English - World Health Organization Regional Office for Europe

chapter
seven
Non-communicable diseases
Anton E. Kunst,
Karien Stronks and Charles Agyemang
Introduction
Populations in the European Union (EU) are increasingly diverse. As compared
to 10 or 20 years ago, a much larger part of European populations is born
in foreign countries, including low- or middle-income countries. Often, the
epidemiological profile of these migrants differs from that of local-born residents.
As a result, the inflow of migrants may greatly increase the diversity in the health
of European populations, including the pattern of non-communicable diseases
(NCDs). As will be illustrated in this chapter, numerous reports have shown
large differences between migrants and locally born populations in the risk of
NCDs. While some diseases, such as diabetes mellitus, occur more frequently
among migrant groups, lower risks have been reported for some other NCDs,
such as lung and breast cancer. Moreover, studies of specific diseases often report
great diversity between different migrant groups, with higher risks for migrants
coming from certain countries or regions (e.g. western Africa), compared to
lower risks for those born elsewhere (e.g. Latin America).
This diversity in risks is an intriguing phenomenon, especially when
compared with the relative homogeneity in inequalities in NCD risk according
to socioeconomic status (Mackenbach et al. 2008). Within locally born
European populations, people in disadvantaged socioeconomic positions are at
an increased risk for all the main NCDs, with the exception of breast cancer. The
combined effect of these consistent patterns is a large degree of socioeconomic
inequality in general health and life expectancy (Majer et al. 2010). In contrast,
for migrants to European countries, the health disadvantage appears to be more
linked to specific diseases, and life expectancy is not consistently lower than
among locally born residents (Bos et al. 2005).
This situation presents particular challenges to the monitoring of NCD
among migrants. Ideally, a fine-grained approach is applied, in which disease
occurrence is measured in a systematic way for a broad range of NCDs and