1. Introduction
The phenomenon of migration has undergone significant transformations over time. Today, as in the past, migration is driven by conflicts; yet, the pursuit of better work, living, and health conditions remains a key motivating factor for populations. The International Organization for Migration defines a migrant as any person who moves from their usual place of residence, whether within a country or across international borders, regardless of the reason for migration, legal status, or duration of stay [
1].
In 2020, the global number of international migrants reached 281 million, with Europe as the main destination, hosting approximately 86 million international migrants, accounting for 30.9% of the global migrant population [
2].
In Portugal, recent data from the Foreigners and Borders Service revealed, for the sixth consecutive year, a growth in the foreign resident population, totaling 781,915 foreign citizens holding residence permits between 2017 and 2022 [
3].
In the context of migration, factors related to the physical, economic, social, and cultural environment are critical to migrant health and their integration processes in host countries. It is widely acknowledged that migration is influenced by multiple determinants (structural, social, and individual) that interact and can affect the health status of migrant populations [
4].
Migrants generally arrive in good health; however, over time, this situation tends to deteriorate, largely due to the conditions they encounter in host countries. These conditions, together with the unique characteristics of this population and their countries of origin, can lead to physical, psychological, and social problems [
5].
As highlighted, part of the migrant population often resides in degraded areas, with inadequate housing conditions and a lack of essential infrastructure, which increases their vulnerability to illness. This situation is exacerbated by predominantly unskilled work environments that expose migrants to various risks [
6,
7].
In Portugal, in 2022, 19.1% of foreigners lived in overcrowded housing with substandard sanitary and hygiene conditions, reflecting a reality common to other European Union countries where migrants live in poor, overcrowded housing, lacking basic infrastructure, in degraded and stigmatized neighborhoods [
8,
9].
Overall, migrant populations experience greater disadvantages in terms of both working and housing conditions, posing clear health risks. Currently, several health and environmental challenges call for actions aimed at reducing environmental health risks and creating sustainable, supportive environments that improve the quality of life for individuals and communities. Among the known environmental risks with significant negative impacts on population health are “Water, sanitation, waste, and hygiene”; “Climate and ecosystem changes”; “Air pollution”; “Built environments”; “Chemical safety”; “Occupational hazards and work environments”; and “Radiation/Noise” [
10] (p. 18).
Recognizing that environmental exposure risks primarily affect the most vulnerable populations, the 2030 Agenda for Sustainable Development offers a new approach to health, environment, and equity [
10]. This United Nations resolution comprises 17 Sustainable Development Goals, each involving a role for everyone, thereby upholding the principle of “leaving no one behind” [
11] (p. 49).
Regarding Goal 11, “Make cities and human settlements inclusive, safe, resilient, and sustainable” by “ensuring access for all to adequate, safe, and affordable housing and basic services and upgrading slums” [
12] (p. 22), improved quality of life for vulnerable populations, such as migrants living in degraded neighborhoods, is an expected outcome.
To facilitate this goal, it is essential to enhance health literacy (HL) by engaging and educating migrant populations. Promoting HL thus constitutes a key strategy for empowering migrants, contributing to their capacity to reduce health inequalities and improve healthcare access and quality [
13,
14].
Recent studies conducted in Europe indicate low HL levels among migrant populations and highlight the need for policies promoting HL [
13]. In the Portuguese context, Medina et al. also underscore inadequate HL levels overall and in relation to healthcare, disease prevention, and health promotion among migrant populations [
15].
In this context, the present study aimed to characterize the perceptions and behaviors of migrants residing in a neighborhood in the Metropolitan Area of Lisbon regarding health risks arising from environmental conditions, as well as to identify their level of HL.
4. Discussion
The distribution of the sample in terms of gender and age aligns with the national context, where the resident foreign population is predominantly composed of women [
21], and the age group with the greatest representation is between 25 and 64 years old [
22].
Acknowledging the heterogeneity of the foreign population residing in Portugal, this study found that, despite the limited scope of the sample, the most represented nationalities were São Toméan (50.5%) and Cape Verdean (39.6%). This does not align with the national reality, where data from 2021 showed that the three most prevalent foreign nationalities were Brazilian (30.7%), British (5.8%), and Cape Verdean (4.7%) [
8]. This discrepancy was also observed in a study conducted in the Lisbon Metropolitan Area, where the population was primarily composed of individuals from North Africa, the Middle East, Afghanistan, and Pakistan [
6,
23].
Regarding the educational profile of the respondents, it was found that more than half had not completed secondary education (71.3%), with 9.9% having no formal education at all. This group exhibited a lower level of education compared to the national migrant population, where 36.1% have basic education, with the remainder at the secondary or higher levels [
21]. This disparity may be associated, on the one hand, with the origin of these migrants, who generally show lower educational progression rates compared to other nationalities and, on the other hand, with the challenges they face in host countries, specifically in terms of language barriers, family structure, and socioeconomic and cultural context [
8,
21].
In this study, it was recorded that 50% of participants were employed, a reality somewhat similar to the national migrant context, where, according to the National Statistics Institute [
21], 48.7% of this population is also employed.
Health status is strongly influenced by a set of individual, social, economic, and environmental factors [
24], with living conditions being particularly significant. Access to quality housing with potable water and good sanitary conditions constitutes a right and a need that ensures a healthy life [
25]. Having proper hygienic and sanitary conditions in adequate housing is therefore a key factor in achieving better health.
As reported in similar studies [
7,
26], a portion of the migrant population tends to cluster by ethnicity, often residing in degraded neighborhoods located on the outskirts of urban centers, with poor habitability and hygiene conditions. This situation is similar to that found in the studied population. Factors such as discrimination, family separation, limited access to goods and services, as well as language barriers, low income, and precarious jobs, create barriers to obtaining stable and safe housing [
27].
Most of the homes in the studied neighborhood consist of four to six rooms, although their small size was noted. In 35.7% of these homes, all rooms had ventilation, while in the remaining homes, only some rooms were ventilated, and some lacked any ventilation. The poor construction quality of these homes, observed by the researchers, with low resistance to cold and heat and reduced ventilation levels, results not only in high humidity but also, as reported by participants, in health risks including potential mold and mildew, respiratory issues, allergic symptoms, and cases of depression and anxiety.
Previous studies have shown that health improvements for populations are only possible when deficiencies in support infrastructure and housing conditions are addressed [
28]. The World Health Organization’s guidelines on housing and health align with this, recognizing the relationship between poor housing conditions and the resulting social and environmental impacts, which can lead to health inequities [
29].
The existing support infrastructure, particularly regarding domestic sewage, stormwater drainage, electricity, and access to housing, is in itself a risk factor due to its inadequacy in promoting health-supportive environments [
30,
31].
Despite the limited external support, it was generally observed that the housing had basic provisions, including running water, lighting, electricity, and sewage systems. This contrasts with the conditions found in settlements resulting from migratory flows in Latin American countries, where such amenities are only partially available [
26]. Given the observed habitability conditions, which may pose health risks, awareness of these risks can predict behavior, with HL being an essential resource for reducing the inequalities seen in these populations.
As an important determinant of health and quality of life [
32], the HL levels found in this study, compared with similar studies [
6,
23], were lower. This may be related to the diverse origins and cultures of the studied populations, which are often associated with lower levels of education. The dimension “Ability to actively engage with healthcare providers” had the highest level of agreement among respondents with secondary or higher education, consistent with findings from Dias et al. [
6], indicating a positive correlation between education and HL [
32].
“Feeling understood and supported by healthcare providers” was the lowest rated dimension, a finding also noted in previous studies [
6,
23]. This may stem not only from a lack of information about healthcare services, linguistic and cultural barriers, including health-related beliefs, but also from the attitudes and communication styles of healthcare providers [
13,
15].
In terms of the level of difficulty in performing certain tasks, participants found “Ability to find good health information” to be the most challenging and “Ability to actively engage with healthcare providers” to be the easiest, which diverges from previous studies [
6,
23]. This latter finding, seemingly contradictory to the low rating of “Feeling understood and supported by healthcare providers”, highlights the need for implementing strategies to enhance interaction and communication between stakeholders [
13].
The results indicate low HL levels across most of the assessed domains, which, given the high vulnerability of these populations, suggests the need for interventions tailored to their cultural, socioeconomic, and environmental conditions.
Environmental health literacy constitutes a crucial aspect of health knowledge, enhancing the ability of individuals and communities to identify and respond to environmental health risks. Recent studies, such as those by Zanobini et al. [
33], highlight that those high levels of health literacy (HL), combined with environmental knowledge, empower individuals and communities to adopt protective behaviors and practices. However, these initiatives often encounter significant socioeconomic and policy barriers that hinder the translation of knowledge into concrete actions. Therefore, promoting HL must be complemented by investments in resilient infrastructures and inclusive public policies that facilitate effective and sustainable change [
33].
Furthermore, HL plays a central role in mitigating health disparities, particularly among marginalized populations with limited access to quality resources and information [
34]. Programs that integrate HL with environmental literacy have demonstrated substantial potential for community empowerment. Such programs enable the identification of environmental risks and the implementation of effective mitigation strategies, thereby not only strengthening the resilience of local communities but also contributing to greater health equity [
33,
34,
35].
Limitations
This study has some limitations that warrant consideration. The use of a convenience sample, characterized by its small size and limited diversity, reduces the representativeness of the findings and limits their generalizability to broader populations. Additionally, the cross-sectional design restricts the ability to establish causal relationships between the variables analyzed, which limits a deeper understanding of the underlying dynamics.
Another limitation relates to the broader context of the research. While existing studies have explored health literacy among migrant populations, there remains a significant gap in understanding the environmental and living conditions that may critically influence health literacy and related outcomes. These factors, often overlooked, are crucial in shaping migrants’ health experiences and access to resources.
This lack of data highlights the need for further research employing more robust methodologies. Future studies should prioritize larger, more representative samples and adopt longitudinal designs to better capture causal relationships over time. Expanding the research focus to include environmental and contextual factors would provide valuable insights, enabling the development of targeted strategies to enhance health literacy and overall well-being among migrant populations.
5. Conclusions
Migration flows are a global phenomenon, and their intensification over recent years has presented significant social, economic, and public health challenges, impacting both host countries and migrant or native populations.
The living conditions of many migrants in host countries often involve residing in peripheral and degraded neighborhoods, where issues related to inadequate housing exacerbate social vulnerability, sometimes negatively affecting their health status.
The results reveal the poor construction quality of housing and the inadequacy of external infrastructure with stagnant water, organic and other waste, and unsafe electrical and outdoor lighting networks. Together, these factors constitute environmental risks that affect the health of these populations.
Additionally, this study allowed for an assessment of health literacy (HL) perceptions within this population, highlighting greater deficits in the following two dimensions: “Feeling understood and supported by healthcare providers” and “Ability to find good health information”. These results suggest significant difficulties in obtaining adequate support from healthcare providers, which can impact confidence and the ability to make informed health decisions. Furthermore, the difficulty in finding reliable and understandable health information limits access to the knowledge necessary for health prevention and management.
These factors are crucial, as HL plays an essential role in promoting self-care behaviors and accessing healthcare services. Thus, the identified deficits in these HL dimensions underscore the need to implement more effective communication and support strategies, ensuring that this population can benefit from more inclusive care focused on mutual understanding and access to quality health resources.
In this context, the relevance of implementing community intervention projects is recognized not only in the promotion of health literacy (HL) among migrant communities but also in addressing environmental health risks in the aforementioned areas. Such initiatives require the active participation of all societal stakeholders to achieve health improvements within these populations.
