost excluded in the latest debates on immigration in Chile (Martinez, 2003a).

Their demographic characteristics and those of their offspring, if returning to Chile, certainly require further attention from researchers and policy makers in the country.

Interesting findings also emerged from spatial exploratory analysis of immigrants living in Chile. Exploratory results from this suggest the importance of place to international immigrants in Chile. Distinctive patterns are related to socioeconomic and historical development in the country and international relationships with bordering countries over time, similar to other studies in Latin America (Bratsberg, 1995). This chapter suggests geographical characteristics of international immigrants in the country and provides some hypotheses to test in the future. Overall, it supports the idea that place probably creates the nature of people and their health and, in this sense, immigrants might choose where to live in Chile according to the social and environmental characteristics of each region and borough in Chile. Nonetheless, much more can be done in terms of place, migration and health in Chile. Chain migration and push and pull theories might be intimately related to immigrants’

decisions as to where to live, along with importance of globalisation and socioeconomic aspects of immigrants and their families. All these elements should be further analysed when more (quantitative, qualitative and mixed) and better (especially longitudinal) data is

available in Chile.