Cultural participation and extra disability and health costs of Syrian migrants in Turkey

• DOI: https://doi.org/10.1108/IJMHSC-12-2021-0116
• Published date: 06 February 2023
• Date: 06 February 2023
• Pages: 58-75
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations,Labour movements
• Author: Elefherios Giovanis

Cultural participation and extra disability and

health costs of Syrian migrants in Turkey

Elefherios Giovanis

Abstract

Purpose –The effects of disability are well recognised by the social security systems worldwide. This

study aims to examine the disability and health-related costs of Syrian migrants in Turkey using the

standardof living (SoL) approach.

Design/methodology/approach –The empirical analysis relies on primary data collected from 1,067

Syrian migrantsin Turkey, and the author applies the ordered Probit model.The SoL is operationalizedby

frequency of attendance to a Turkish theatrical play or movie, inviting Turkish friends for food and

attendinga theatrical play or movie with Turkishfriends.

Findings –The findings showthat health problems and disability arenegatively related to the frequency

of participationin socio-cultural activities. Moreover, employed, wealthier and educatedSyrian migrants

participatemore frequently in the social and cultural activitiesexplored.

Practical implications –The resultsshow that the costs range between 9% and 38%, whichtranslates in

monetary values between 3,700 and 10,700 Turkish Liras (TL) per annum or between US$530 and US

$1,530 expressedin 2020 values. These findings highlight the significantcost and burden that disability

and healthproblems may put in migrant households.

Social implications –Policies encouraging immigrants to participate in socio-cultural events,

particularly thosewith disabilities and health issues, may promotetheir integration into the host society’s

social and cultural values. Furthermore, policies improving employment opportunities, income and

educationalattainment of Syrian migrants may enhancetheir participation in socio-cultural activities.

Originality/value –To the best of the author’s knowledge, thisis the first study exploring the disability

and healthcosts of migrants related to integration and participationin cultural activities.

Keywords Disability and health costs, Mental health, Standard of living approach, Syrian migrants,

Socio-cultural participation

Paper type Research paper

1. Introduction

Depending on the type and disability severity, households with disabled members and

those having health issues incur a significant additional financial burden. Social security

systems offer health benefits that arecontext-specific, should be adjusted for the severity of

the disability and the health issue and are designed to compensate individual short- and

long-term costs. Disability and its complex relationships to poverty and well-being have

received considerable attention (World Bank and World Health Organization, 2011).

References to disability and health in various aspects of the Sustainable Development

Goals, notably on inequality,highlight this case.

To achieve and sustain a decent standard of living (SoL), individuals who live in household s

with people with impairments and poor health conditions must designate supplementary

resources to those living in non-disabled households. Thus, the existence of a disabled

household member has significant implications for poverty. Ext ra out-of-pocket expenditures

for medication, health-care services, support with everyd ay tasks and disability-specific aid

equipment are examples of direct costs linked with disability. Direct cos ts differ from indirect

Elefherios Giovanis is

based at Department of

International Trade and

Business, Faculty of

Economics and

Administrative Sciences,

Izmir Bakircay University,

Izmir, Turkey.

Received 16 December 2021

Revised 8 October 2022

Accepted 14 January 2023

PAGE 58 jINTERNATIONAL JOURNAL OFM IGRATION,HEALTH AND SOCIAL CARE jVOL. 19 NO. 1 2023, pp. 58-75, ©Emerald Publishing Limited, ISSN 1747-9894 DOI 10.1108/IJMHSC-12-2021-0116

costs, which include foregone economic activities, such as employment , where a household

member may reduce the working hours or change the type of work to mitigate and cope with

the needs required for the caring of disabled family members.

Three main approaches are used to measure disability and health-related costs, in particular, the

direct survey approach (DSA), the expenditure diary approach (EDA) and the SoL approach.

The DSA approach derives the economic costs of disability by directly asking the individuals with

a disability how much they are willing to spend on specific items associated with the impairment

status. The implicit counterfactual is the same individual’s expenditures, assuming they did not

have a disability. This is an inexpensive and straightforward approach, but one major limitation is

that if persons with disabilities are uninformed of specific goods or services that could help them

perform more fully in society, they will be overlooked. As a result, is difficult for respondents to

report their actual expenditures on needs because the answers often rely on hypothetical

expenditures without any recent experience in a non-disability environment, which can further

lead to misleading estimates (Berthoud et al., 1993;Mitra et al., 2017).

EDA explicitly evaluates expenses for people with disabilities or poor he alth conditions and

compares them against the expenditures of people without disabilities, with the differential

implied as disability or health-related costs. Because they offer a precise measurement of

expenditures connected to persons with disabilities compared to similar exp enditures for a

sample of people without disabilities, akin to a case–control study, these approaches can

improve on some of the measurement concerns left unresolved by DSAs. Using this

approach, it is possible to determine where impaired people are most likely to i ncur additional

costs (Stowell and Day, 1983;Berthoud et al.,1993;Jones and O’Donnell, 1995;Martin and

White, 1998;Thompson et al.,1998;Wilkinson-Meyers et al.,2010;Mitra et al., 2017).

The third approach is the SoL, which is based on the question of how much more money a

person with a disability would have to spend onall activities to reach the same level of well-

being as a person without a disability. The SoL method does not require any measurement

of expenditure, and it is an indirect way of identifying changes in the relationship between

income and well-being, which is referred to as SoL. It can be measured in different ways

(Mitra et al.,2017), such as material deprivation and asset ownership, ability to face

financial burden and housing costs or life satisfaction, and it is assumed to have a positive

relationship with income (Berthoud et al.,1993;Cullinan et al.,2011;Morciano et al.,2015;

Decancq and Schokkaert, 2016;Mitraet al.,2017;Ozdamar et al.,2020).

Extra disability and health-related costs are calculated as t he additional income needed to

maintain the same SoL as a non-disabled or healthy person, with other sources of variation

controlled for using regression analysis. Costs are estimated in aggregate and can be used to

account for differences in cost levels because of confounding factors, incl uding the severity of

disability and health conditions, life cycle and household composition (Ber thoud et al.,1993;

Zaidi and Burchardt, 2005;Cullinan et al.,2011;Morciano et al.,2015;Decancq and

Schokkaert, 2016;Mitra et al., 2017;Ozdamar et al.,2020;Giovanis et al., 2022).

2. Socio-cultural participation and disability costs

The Convention on the Rights of Personswith Disabilities requires governments to ensure all

persons with disabilities and health problems can enjoy cultural activities. The aim is to

provide access to places for cultural performances, such as galleries, cinemas and

theatres, and grant access to museums, historical sites and monuments of national cultural

importance (UN General Assembly, 2007). We aim to estimate the disability and health-

related costs of Syrian migrants in Turkey operationalised by participation in socio-cultural

activities and identify the inequalities between the disabled and non-disabled. Migrants

may face a range of institutional barriers, not only in socio-cultural activities, such as arts,

theatre and cinema, but also in education, health care and the labour market. However,

participation in socio-cultural activities may serve as a point of contact among natives,

VOL. 19 NO. 1 2023 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jPAGE 59