Health Status Of Migrant Workers And Their Health Policy Research

[Objectives]Recently the studies on migrant workers were concerned in body health status, sexually transmitted disease (STD) and reproductive health. The sample size of survey often is small for limited by fund and other material resources and seldom refers to comparing between migrants and urban/rural dwellers. In this thesis migrant workers' health status and affected factors were all round evaluated and compared between migrants and urban/rural dwellers including physiological health, mental health, occupational health, health services need and utilization and reproductive health. Based on the results of survey and medical care assurance in our country, the new medical care assurance system including migrants was constructed to elevate migrants' health level.[Methods]According to principles of stratified and cluster sampling, Xihu district and Xiaoshan district in Hangzhou city were randomly selected as study areas, then 21 and 16 enterprise were respectively selected among 51 enterprise in Xihu district and 26 enterprise in Xiaoshan district (the number of migrant is above 30), the migrant workers from rural were investigated, who were over 15 years old and worked in the district over three months. The urban dwellers were selected over 15 years old and worked in the district over three months at the same work units in Hangzhou city. The rural dwellers were selected among permanent residence in Kaihua county, which was center of Zhejiang, Anhui and Jiangxi province (about 58 percent migrants were from the three provinces). A total of 4453 rural migrant workers, 1957 urban dwellers and 1909 rural dwellers in Kaihua county were surveyed and eligible for analysis. The database was established and enrolled by Epidata software and analyzed by SPSS,SAS,STATA and Amos software. [Contents]Based on references and pre-investigation, the health status questionnaires of migrants, urban dwellers and rural dwellers were designed by oneself involved eight parts—general information, occupation, health status, health services utilization, recreation and living habit, recognition for AIDS/STD, mental health and female reproductive health, in addition all surveyed migrants' routine physical examination was carried out. After pre-investigation and modification based results, the large-scale formal investigation was conducted and the quality of on-the-spot investigation was controlled by specified personnel.[Results]1. Physiological healthThe prevalence rate of hypertension in migrant workers was 13.6 percent and male was higher than female. The simple factor analysis results indicated that the prevalence rate of hypertension was positively correlated with body mass index (BMI) and age in both male and female migrants. The education degree was negatively correlated with the prevalence of hypertension of female (p<0.05). The prevalence of hypertension of smoker or drinker was higher than nonsmoker or nondrinker respectively. There was not correlated between the prevalence of hypertension and mental pressure. The multiple factors analysis results indicated that main influential factors were gender, age and BMI. The prevalence rate of hypertension of male was 2.6 times more than female and was positive correlation with age and BMI both male and female.The detection results of communicable disease of migrant workers indicated that the positive rate of HBsAg was 12.1 percent and male was higher than female. The positive rate of Syphilis was 0.4 percent and there was not significant difference between male and female. There was none cases of positive HIV.2. Mental healthThere was significant difference of SF-36 MH scale scores between migrant workers and urban/rural dwellers (p<0.01). Migrant workers had higher SF-36 MH scale scores than urban counterparts but lower than rural counterparts. In importance ranking about daily concerns, low income, unemployment and children's education were highly ranked, which was similar to the ranking of urban counterparts. However the rank of rural counterparts was low income, children's education and other factors. With respect to negative coping styles, there was not significant difference between migrants and urban dwellers. However the proportion of thinking about suicide and unknown of migrants was higher than rural counterparts. About positive coping styles, there was significant difference between migrants and urban/rural dwellers. The proportion of demanding help because of anxiety and unhappiness of migrants was higher than urban/rural counterparts. However the proportion of seeking help for other person was lower than urban/rural counterparts.3. Occupational healthMigrant workers were satisfied with life and habitation condition. The average work time of migrant workers was 9.5h per day and longer than urban counterparts (8h). About 58.0 percent of migrant workers, the average work time was over 8h per day. However the income of migrants didn't increase with prolonging work time and average salary monthly was lower than urban counterparts. There was significant difference of occupation and signing labor contract between migrants and urban counterparts (p<0.01). The proportion of migrants worked in industry, service and architecture was up to 92.3 percent and higher than urban counterparts in architecture specially. The rate of signing labor contract of migrant works was 58.3 percent and lower than urban counterparts (80.8%). The proportion of none signing industrial injury insurance was up to 80 percent.The rate of occupational injury was 22.8 percent and the main influential factors were sex, occupation, work time per day, regulation or regime for security and marriage based on multiple factors analysis. The rate of occupational injury of migrants, male was 2.6 times than female, service was 1.5 times than industry, industry was 2.4 times than commerce, work time per day over 8h was 1.4 times than less or equal 8h, none regulation or regime for security was 1.4 times than had it, unmarried was 1.7 times than married. The rate of recess for illness was 14.8 percent and the main influential factors were age and work time per day by logistic regression. The rate of recess for illness was negatively correlated with age and work time per day over 8h was 1.7 times than less or equal 8h.4. Health services need and utilizationThe proportion of self-feel better health status of migrants was 67.8 percent and higher than urban/rural counterparts. The rate of disable and chronic disease of migrants was lower than urban/rural counterparts. However the rate of recess for illness was not significant difference between them. Among migrant workers, the proportion of none seeking medical care but should see doctors exceeded 10 percent and 41 percent of migrants was not seeking medical care for high medical expense. The proportion of participating medical insurance of migrants was only 19.6 percent and lower than urban/rural counterparts. The proportion of unknown medical insurance was 31 percent and higher than urban/rural counterparts. Migrant workers considered that the co-payment of medical insurance should be 30 percent and may pay 300 yuan each year.The results based on structural equation modeling analysis indicated that some factors directly influenced seeking medical care involving physiological status, social factors, behavior and mental health, social insurance and health status. Three factors including physiological status, social factors and behavior and mental health also indirectly influenced seeking medical care by health status.5. Female reproductive healthThe rate of gynecologic examination of female migrant workers was lower than urban counterparts, but higher than rural counterparts. The rate of health examination each year was no significant difference between migrants and urban counterparts (p>0.05), but higher than rural counterparts. The rate of antenatal care of female migrant workers was lower than urban counterparts, but higher than rural counterparts. The average time of antenatal care of female migrants was 4.77±3.96 and lower than urban counterparts (8.14±4.93) and was similar to rural counterparts. The proportion of female migrants who received five and more times of prenatal checkup was 40.5 percent and lower than urban/rural counterparts. The influential factors on the proportion of women who received five and more times of prenatal checkup main were three population and education degree based on logistic regress. About the proportion urban counterparts was 4.9 times than migrants and rural counterparts was 2.7 times than migrants. The proportion was positively correlated with education degree. The proportion of delivery at home of migrants was up to 30 percent and higher than urban counterparts (3.5 percent). The percentage of hospitalized delivery of migrants was lower than urban counterparts. The percentage of hospitalized delivery of migrants was negatively correlated with age but positively correlated with education degree. The percentage of abortion of migrants was 24.4 percent and up to 43.2 percent in married or cohabitation. 18.2 percent of female migrants didn't adopt any contraception measure and higher than urban counterparts (7.2 percent) or rural counterparts (8.7 percent).The results on influential factors on contraception measure based simple factor analysis indicated that most of migrants and urban dwellers chose intrauterine contraceptive device (IUD) but most of rural dwellers chose deligation. The results showed that reproductive aged migrants' women were prone to choosing deligation compared with urban counterparts based discrete choice model. The main places where migrants got contraception drug or instrument were hospital and drugstore and the ranking of satisfaction for contraception effect was condom, deligation and anticoncipiens.[Conclusion]1. Question of occupational health1.1 There were lower salary and bad welfare and serious phenomenon on payment not in time and full number toward migrant workers.1.2 The management on labor was complicated and was not legal insurance for migrants' rights.1.3 Over work time and intensity was general and the right of rest could not be guaranteed.1.4 There were serious occupational hazard and high percentage of occupational injury.2. Questions of public health2.1 Migrant workers were primal population of prevention and control against communicable disease.2.2 The level of female migrants' reproductive health was very low.2.3 The health status of floating children was not well.3. Questions of mental health and behavior3.1 The level of mental health of migrant workers was low.3.2 Behavior of High risk on health involving smoke, drink and unsafe sexual behavior was serious.4. Question of medical care assurance4.1 The utilization of medical service was not enough.4.2 The coverage of medical care assurance was limited.[ Recommendations ]1. Standardize migrant workers' labor management based on laws and regulations and raise the level of occupational health.1.1 Establish and consummate the labor law system around the center of low on employment contracts.1.2 Execute strictly regulation on work-related injury insurances.1.3 Ensure occupational safe health of migrants and elevate occupational health level.2. Provide really public health service to migrant workers.2.1 Strengthen migrants' prevention and control against disease.2.2 Strengthen family planning administration and service and raise reproductive health level of migrant workers.2.3 Enhance education and management on floating children. 3. Advocate healthy life style and raise mental health level of migrant workers.3.1 Develop propaganda and education of health and decrease the incidence of high risk behavior.3.2 Enhance intervention on behavior and mental matter and increase mental health level.4. Set up medical care assurance system for migrant workers.4.1 Reform censue register institution and implement integration of city and countryside.4.2 Government pays the expense of public health service.4.3 Build transferred payment system based national network.4.4 The coverage from in-patient to in-patient and out-patient.