This article is linked to ‘Mediating pathways between neighborhood disadvantage and cardiovascular risk: quasi-experimental evidence from a Danish refugee dispersal policy’ and ‘Invited commentary: dispersal policies, neighborhood disadvantage, and refugee health in a Nordic context’ (https://doi.org/10.1093/aje/kwae158 and https://doi.org/10.1093/aje/kwae239).
We appreciate Dr. Mikael Rostila’s commentary1 on our study,2 which leveraged a natural experiment in the form of a Danish refugee dispersal policy to estimate the health effects of neighborhood disadvantage among refugee populations later in life. We agree with Dr. Rostila that being assigned to a less disadvantaged neighborhood may not necessarily have positive effects on health or social outcomes—for example, if there are fewer immigrants in such neighborhoods to provide social support or increased discrimination against newcomers.3-5 Dr. Rostila referenced studies that suggest there are potentially harmful effects of dispersal policies on social and economic integration. We would also add evidence from US-based studies showing that the Moving to Opportunity experiment resulted in worse mental health outcomes for Black boys randomized to low-poverty neighborhoods,6 which has been similarly hypothesized to be due to disruption of social networks and supports. Yet, there is additional counter-evidence that supports the positive effects of refugee dispersal policies. For example, in Sweden, exposure to peers with high levels of education (independent of the share of peers with the same ethnicity) was associated with better school performance,7 and exposure to a larger share of welfare receipts among same-ethnicity nationals was associated with welfare receipt8 among refugees under the dispersal policy. In Denmark, refugees placed in socioeconomically better neighborhoods had lower criminal involvement,9 higher chances of finding employment,10 and higher wages.11
Clearly, social connections and cultural coherence available in segregated neighborhoods are one of several major pathways affecting refugee health; others include material or socioeconomic opportunities available in neighborhoods disproportionately comprised of individuals from advantaged groups. Refugee dispersal policies will almost certainly have different effects in different country contexts (eg, if the broader policy environment is different), for different subgroups of refugees, and for different types of outcomes; our previous work in Denmark also found heterogeneous effects.12-14 Policymakers interested in supporting the transition of incoming refugees and other immigrants should consider a suite of policies to maximize the outcomes for the refugees themselves and society as a whole.15,16 Health is one of several outcomes of interest to policymakers, and our study suggests one of several ways to support refugees, for which evidence is critically needed given the large scale of current global population shifts.
Contributor Information
Min Hee Kim, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94158, United States; Institute for Health, Health Care Policy and Aging Research & School of Nursing, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States.
Trine Frøslev, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, 8200 Aarhus N, Denmark.
Justin S White, Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, MA 02118, United States.
M Maria Glymour, Department of Epidemiology and Biostatistics, School of Public Health, Boston University, Boston, MA 02118, United States.
Sindana D Ilango, Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, United States.
Henrik T Sørensen, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, 8200 Aarhus N, Denmark; Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA 94305, United States.
Lars Pedersen, Institute for Health, Health Care Policy and Aging Research & School of Nursing, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States.
Rita Hamad, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 94158, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, United States.
Funding
This work was funded by National Institutes of Health grants R01AG063385 and K99AG078405-01.
Conflict of interest
The authors declare no conflicts of interest.
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