RETORNO: Interventions on Social Determinants of Health: A comparative study of returned migrants from the UK and Spain post-Brexit referendum

Project Information

RETORNO

Grant agreement ID: 894303

DOI

10.3030/894303

Project closed

EC signature date 28 April 2020

Start date 12 April 2021

End date 11 April 2022

Funded under

• EXCELLENT SCIENCE - Marie Skłodowska-Curie Actions

Total cost

€ 112 466,88

EU contribution

€ 112 466,88

Coordinated by

UNIVERSITY OF LEEDS
United Kingdom

Periodic Reporting for period 1 - RETORNO (RETORNO: Interventions on Social Determinants of Health: A comparative study of returned migrants from the UK and Spain post-Brexit referendum)

Reporting period: 2021-04-12 to 2022-04-11

Summary of the context and overall objectives of the project

The topic addressed was return migration in the post-Brexit European context. Health return migrants are influenced by multiple interacting Social Determinants of Health: structural social determinants include socio-economic factors, cultural and social values and political factors (structural conditions in the country of origin are a key determinant of return, but can also be a barrier to reintegration when social and gender differences exist) and others closer to the individual level (intermediate social determinants).
While there is strong evidence that migrants are more vulnerable to many health problems, there are gaps in research, policy and practice when it comes to return migrants, implying the need for further research to truly understand the psychosocial wellbeing and health challenges of returnees.
Furthermore, Brexit has been a disruptive event that has triggered problems for the free movement of people, as well as for the maintenance and preservation of citizens' rights, issues that may ultimately lead to social health inequalities.
The objectives of the RETORNO study were: to explore how Brexit affects health and social care services provision for returned migrants and the implications for different stakeholders; to classify interventions for Social Determinants of Health to understand for whom, under what circumstances, in what respects and why they may impact returned migrants’ health inequalities; to identify contextual factors and main mechanisms triggered by interventions and how these impact health outcomes, focusing on gender inequalities; and to support the design of interventions by providing a unified theory constructed with stakeholders on how public policies on migrant welfare and health may impact citizens returning home after residence in other EU member states.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

We carried out a Realist Synthesis (RS), an innovative review method used in health and social policy to review heterogeneous bodies of evidence, typical of complex interventions. As part of the RS, a Realist systematic review (the protocol is registered in PROSPERO) was conducted using bibliographic databases (Medline/Pubmed, PsyInfo, Cochrane Library, Embase, Web of Science) and grey literature (web pages, reports, guides and regulations of governments, institutions, associations and organisations). In addition, working meetings were held with experts in the study phenomenon, as well as participation in meetings of the Post-Brexit working group of the Spanish Residents' Councils in the UK. In addition, two initial co-productive workshops (one focused on return to Spain and the other on return to the UK) were held with stakeholders. This process identified initial contextual differences between Spain and the UK, and contributed to the development of an initial theoretical framework to guide research and the generation of initial programme theories.
Through analysis of the selected documents, we identified 25 return migration interventions using the World Health Organization's Social Determinants of Health Framework. Information from the two initial workshops was also used in this process.

Given the incursion of the COVID-19 pandemic, it was considered highly pertinent, at the outset of the research, to conduct the analysis of the pandemic, through documentary sources, in the two study settings, the UK and Spain, and from the lenses of Complexity and Realism theory.
Continuing with the Realist systematic review, empirical evidence was identified to generate context-mechanism-outcome (CMO) configurations and to test and refine programme theories. In addition, two further co-productive stakeholder workshops were held (one aimed primarily at return to Spain and the other at return to the UK). Seven CMOs were identified: “Disaffection”, “Lost and forsaken”, “Jump into the void”, “Empowerment to act”, "The best of both worlds", “In no one's land” and “Face to face and at home".
In the last phase of the RS, a final co-productive workshop was held with stakeholders. Focusing on the key results (CMOs), we drafted four policy briefs that were presented at this final workshop to obtain stakeholder input and reach agreements from an intersectoral approach. The policy briefs finally agreed were: “How to overcome barriers to a healthy return”, “Promoting the return of human capital”, “Maintaining mobility rights to reside, work and study” and “Getting out of limbo“.

Overview of the results and their exploitation and dissemination (at the time of writing):
• News, participation in events and publications have been published in the RETORNO website, as well as on Twitter.
• Presentations at scientific conferences (International Conference on Education and Migration 2022; 2022 Realist Methodology Training Conference; British Sociological Association 2022; XL Reunión Anual de la Sociedad Española de Epidemiología and XVII Congresso da Associacao Portuguessa de Epidemiologia).
- Scientific publications:
• Serrano-Gallardo, P. & Manzano, A. (2021). A realist synthesis of interventions on social determinants of health for returned migrants: the case of the UK and Spain post-Brexit referendum. PROSPERO 2021 CRD42021254868 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021254868
• Serrano-Gallardo P, Manzano A and Pawson R. Non-pharmaceutical interventions during COVID-19 in the UK and Spain: a rapid realist review [version 1; peer review: 1 approved with reservations]. Open Res Europe 2022, 2:52 (https://doi.org/10.12688/openreseurope.14566.1 ).

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

Through my participation in the APPG (All-Party Parliamentary Group) seminar on Britons in Europe, invited by New Europeans UK, I was able to highlight and emphasise the importance of the social and health issues of return migrants in the post-Brexit era, especially between the UK and Spain, but also at the European level, and the challenges it poses for governments and society in general.
During the research process of my Marie Curie fellowship, I held conversations with the heads of different Spanish autonomous communities, who were very interested in receiving the results of the RETORNO study to incorporate them in the development and improvement of their Return Plans. Finally, after finishing my stay at the University of Leeds, the Generalitat Valenciana has asked me to collaborate as an expert in the development of its Return Plan.
Throughout the year I have participated in numerous meetings of the Post-Brexit working group of the Council of Spanish Residents in the UK. Among the actions most related to the RETORNO project has been the elaboration of the "Joint Manifesto on the loss of rights after Brexit". I have been asked to continue to be part of the group, and I will continue with this collaborative work.
Being invited by the Spanish Department of Labour, Migration and Social Security in the UK to participate in the webinar "Return to Spain after Brexit" also demonstrates the impact of my project for some of the main actors to influence the study phenomenon.
One of my objectives is to maintain contact with the researchers I have worked with this year in order to launch new projects, especially those focused on the social determinants of health and migratory phenomena in the European context.

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