Associations between life conditions and multi-morbidity in marginalized populations: the case of Palestinian refugees

Abstract

Background: Evidence suggests that higher multi-morbidity rates among people with low socioeconomic status produces and maintains poverty. Our research explores the relationship between socioeconomic deprivation and multi-morbidity among Palestinian refugees in Lebanon, a marginalized and impoverished population.

Methods: A representative sample of Palestinian refugees in Lebanon was surveyed, interviewing 2501 respondents (97% response rate). Multi-morbidity was measured by mental health, chronic and acute illnesses and disability. Multinomial logistic regression models assessed the association between indicators of poverty and multi-morbidities.

Results: Findings showed that 14% of respondents never went to school, 41% of households reported water leakage and 10% suffered from severe food insecurity. Participants with an elementary education or less and those completing intermediate school were more than twice as likely to report two health problems than those with secondary education or more (OR: 2.60, CI: 1.73-3.91; OR: 2.47, CI: 1.62-3.77, respectively). Those living in households with water leakage were nearly twice as likely to have three or more health reports (OR = 1.88, CI = 1.45-2.44); this pattern was more pronounced for severely food insecure households (OR = 3.41, CI = 1.83-6.35).

Conclusion: We identified a positive gradient between socioeconomic status and multi-morbidity within a refugee population. These findings reflect inequalities produced by the health and social systems in Lebanon, a problem expected to worsen following the massive influx of refugees from Syria. Ending legal discrimination and funding infrastructural, housing and health service improvements may counteract the effects of deprivation. Addressing this problem requires providing a decent livelihood for refugees in Lebanon.

Figure 1

The association of age with the number of health problems and determinants of poverty. (a) Health problems include multiple chronic illness, acute illness, mental illness and disability. (b) Poverty determinants include 1. Educational level (below secondary determined low educational level); 2. Wealth Index (the lowest half determine poor assets); 3. Crowding (above the median = 1.67 people per room was determined as crowded); 4. Water leakage in the household (determined poor condition); and 5. Severe food insecurity (based on the definition provided in the methods)

Figure 2

The association of self-rated heath with the number of health problems and determinants of poverty. (a) Health problems include multiple chronic illness, acute illness, mental illness and disability. (b) Poverty determinants include 1. Educational level (below secondary determined low educational level); 2. Wealth Index (the lowest half determine poor assets); 3. Crowding (above the median = 1.67 people per room was determined as crowded); 4. Water leakage in the household (determined poor condition); and 5. Severe food insecurity (based on the definition provided in the methods)