Moroccan immigrants in Italy

Meriem Khyatti

Institut Pasteur du Maroc

and

Emanuela Gualdi, StefaniaToselli

Ferrara and Bologna Universities, Italy

EUNAMFP7- HEALTH-2010

EU and North African Migrants: Health and Health Systems

Ferrara Meeting

Sept. 8 – 9, 2011

Moroccan immigration in Italy:

a brief history

First Moroccan immigrants worked in agriculture and as street

vendors of carpets and handicrafts;

the immigrants flow moved from southern Italy to northern Italy owing to

better employment opportunities;

first Moroccans (from Khouribga) arrived in Milan in the ’70s, in Turin in the

'80s;

about 60% of the Moroccan immigrants is located in three Italian regions:

Lombardy, Piedmont, Emilia-Romagna;

the phase of family reunification started since the ’90s;

the presence of women in the Moroccan community is about 40%, on average,

Moroccan immigrants inItaly: demographic trend

Ferrara Meeting

Sept. 8 – 9, 2011

+47.5%

Overall in the same period, the increase was 14.4% in the

European Union.

Immigration in Italy

Italy: a multicultural society

ISTAT data updated to January 2010

Immigrants by geographical area and by sex

ISTAT data updated to January 2010

•People from these 16 countries account for 75% of the foreign population

resident in Italy.

•Foreign people from the first five countries exceed 50% of the foreign population

resident in Italy.

Foreign population - first 16 countries-

2,148,457

+44%

Regular immigrants from Morocco to Italy

Marocco, sett.09, RACINE -Mapping. Project

financed by the European Return Fund

During the same period there was an increasing

percentage of females in Moroccan community linked to

.the increasing

propensity of Moroccan

immigrants

to family reunification

Distribution of Moroccans of both sexes

in Italy

• Prevalence of males (in blue)

in the Moroccan community

(about 60%).

•The stabilization areas (in

green) are still few.

• There is a prevalence of Moroccans in the working age-group “25-50 years”.

Age of Moroccans in Italy in comparison

with Italians

• A balance between the sexes is present up to 30 years of age.

•The age pyramid for the Italians is very different from that of Moroccan immigrants,

owing to the dramatic drop in births and the spread in life expectancy.

Marocco, sett.09, RACINE -Mapping. Project

financed by the European Return Fund

• 55 % of Moroccan

immigrants lives in

Lombardy, Emilia-

Romagna and Piedmont.

Moroccan citizens resident per 1,000 Italians

• High incidence of

Moroccan immigrants in

the industrialized area of

Northern Italy.

• Anomalous high

incidence of Moroccans in

some municipalities of

Central -L’Aquila- and

Southern Italy –Catanzaro-.

Moroccan citizens resident per 1,000 Italians

• Moroccans in

Emilia-Romagna region

Comune di Bologna data – Aprile 2010

Moroccan citizens resident in Bologna from Dec.31,1986 to Dec.31, 2009

• From a small group in 1986, Moroccans exceeded 1,000 units in 1994;

• Moroccans are one of the largest foreign communities in Bologna;

• Their number is currently about 7.5% of foreigner residents in Bologna.

Moroccan males and females resident in Bologna

•Males are prevalent in Moroccan community.

Moroccan male and female citizens resident in Bologna

( from Dec.31,1986 to Dec.31, 2009)

• The presence of

Moroccan women

increased over the

time: from 15% in 1989

to 45% at the end of

2009.

Males Females

• Family reunification

influenced this trend.

Age of Moroccans resident in Bologna (Dec.31, 2009)

•Moroccan community in Bologna

is quite young.

•78% of the community falls in age-

group “0 - 44 years”.

• The average age of the Moroccan

citizens (31.9 years) resident in

Bologna is significantly lower than

the average age of the population

of Bologna (47.4 years).

47.4 in Bolognese

population

Moroccan immigrants inItaly: health and nutritional

status

Ferrara Meeting

Sept. 8 – 9, 2011

•There is a tendency of immigrants to

acquire chronic diseases in the host

country (Ngo et al., 2000).

• The predisposition to chronic diseases

may be amplified by environmental

factors (diet, low physical activity, stress,

low quality of life and health care) (Ngo et

al., 2009; Gilbert and Khokhar, 2008).

• The close association between changes in lifestyle and increased

incidence of obesity was reported in immigrants ( Patel et al., 2006;

Jorgensen et al., 2006; Toselli et al, 2008).

• In Italy there are low hospitalization rates forforeigners not related to good health status, but toadministrative, linguistic and cultural barriers(Cacciani et al, 2006).

•Cardiovascular diseases cause 36.6% of theimmigrants deaths (Gaudio et al., 2004).Therefore itis important to evaluate their health and CVD risk.

•Some anthropometric traits and indices may be used as a measure ofmetabolic and cardiovascular risks. In addition to BMI, waistcircumference is considered the best marker of central adiposity(Jansen et al, 2002).

• Studies were carried out in Italy to analyze anthropometriccharacteristics, weight status, adiposity patterns, and hypertension inimmigrants and to assess their susceptibility to disease withreference to obesity and cardiovascular response (Toselli et al, 2008;Gualdi-Russo et al., 2009).

68,2

23,3

120,0

80,0

42,5

74,1

25,2

126,5

80,0

46,5

0

20

40

60

80

100

120

140

weight BMI syst. b. press. dias. b. press. dif. press.

'902000

Longitudinal study on North-African immigrants (90% of Moroccans,

10% of Tunisians) - anthropometric data from 1990 to 2000-

• Weight and BMI increased after 10 yrs of permanence in Italy.

• The mean BMI value indicated an overweight condition (BMI>25) after a

decade.

Toselli et al., 2008

• Blood pressure increased during the same period .

Longitudinal study on North-African immigrants (90% of Moroccans, 10%

of Tunisians) - percentage of nutritional disorders from 1990 to 2000-

Toselli et al., 2008

• Trend in nutritional disorders after ten years: underweight subjects disappeared;

there was an increase in overweight and a decrease in normal weight; obese

subjects appeared.

• Immigrants may develop the risk of obesity-related comorbidities.

Percent distribution of immigrants in underweight, overweight and obese subjects and prevalence of

central adiposity (WC: >102 in males;>88 cm in females) and of hypertension (SBP≥140 or DBP≥90 mm/Hg).

ETHNIC

GROUP BMI <18.5 25.0≤ BMI <29.9 BMI ≥30

Central

adiposity

Hypertensive

subjects

% % % % %

SENEGALESE -

Males 7.9 21.1 5.3 - 35.0

MOROCCANS -

Males

-

Fem.

1.6

15.4

44.1

46.2

7.1

23.1

15.0

54.5

18.2

0.0

TUNISIANS -

Males 0 33.3 13.3 14.3 22.2

PAKISTANIS -

Males 12.8 25.6 0 13.9 15.4

KOSOVARS -

Males

-

Fem.

10.0

0

30.0

33.3

30.0

40.0

37.5

83.3

36.4

5.3

ROMA

-

Males

-

Fem.

0

15.4

35.5

33.3

32.3

12.8

37.5

32.1

33.3

23.5

Gualdi-Russo et al., 2009

• Moroccan immigrants (+Kosovars and Gypsies) had a particularly high

prevalence (> 50%) of overweight/obesity (BMI>25 kg/m 2 ).

•High percentage of subjects with central adiposity was found in female Moroccans

(+Kosovars).

Gualdi-Russo et al., 2009

Prevalence of immigrants at high CVD risk

( hypertension plus overweight/obesity and waist circumference (WC) > 102 in males or

hypertension plus WC > 88 in females)

•There was a significantly high variability in the prevalence of CVD risk among

different ethnic groups.

•The prevalence was low in Moroccan males. No subject with high CVD risk was

observed among Moroccan women.

In conclusion:

Our previous studies confirm the general problem of obesity in Italian immigrants.

The overall percentages of overweight/obesity are similar to those of native

Italians for males, but they are higher in immigrant females, especially in

Moroccans (Gualdi-Russo et al,09; ISTAT, 08).

In Morocco and Tunisia overweight is on the rise in both sexes. However the

prevalence of obesity (and central adiposity) is higher in Moroccans living in Italy

(Gualdi-Russo et al,’09) than in Morocco (Mokhtar et al, ‘01; Rguibi and Belahsen, ‘07).

Some major risk factors, such as diabetes, smoking and obesity, are more

prevalent among Moroccan minorities than among the native European

population (El Fakiri et al, ‘08)

Since diabetes is one of the most prevalent cardiovascular risk factors among

all ethnic minorities at risk of developing CVD, particularly Moroccans, (El Fakiri

et al, ‘08) and the tendency to an health decline as the time since immigration

increases was observed in Moroccans (Toselli et al,’08 )

the need for further research concerning the

relationship between obesity and CVD risk and

to tailor interventions for different ethnic

groups in general practices is evident.

Moroccan immigrants in Italy

Meriem Khyatti

Institut Pasteur du Maroc

and

Emanuela Gualdi, StefaniaToselli

Ferrara and Bologna Universities, Italy

EUNAMFP7- HEALTH-2010

EU and North African Migrants: Health and Health Systems

Ferrara Meeting

Sept. 8 – 9, 2011