Social Determinants of Health and Multidimensional Health Needs among Immigrants Participating in a Community-based Programme in Portugal: A Cross-sectional Study
This cross-sectional study of 152 immigrants in Portugal's ACOLHER programme reveals significant social vulnerabilities and unmet multidimensional health needs, particularly regarding mental health and oral hygiene, highlighting the critical role of community-based initiatives in overcoming barriers to healthcare access despite universal coverage.
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Health is not merely the absence of illness; it is the result of the conditions in which people are born, grow, live, work, and age. These conditions, known as social determinants of health, include factors like where a person lives, their ability to find work, their education, and the support they receive from family and community. For people who have moved to a new country, these factors often become more complex. Even when a nation offers free healthcare to everyone, the path to receiving that care can be blocked by language barriers, confusing paperwork, or a lack of trust in the system. Understanding how these daily realities shape physical and mental well-being is crucial for building societies where everyone has a fair chance at a healthy life.
In the coastal city of Almada, Portugal, a team of researchers and community workers set out to understand these challenges within a specific group: immigrants participating in a local support initiative called the ACOLHER Programme. This community-based project brings together health professionals, students, and local organizations to offer free health screenings and guidance to newcomers. The researchers wanted to move beyond simple medical checkups to see the full picture of their lives. They used a framework that looks at place of residence, race, occupation, gender, and social connections to map out the specific hurdles these individuals face. By gathering data from 152 adults who attended the programme, the team documented not just their health status, but the social and structural barriers that might prevent them from getting better.
The people who took part in the study represented a diverse mix of backgrounds, with many arriving from Cape Verde, São Tomé, and Angola, though some came from Brazil and other nations. More than half had arrived in Portugal only recently, within the last few years. Despite living in a country with a universal health system, the participants faced significant obstacles. Over one-third of them reported that they had encountered barriers when trying to access healthcare services. These hurdles were not about a lack of legal rights, but rather the practical difficulties of navigating a new system, often compounded by unemployment, limited social support networks, and housing insecurity. Nearly a quarter of the participants said they had no close support network to rely on, leaving them to manage their health challenges in isolation.
When the team looked at the physical and mental health of these participants, the results revealed a high level of unmet need. Almost half of the people screened for mental health showed signs of significant psychological distress, with symptoms ranging from anxiety and depression to feelings of paranoia. This suggests that the stress of migration, combined with the uncertainty of their current situation, is taking a heavy toll on their minds. In terms of oral health, the situation was equally concerning. Among those examined, more than four out of five had dental cavities, and nearly eight out of ten had visible plaque on their teeth. Most had not seen a dentist in over a year, and when they finally did seek help, it was usually because of severe pain or the need for an extraction, rather than for routine prevention.
The study also examined other aspects of health that are often overlooked. For the women who participated, assessments of pelvic health showed that while severe symptoms were not the norm, many experienced mild to moderate issues with bladder and bowel function. In the area of heart and metabolic health, the data painted a picture of risk. The average participant was overweight, and their blood pressure readings were higher than what is considered optimal. Many had no assigned family doctor, and some reported that they had stopped taking medication for conditions like diabetes or high blood pressure after moving to Portugal. These findings highlight a pattern where chronic diseases go unmanaged not because treatment is unavailable, but because the connection between the patient and the healthcare system has been broken.
The researchers concluded that while the ACOLHER Programme successfully identified these deep-seated vulnerabilities, it also demonstrated the value of bringing health services directly into the community. By meeting people where they are, offering screenings in familiar settings, and providing guidance on how to register for the national health service, such initiatives can bridge the gap between legal entitlement and actual care. The study suggests that to truly support immigrant health, systems must do more than offer services; they must actively help people navigate the complex social and administrative landscapes that often keep them from accessing those services. The work underscores that health equity requires addressing the whole person, including their social circumstances, not just their medical symptoms.
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