Public HealthEntry ID: 9780199756797-0XXXCitation Style: HumanitiesVersion Date: July 1, 2013

MIGRANT HEALTH

Kevin Pottie, Kamila Premji Author Contributions: Pottie and Premji conceived the bibliography and both authors substantially contributed to the review and interpretation and organization of bibliographic content and gave final approval to the version submitted for publication. IntroductionGeneral OverviewsTextbooks

Public Health and Tropical MedicineMedical AnthropologyHealth Services

Journals Models, Frameworks, and Definitions Integration and Acculturation of Immigrants Healthy Immigrant Effect Ethics and Gender in Migrant HealthSocial Determinants of Health Migrant Workers and Circular MigrationIrregular Migrants, Detention and DeportationHealth Equity and Right to Health for Migrants Policy and Health Infectious DiseasesPrimary Health Care ResourcesClinical Practice GuidelinesPriority Areas for Future Work on Migrant Health

INTRODUCTION Migration is a historic process that has dramatically increased in scale and scope in recent decades. There are more than 214 million international migrants worldwide. This global movement of people has implications for both individual and public health. The 2009 United Nations Human Development Report suggested that overall, migration benefits people who move towards increased economic and education opportunities, but migrants also frequently face barriers to local health and social services. In addition to access issues, migrants moving across social and disease prevalence gradients face an

array of unique health risks. The UN Post-2015 agenda reflects these concerns in its recognition of the gap in funding and research for mobile and undocumented migrants who face increasingly restrictive rights and services. This entry will consider general overviews and key reference works on migrant health, as well as textbooks, anthologies and journals including sections on migrant health services. It will also provide references to definitions in thefield of migration, models and the multiple dimensions that contribute to or detract from migrant health, and the role of human rights-based approaches andinterdisciplinary approaches in reducing inequities in access and health outcomes for migrant populations. Irregular migrant health references pertaining to priority areas for future funding and research will also be provided. While a limitation of some sections is a paucity of non-Western resources, international and multilingual references are incorporated whereverpossible. This entry will be of interest to a broad range of readers, including scholars, policymakers, public health professionals, and health carepractitioners.

GENERAL OVERVIEWSMigrant health is a relatively new discipline that has emerged from the fieldsof tropical medicine and public health, medical anthropology, and health equity The Encyclopedia of Global Human Migration provides a comprehensive, thematic exploration of human migration from prehistory to the present day. Aswith all new disciplines, the nomenclature surrounding types of migrants, types of migration, and national programs for migrants has been a stumbling block in relation to international comparisons. Gushulak and MacPherson 2006 have helped lay a solid foundation for migrant health nomenclature. In recentyears, migrant health practitioners such as Walker, et al. 2007 have provided practical reviews of health conditions that commonly affect migrant health. Most recently, Pottie, et al. 2011 used the GRADE approach (The Grades of Recommendation, Assessment, Development, and Evaluation) to develop a series of evidence-based clinical recommendations to guide practitioners and public health in serving migrant populations. Content covers: infectious diseases; mental health and physical and emotional maltreatment; chronic non communicable diseases; and women’s health. Rechel et al 2011 provide a European Union perspective to their overview of migrant health, and the International Organization for Migration’s World Migration Report 2010 provides important demographic data on global migration. [au: consolidated into one paragraph per OB style]

The Encyclopedia of Global Human Migration Wiley: ISBN: 978-1-4443-3489-0 Authoritarian source for students and professionals, this five- volume collection (also available online) explores the prominent themes, events, and theoretical foundations of human migration with a global – rather than Western – perspective. It includes thematic interpretationsand theories of migration and scholarly interpretations that have reshaped the way historians and social scientists analyze and map the past.

Gushulak, Brian D & MacPherson, Douglas W. 2006. Migration Medicine and Health Principles and Practice. BC Decker Inc, Hamilton.

Explores how travel, complex emergencies, and various forms of migrationshape our world and impact health services and public health policies. A useful introduction for university students interested in the role of population mobility and types of migration, migrant health nomenclature,and global burden of disease in the context of population mobility.

Walker, Patricia, Barnett, Elizabeth, Stauffer William (Eds). 2007. Immigrant Medicine. Sanders Elsevier.

The first comprehensive book supporting health practitioners caring for immigrant and refugee populations. Contains practical and clinically relevant information and considerations with a strong focus on primary care. Useful advice on screening and vaccination, as well as many maps and tables to help estimate global foci of disease prevalence.

Pottie, Kevin, Greenaway, Christina, Welch Vivian et al. 2011. Evidence Based Guidelines for New Immigrants and Refugees. Canadian MedicalAssociation Journal. E824-E8925 DOI:10.1503/cmaj.090313.

Peer reviewed evidence-based syntheses on 20 selected diseases for whichthere were perceived or real equity gaps in the Canadian immigrant population and for which potential health interventions exist. Clinicalguidelines focus on infectious diseases; mental health and maltreatment;chronic and non-communicable diseases; and women’s health.

Rechel B, Mladovsky P, Deville W, Rijks B, Petrova-Benedict R, and McKee M (Eds.) Migration and health in the European Union. Open University Press, 2011

Explores migration and health in the European Union with a focus on rights to health, barriers to health services access, health issues faced by migrants, and policy implications and recommendations based on examples of best practice.

The International Organization for Migration. World Migration Report 2010. Geneva: IOM; 2010. Available at:

http://www.iom.int/jahia/Jahia/policy-research/migration-research/world-migrationreport-

2010. Accessed 25 Jun 2013.

The International Organization for Migration is a world leading organization that produces an annual report on world migration. This annual report includes data on demographics and movement of populations for policy makers and academics.

TEXTBOOKS There are no course textbooks devoted exclusively to migrant health. However, substantial proportions of texts used in courses on public health, tropical medicine, medical anthropology, and health-services research include comprehensive treatments of various practical and theoretical dimensions relevant to migrant health.

Public Health and Tropical MedicinePublic health is the practice of preventing disease and promoting good health within groups from small communities to entire countries. It includes health professionals from many fields working together to protect the health of a population. Access to health care is one means to attaining its goals. The texts cited below (Eddleston et al 2008; Magill et al 2012) are among the most used by schools and programs in public health in their introductory survey courses on public health practice. As a tool of public health, these texts frequently reference access to health care.

Eddleston M, Davidson R, Brent A, Wilkinson R. Oxford Handbook of Tropical Medicine. 2008.

Pocket-sized medical reference for diagnosis and management useful for medical students and residents. Sections are organized by system as wellas by tropical condition (malaria, HIV/STI, tuberculosis, diarrheal diseases, acute respiratory infections, and fevers). Many illustrationsand photographs.

Magill AJ, Strickland GT, Maguire JH, Ryan ET, Solomon T. 2012. Hunter’s Tropical Medicine and Emerging Infectious Diseases. Saunders.

Comprehensive medical reference for diagnosing and managing diseases arising from the tropics. Includes infectious diseases, poisoning and toxicology, animal injuries, and nutritional and micronutrient deficiencies. Print and e-book versions available. Ideal for medical professionals,

Medical AnthropologyMedical anthropology is the interdisciplinary study of "human health and disease, health care systems, and biocultural adaptation” (McElroy, A, 1996). Its relevance to migrant health is its focus on understanding how culture and society relate to issues of health and health care, and it has been applied to, among other areas, the development of community health programs, transcultural psychiatry, the study of cultural acceptance of or resistance totherapeutic interventions, and the study of health providers including traditional healers. Cecil et al 2007 provide a comprehensive overview of this important discipline.

McElroy, A (1996), "Medical Anthropology", in D. Levinson & M. Ember, Encyclopedia of Cultural Anthropology

This chapter details the history and theoretical underpinnings of the three major orientations of medical anthropology: Medical ecology, ethnomedicine, and applied medical anthropology. Prominent publicationsthat have shaped the discipline of medical anthropology are also discussed. Ideal for emerging migrant health scholars.

Helman, Cecil. 2007. Culture, health, and illness. 5th ed. London: Hodder Arnold.

A comprehensive and important text that introduces and builds upon the theoretical concepts from anthropology relevant to migrant health. Includes detailed definitions and examinations of the culture concept and contextual social factors, and explores how these relate to and influence health, illness, and medical care. International examples and case studies are presented.

Health Services With increasing emphasis on the accountability, effectiveness, and efficiency of health care delivery programs, most programs in health services research and management require courses in evaluation of health programs. These texts provide surveys of how the health services system is organized and financed. They provide considerable detail regarding the relationship between organization and finance and access to health care. Some, such as Andersen at al 2007 and Williams and Torrens 2007, are primarily intended for an introductory course for graduate students in schools of public health, the health sciences, public policy, and management. Others, such as Barton 2009, contain fewer technical references and are aimed at undergraduate college students.

Andersen RM, Rice TH, Kominski GF, Afifi AA, Rosenstock L. 2007. Changing theU.S. Health Care System: Key Issues in Health Services Policy and Management. San Francisco: Jossey-Bass.

Overview of the U.S. health care system with a focus on access, quality,and cost. Includes sections on special populations and future directions, including a discussion of ethical considerations. Useful forstudents, academics, and programmers, and policymakers.

Barton PL. 2009. Understanding the U.S. Health Services System, Fourth Edition. Chicago: Health Administration Press.

Introductory text on the complex U.S. health services system and its users. Highlights basic concepts as well as health system organization,management, and financing. Includes a discussion of managed care and legislative changes proposed by the Obama administration to move toward universal coverage. Ample statistical data including graphs.

Williams SJ, Torrens PR. 2007 (Eds). Introduction to Health Services. New York: Delmar Cengage Learning.

A multidisciplinary, practical overview of the various services within the U.S. health care system. Includes a review of patterns of disease, inpatient and outpatient health services, financial and nonfinancial considerations related to heath care services, and health system monitoring, evaluation, and regulation, including policy and ethical implications for health systems.

JOURNALS Core journals on health services research that would be of most interest to migrant health researchers and students include the following international, interdisciplinary publications: Culture, Medicine, and Psychiatry; Ethnicity and Health; International Migration Review; and Journal of Immigrant and Minority Health. The Journal of Health Care for the Poor and Underserved is abroad and interdisciplinary publication with a focus on North American, Central American, Caribbean, and sub-Saharan African perspectives. Medical Anthropology Quarterly brings together international research and theory in the field of medical anthropology. Health and Human Rights: An International Journal combines scholarship with activism in its endeavour to increase human rights knowledge in the health field. These journals are listed here in orderof journal impact factor (assessed 2013 :

Culture, Medicine, and PsychiatryThis journal is devoted to publishing original work that bridges anthropological, public health, and medical perspectives and methods as they inform cultural contexts of health behavior. Topics include culturein health care and comparisons of how the concept of culture operates inanthropological and medical disciplines.

Ethnicity and HealthAn interdisciplinary journal publishing research on the relationship between ethnicity and health. Includes papers in the fields of medicineand nursing, public health, epidemiology, social sciences, population sciences, and statistics. Anthropological and social aspects of health are addressed.

International Migration ReviewAn international, interdisciplinary publication focused on sociodemographic, historical, economic, political, legislative and pastoral aspects of human mobility.

Journal of Health Care for the Poor and UnderservedBrings together North American, Central American, Caribbean, and sub-Saharan African perspectives to examine the health issues experienced bymedically underserved populations, including issues pertaining to access, quality, costs, legislation, regulations, health promotion, and disease prevention. Publications include original research, reviews, policy analyses, and evaluations of health care programs.

Journal of Immigrant and Minority Health This international journal publishes original interdisciplinary researchand review articles pertaining to immigrant health, bringing in perspectives from public health, epidemiology, medicine and nursing, anthropology, sociology, population research, immigration law, and ethics.

Medical Anthropology QuarterlyThis journal is devoted to publishing research and theory in the field of medical anthropology. This includes articles that are holistic and cross-cultural, and range in topics from ethnomedicine to public health and healthy policy.

Health and Human RightsThis online, open access journal aims to advance health as an issue of fundamental human rights and social justice. Engaging academics, practitioners, and activists across various health and rights-related disciplines, HHR publishes commentary and analyses on the conceptual foundations and challenges of human rights discourse and action in relation to health.

MODELS, FRAMEWORKS, AND DEFINITIONS Models provide guidance for defining variables, specifying the relationships among them, and evaluating programs and policies concerned with health, accessand utilization of health care. Models may be used to guide the conduct of descriptive, analytic, or evaluative studies of the operation and performance of the health services delivery system. Models of healthcare access have beenconstructed from a variety of theoretical or disciplinary perspectives, beginning with the 1968 Andersen behavioural model. Davidson et al 2004 buildupon this model with a focus on low-income populations. Betencourt et al 2003propose a framework for interventions to reduce sociocultural barriers to health equity and cultural competence. Bierman et al 2012 focus on the role of gender in health inequities. Gulshulak et al 2010 bring in a public healthand health policy perspective, as do Hruschka and Hadley 2008 through an examination of the culture concept.

Andersen, RM. Revisiting the behavioral model and access to medical care: Doesit matter? Journal of Health and Social Behavior 1995;36( 1):1-10

Developed in 1968, the Andersen model is the leading conceptual model describing the factors leading to health service usage. It proposed that usage is determined by three dynamics: predisposing factors (including race, age, health beliefs), enabling factors (including family and community supports, health insurance), and need (both perceived and actual). This article reviews the development of this model and discusses its relevance today for researchers.

Betancourt, Joseph R., Alexander R. Green, J. Emilio Carrillo, and Owusu Ananeh-Firempong. Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports 2003;118(4):293–302.

In this work, authors review the literature on sociocultural barriers tohealth and cultural competence to develop a framework of organizational,structural, and clinical cultural competence interventions aimed at reducing racial/ethnic inequities in health. Useful for students and health professionals.

Bierman AS, Johns A, Hyndman B, Mitchell C, Degani N, Shack AR, Creatore MI, Lofters AK, Urquia ML, Ahmad F, Khanlou N, Parlette V. Social Determinants of Health and Populations at Risk In: Bierman AS, editor. Project for an Ontario Women’s Health Evidence-Based Report: Volume 2: Toronto; 2012.

Report from an Ontario-based commission studying health inequities associated with social determinants of health with a specific focus on how these inequities differ by gender. Highlights of immigrant and minority populations are useful for health equity researchers.

Davidson PL, Andersen RM, Wynn R, Brown ER. A Framework for Evaluating Safety-Net and Other Community-Level Factors on Access for Low-Income Populations. Inquiry 2004; 41: 21–38

Authors extend the Andersen behavioral model of health services utilization research to develop a new conceptual framework for examining the determinants of access to health care with a focus on factors influencing low-income populations. Useful for health policy researchers.

Gushulak BD, Pottie K, Hatcher Roberts J, et al. Migration and health in Canada: health in the global village. CMAJ 2010 DOI:10.1503/cmaj.090287

Analyses migration and types of migrants and how diversity and country of origin affect public health and health policy. Broad overview createdfor evidence based clinical guidelines.

Hruschka D. J., and C. Hadley 2008. A glossary of culture in epidemiology. Journal of Epidemiology and Community Health 62.11: 947–951. DOI: 10.1136/jech.2008.076729

Examines definitions, theories, and methodologies used to understand theculture concept. This article is useful for acquiring a basic understanding of key culture-related concepts and terms, and for considering how to approach effective integration of cultural processes into public health programs.

INTEGRATION AND ACCULTURATION OF IMMIGRANTS The integration of immigrants into a host society/economy has received intensepolitical attention from Western Countries, the International Organization forMigration, and academics in health and public health programs. In the US, thepersonal element of this process is more commonly referred to as acculturationand defined as the process of acquiring knowledge of a culture context other than the one in which the individual grew up. This complex process of integration or acculturation has been shown to have positive and negative impacts on health behaviors and outcomes. Kleinman 1980 has played a pivotal role in helping clinicians and public health officials begin to understand howa person’s explanatory beliefs and models are critically linked to their behaviours and health-related decisions. Helman 2007 has effectively demonstrated for policymakers and practitioners the link between culture and illness. Beiser 1999, a cultural psychiatrist, analyses this process using over 15 years of study of the Vietnamese Boat People, a mass movement of refugees to Canada. At the 2010 Annual Meeting of the German Ethics Council,legal and ethical aspects of migrant health and acculturation are explored. Finally, Fadiman 1997 is a popular account of misunderstanding among the Hmongin the US which provides a helpful introduction to the many different belief systems encountered in migrant health.

Beiser, Morton. 1999. Strangers at the Gate: The "Boat People's" First Ten Years in Canada. University of Toronto Press.

Drawing from his ten-year cohort study of 1,300 Boat People, Beiser documents, in plain language, struggles with language and economic independence, and the low rate of health and social service use of Vietnamese compared to Canadian born individuals. Beiser dispels key misconceptions about immigrants and reframes central debates on refugee policy.

Fadiman, Anne. 1997. When the spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus and Giroux.

An ethnographic case study of miscommunication between a Hmong family, their doctors, and the associated civil servants charged with protectingthe health of a child. Uses a popular narrative approach to present cross-cultural misunderstandings inherent at the service provider level of migrant health with the concomitant implications for public health. Ideal for students.

Helman, Cecil. 2007. Culture, health, and illness. 5th ed. London: Hodder Arnold.

Comprehensive introduction of the theoretical concepts from anthropologythat are very important to migrant health. Includes detailed definitions and examination of the culture concept and contextual socialfactors, and how these relate to and influence health, illness, and medical care.

Kleinman, Arthur. 1980. Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Comparative Studies of Health Systems and Medical Care 3. Berkeley: Univ. of California Press.

Builds on Kleinman’s work on explanatory models in clinical care. Uses experiences from his own practice and interviews with health practitioners to demonstrate how understanding cultural perspectives of patients and the context in which care is delivered can lead to improvedhealth outcomes. Ideal for university students.

Deutschen Ethikrates 2010. Migration und Gesundheit: Kulturelle Vielfalt alsHerausforderung für die medizinische Versorgung. (German) Available at: http://www.ethikrat.org/dateien/pdf/tagungsdokumentation-migration-und-gesundheit.pdf. Accessed 25 Jun 2013.

This 2010 document from the Annual Meeting of the German Ethics Council explores the challenges of health and acculturation for the more than 16million German residents with a “migration background”. Ethical and legal aspects of migrant health are explored, and specialized discussions pertaining to women’s health and child and adolescent psychiatry are included.

HEALTHY IMMIGRANT EFFECTThe healthy immigrant effect is the well-described phenomenon whereby voluntary immigrants, are on average and at least upon arrival, healthier thanthe native-born population. Various explanations for this phenomenon and its impact on health service usage and outcomes exist. McDonald et al 2004, Ng etal 2005, and Ng 2011 provide Canadian perspectives, while Chiswick et al 2008 examine the healthy immigrant effect from an American perspective. Cognet et al’s 2012 collection of migrant health articles analyze the various socio-cultural and public policy impacts on the health of new immigrant.

Ng E, Wilkins R, Gendron F, Bertolot DM. Dynamics of Immigrants' Health in Canada: Evidence from the National Population Health Survey. 2005. StatisticsCanada ISSN: 1713-8833

Analyses of a national population health survey demonstrating that immigrants typically arrive in Canada with better-than-average health. In fact, many studies conducted in Canada and in the United States have established the existence of the "healthy immigrant effect."

Chiswick B, Lee WL, Miller P. Immigrant selection systems and immigrant health. Contemporary Economic Policy 2008; 26(4): 555-77.

Detailed analysis of longitudinal data from the United States examining the healthly immigrant effect and the role of immigrant selection systems.

McDonald JT, Kennedy S. Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada. Soc Sci Med 2004;59(8):1613-27.

Series of analyses documenting the healthy immigrant effect based on health status and health service utilization of immigrants compared withnative born populations.

Ng E. The healthy immigrant effect and mortality rates. Health Reports, Vol. 22, no. 4, December 2011. Statistics Canada, Catalogue no. 82-003-XPE.

Analyses of national mortality databases providing once evidence that immigrant or foreign born populations have lower levels of mortality than Canadian born population, with only a few exceptions.

Cognet M, Hoyez A, Poiret C. (Eds.) Expériences de la santé en migration. Revue Europeenne des Migrations Internationales, Vol 28, no 2, 2012. (French) Available at: http://remi.revues.org/5841?lang=en . Accessed 25 Jun 2013.

The articles in this issue of REMI are devoted to analyses of the healthexperiences of migrant populations with a focus on the impacts of mobility, public policy, social inequalities, and discriminatory processes.

ETHICS AND GENDER IN MIGRANT HEALTHEthics frequently encounters challenges in the interpretation of norms and values across cultures. Fleichmacher 1994 analyzes how Western philosophy andmodern anthropology have been too quick to accept culture as the source of people’s ethical beliefs. He cites the danger in seeking ethical understanding across cultures, and the risk that a practitioner or researcher may impose their own values on others or abandon all norms to relativism. Spitzer 2012 provides a detailed account of how values and gender play a role for immigrant women. The Australian National Health and Research Council provides a framework for engaging immigrant communities to improve health services.

Fleishchacker, Samuel. 1994. The Ethics of Culture. Cornell University Press. Analysis of how Western approaches to ethics often fail when applied across cultures. Pays special attention to the paradox of our Western liberal heritage that claims to reject tradition and authority as inherently oppressive, arguing we all need a tradition that provides a foundation for moral judgment. Ideal for the migrant health scholar.

National Health and Research Council AG. Cultural competency in health: a guide for policy, partnerships and participation. Canberra (Australia): The Council; 2005.

This book provides very practical frameworks for immigrant community engagement. It uses a series of case studies to illustrate how stakeholder engagement and community participation can improve health services.

Spitzer, Denise (Ed). 2012. Engendering Migrant Health: Canadian Perspectives.University of Toronto Press, Scholarly Publishing Division

Addresses the intersections of gender, immigration, and health in the lives of new Canadians to understand why the health of new migrants deteriorates and how these effects can be mitigated. Contributors illuminate migrants' testimonies of struggle, resistance, and solidarityas they negotiate a place for themselves in a new country.

SOCIAL DETERMINANTS OF HEALTH Social determinants of health are defined by the World Health Organization as the range of personal, social, economic and environmental factors that determine the health status of individuals or populations. (WHO 1998) These factors include, among others, income and socialstatus, social supports, education and literacy, gender, and culture. Dunn andDyck 2000 present the results of a Canada-wide survey studying the social determinants of health in immigrant populations, and Ng et al 2011 describe the impact of official language proficiency on the health of new immigrants toCanada.

Dunn JR, Dyck I. Social determinants of health in Canada's immigrant population: results from the National Population Health Survey. Social Science& Medicine, 2000; 51 (11): 1573-1593

Analysis of a national survey that was used to study the social determinants of health.

Edward Ng E, Pottie K and Spitzer D. Official language proficiency and self-reported health among immigrants to Canada. Health Reports, Vol. 22, no. 4, December 2011 Statistics Canada, Catalogue no. 82-003-XPE.

Longitudinal study of immigrants demonstrates that official language proficiency, of speaking the local language, is significantly associatedwith self-perceived health, and limited language proficiency is a risk for decline in health status.

World Health Organization. The WHO Health Promotion Glossary. 1998. Available at: http://www.who.int/healthpromotion/about/HPG/en/. Accessed 1 Jul 2013.

A glossary of terms facilitating consensus among health promotion professionals at various levels. Includes definitions of terms pertaining to social determinants of health.

INFECTIOUS DISEASEHistorically, due to disease exposure and precarious living conditions during and after travel, infectious disease has played a significant role in field migration. Examples include tuberculosis and intestinal parasites. The CDC’s Yellow Book, the Australasian Society for Infectious Diseases, and Magill et al 2012 and Greenaway et al 2011 summarize diagnostic and treatment recommendations relevant to both travelers and new immigrants and refugees. Policy implications of migrant health as it relates to infectious diseases aresummarized in MacPherson et al’s 2007 WHO Bulletin.

Magill AJ, Strickland GT, Maguire JH, Ryan ET, Solomon T. 2012. Hunter’s Tropical Medicine and Emerging Infectious Diseases. Saunders.

Comprehensive medical reference for diagnosing and managing diseases arising from the tropics. Includes infectious diseases, poisoning andtoxicology, animal injuries, and nutritional and micronutrient deficiencies. Print and e-book versions available.

Centers for Disease Control. CDC Health Information for International Travel (The Yellow Book). Oxford University Press 2012.

Every two years, the CDC publishes an online and print update to this U.S. reference for health professionals serving international travelers.Content includes an extensive chapter on infectious diseases as well as a popular chapter on special destinations, wherein experts who have lived in or visited particular regions share their insider’s knowledge of the health considerations relevant to these places.

Greenaway C, Sandoe A, Vissandjee B, Kitai I, Gruner D, Wobeser W, Pottie K, Ueffing E, Menzies D, Schwartzman K. Canadian Collaboration for Immigrant and Refugee Health, Tuberculosis: evidence review for newly arriving immigrants and refugees. CMAJ 2011; 183(12):E939-E951

This review paper provides a synthesis of burden of risk, screening and interventions and number needed to treat and number needed to harm in relationto latent TB. Useful for public health and health service policy makers.

Australasian Society for Infectious Diseases. Draft guidelines for diagnosis, management and prevention of infection in recently arrived refugees. Sydney (Australia): The Society; 2007.

A comprehensive series of guidelines for infectious disease screening for refugees arriving in Australia.

MacPherson DW, Gushulak BD, Macdonald L. Health and foreign policy: influencesof migration and population mobility. Bull World Health Organ 2007;85:200-6.

As globalization increases, so too does the international community’s interest in the health effects of globalizing processes, especially regarding emerging and re-emerging infectious diseases like malaria, tuberculosis, and HIV/AIDS. This bulletin from the World Health

Organization summarizes migration-related health issues relating to past, current, and future foreign policy initiatives.

MIGRANT WORKER HEALTH AND THE HEALTH IMPACTS OF CIRCULAR MIGRATION

An important and often neglected group of international migrants are migrant workers. In this group we include both the international expatriate and the migrant worker (also referred to as the temporary foreign worker). Several countries have developed programs to recruit temporary migrant workers, and through some of these programs efforts have been made to ensure health and security. However, as the International Labour Organization 2004, Ling 2012, Kaur 2010, Barnes 2013, and Binford 2013 describe, more work is needed. Yeates 2009 provides a focus on women migrant workers through an exploration of “global care chains”. Circular migration, which refers to the movement ofpeople across borders and then back to their country of origin, is often related to work contracts and also impacts migrant workers and their health. Family pressures are another significant reason for circular migration. Potts2010 and Cordel et al 1998 provide an African perspective of this phenomenon, and Deshingkar and Farrington 2009 provide an exploration of the enormous volume of circular migration occurring in India. These references will be of particular interest to academics in migrant health and migration, economists, public health workers, and policymakers.

International Labour Organization. Towards a fair deal for migrant workers inthe global economy. Report from the International Labour Conference, 92nd Session, 2004. Available at: http://www.ilo.org/public/english/standards/relm/ilc/ilc92/pdf/rep-vi.pdf. Accessed 25 Jun 2013.

Analyzes research and data on global migration, synthesizes lessons learned from the experiences of origin and host countries, and presents recommendations and insights aimed at protecting human rights of migrantworkers, managing flow of migration, maximizing migration’s contributionto growth and development, and preventing illicit flows and trafficking.Important source for policymakers and workers in public health and humanrights.

Kaur A. Social Determinants of Health and Migrant Workers in Southeast Asia. In: Bhattacharya S. et al. Social Determinants of Health Assessing Theory, Policy and Practice. Wellcome Trust Centre for the History of Medicine and Orient Blackswan, New Delhi: 2010.

The millions of migrant workers in Southeast Asia, shared mainly betweenMalaysia and Thailand, are generally not privy to fundamental civic rights and social protection and have limited access to adequate healthcare. This chapter examines international labour migration in thisregion since the 1970s, reviews immigration policies for unskilled workers, and evaluates Malaysia and Thailand’s ratification of core International Labour Organisation (ILO) Labour Conventions.

Barnes N. Is health a labour, citizenship or human right? Mexican seasonal agricultural workers in Leamington, Canada. Glob Public Health. 2013 May 14. [Epub ahead of print]

Using a comparative case study from Canada, this paper aims to understand how different types of health care rights for migrants are activated and applied, in turn contributing to policymaking for improvedmigrant worker access to health and human rights.

Yeates N. Globalizing Care Economies and Migrant Workers: Explorations in Global Care Chains. Palgrave MacMillan, 2009.

Applies a feminist, “global care chain” perspective to explore and analyse the experiences and impacts of women migrant workers worldwide. Also explores the policy implications of globalization, labour, and migration of women for both developed and developing countries.

Ling D. Burmese Migrant Workers' Access To Health Care Services In Thailand. LAP LAMBERT Academic Publishing, 2012

Presents the findings of 150 interviews of registered and unregistered Burmese migrant workers in Thailand, with a focus on workers' access to health care services, health problems and health care seeking behaviours. Highlights important barriers faced by migrant workers, especially women, and recommends strategies for addressing these barriers. Interesting to practitioners and workers in public health.

Potts D. Circular Migration in Zimbabwe and Contemporary Sub-Saharan Africa. James Currey, 2010.

Reviews the current evidence on circular migration and urbanization in sub-Saharan Africa using, as a case example, Zimbabwe, where circular migration in the face of political and economic pressures has had significant, negative impacts on the city of Harare. Useful resource for scholars in migration and migrant health.

Cordell DD, Gregory JW, Piche V. Hoe And Wage: A Social History Of A CircularMigration System In West Africa (African Modernization & Development) . Westview Press, 1998.

An analysis of internal and international labour migration in Burkina Faso, the West African coast, and other parts of Africa, including special attention to female labour migration. Integrates data from a retrospective survey of nearly 100,000 migrant workers with historical and anthropological research.

Deshingkar P and Farrington J (eds.) Circular Migration and Multi Locational Livelihoods: Strategies in Rural India. Oxford University Press, 2009.

A synthesis of various studies on the millions of rural Indian migrant workers who migrate from the poorest areas of the country to work largely in the informal organized sector.

Binford L. Tomorrow We're All Going to the Harvest: Temporary Foreign Worker Programs and Neoliberal Political Economy. University of Texas Press, 2013.

An exploration of the daily lives of temporary migrant workers from Mexico participating in the Canadian Seasonal Agricultural Worker Program (SAWP). Draws from extensive quantitative and interview data todescribe the work conditions, the personal and family sacrifices made bySAWP workers, and the political, economic, cultural, and ethical implications of globalization and temporary migrants.

IRREGULAR MIGRANTS, DETENTION AND DEPORTATIONMobile migrant families will receive an array of often fragile legal status designations, from illegal alien/undocumented migrant, low income migrant worker, and internally displaced person, to refugee claimant, asylum seeker ordenied refugee claimant in the country of destination. The Medecins Sans Frontiers (2013) report on Morocco and Europe sshows how during the journey ofmigration and the legal status of vulnerable migrant families constrains political and economic rights in transit countries and countries of destination. Viruell-Fuentes (2012) cite concerns regarding the over- reliance on cultural explanations and the need for more research on racialization and segregation within the struggle to overcome socioeconomic, language, gender discrimination. Lidén (2013) document detention conditions for asylum-seeking children in Norway, and Icaria and Blume examine undocumented (irregular) migrant stories and photographs from the Northern Triangle of Central America.

Violence, Vulnerability and Migration: Trapped at the Gates of Europe. A report on the situation of sub-Saharan migrants in an irregular situation in Morocco. Medecins Sans Frontieres (2013) Available at http://www.msf.org.uk/reports-0 (accessed June 28, 2013)

This report examines how the European Union (EU) has tightened its border controls and how Morocco has changed from being a transit countryto being both a transit and destination country for irregular migrants. MSF’s experience demonstrates that the longer sub-Saharan migrants stay in Morocco, the more vulnerable they become. Provocative for students to policymakers.

More than culture: structural racism, intersectionality theory, and immigrant health. Viruell-Fuentes EA, Miranda PY, Abdulrahim S. Soc Sci Med. 2012. 75(12):2099-106. doi: 10.1016/j.socscimed.2011.12.037.

Authors analyse the factors associated with health or illness and migration and shift from culture to racialization and discrimination. Ideal for migrant health scholars.

Living conditions in reception centers for unaccompanied minors. Hilde Lidén , Knut Hidle, Ann-Christin Nilsen, Randi Wærdahl (2013) (Norwegian) Available at : http://www.samfunnsforskning.no/Publikasjoner/Rapporter/2013/2013-003 (accessed June 28th, 2013)

Examines unaccompanied asylum seekers between 15 and 18 years of age anddiscusses whether existing regulations are sufficient to ensure adequatethe living conditions. Methods useful for students include reviews, mapping detention centres, intersectoral interviews, and photovoice.

Los migrantes que no importan, Icaria (2010). Isbn 978-84-9888-216-2 (Spanish) EN EL CAMINO México. La ruta de los migrantes que no importan Blume editorial Isbn: 978-84-9801-478-5 (Spanish)

A series of provocative stories (Icaria) and photographs (Blume) based on following undocumented (irregular) migrants along the migrant corridors in the Northern Triangle of Central American.

HEALTH EQUITY AND RIGHT TO HEALTH FOR MIGRANTSAn increasing push toward understanding social determinants of health and the experiences of minority and visible minority populations has in turn led to anincreasing interest in understanding how migrating populations experience health, and the disparities and inequities that can result. The IOM’s 2008 World Migration Report provides important demographic data on migrating populations, the UN’s 2009 Human Development report applies a human development lens to explore the complexity and variability of migration and

its impact on all communities involved, and the 2008 World Health Organization’s report, “Closing the Gap,” calls on programmers and policymakers to improve migrant health equity through social determinants of health. Beach et al 2006 contribute to our understanding of how racial and ethnic minority status impacts health, and Nichter et al 2008 highlight the importance of cultural competence in implementing public health interventions for migrant populations. Thomas et al 2013 examine more recent developments in global migration, human rights, and health.

Beach MC, Gary T, Price E, et al. Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions. BMC Public Health 2006;6:104.

Systematic reviews examining interventions for racial and ethnic minorities. Provides evidence of the negative impact of minority statuson health services and health, and provides some examples where interventions can partially address these disparities.

*Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health[http://www.who.int/social_determinants/thecommission/finalreport/en/index.html]*. Geneva (Switzerland): World Health Organization; 2008.

Report from an international WHO commission that studied the social determinants of health and their impact on health equity. Makes evidence-based recommendations for equity-oriented actions.

The International Organization for Migration. World Migration Report 2010. Geneva: IOM; 2010. Available at http://www.iom.int/jahia/Jahia/policy-research/migration-research/world-migrationreport- 2010. Accessed 25 Jun 2013.

The International Organization for Migration is a world leading organization that produces an annual report on world migration. This report includes data on demographics and movement of populations.

Nichter, Mark. 2008. Global health: Why cultural perceptions, social representations, and biopolitics matter. Tucson: Univ. of Arizona Press.

Examines the intersections between social contexts and cultural understandings of infectious diseases. Demonstrates through case studies, theory, and method the importance of integrating local understandings of health, illness, and medical care in public health interventions. Provides examples and insights useful for community-basedparticipatory research.

*Overcoming barriers: human mobility and development [hdr.undp.org/en/media/HDR_2009_EN_Complete.pdf]*. 2009. New York (NY): Human Development Reports; 2009. (accessed 2013 June 28).

Applies a human development approach to challenge negative stereotypes about migration and migrants and explore the complexity and variability

of migration, both and external, including its impacts on all communities involved: migrants themselves, their origin communities, and their destination communities. Financial, social, cultural, and health considerations are addressed.

Thomas, Felicty and Gideon, Jasmin (Eds). 2013. Migration, Health and Inequality. Zed Books.

This introductory text examines global migration, human rights, and health. Ideal for graduate students, it highlights the importance of considering transnational health networks and indigenous ideas when trying to understand the various factors contributing to disparities in health between migrant and host population health.

POLICY AND HEALTH Several excellent resources address current and future health policy implications of migration. The UN Human Development Program and San Martin etal 2006 describe the difficulties faced by migrants in accessing health services. Incorporating health into all policies is a powerful message from the 8th Global Health Promotion Conference, Helsinki 2013. The World Health Organization (2007, 2010) recommendations relate to migrant health inequities,as do Mladovsky et al 2012 with a European focus. The International Organization for Migration 2009 proposes strategies to improve migrant health-related training of public health workers. Steele et al 2002 describe the negative impacts of policy changes on the health of a Canadian subpopulation of vulnerable migrants.

How health systems can address health inequities linked to migration and ethnicity. Copenhagen, WHO Regional Office for Europe, 2010.

Explores how health systems in the WHO European Region can address health inequities linked to migration and ethnicity. Emphasis is placed on social determinants of health in addressing two main topics: the state of health of migrants and ethnic minorities; and the access these groups have to appropriate, high-quality health services. An agenda forfuture research is proposed.

International Organization for Migration (IOM). Developing a public health workforce to address migrant health needs in Europe. Background document for the EC-funded project Assisting Migrants and Communities. Geneva, IOM, 2009

This paper for presents study findings and training and policy recommendations aimed at improving the competencies and skills of the public health workforce in meeting the health needs diverse migrant populations.

MacPherson DW, Gushulak BD, Macdonald L. Health and foreign policy: influencesof migration and population mobility. Bull World Health Organ 2007;85:200-6.

As globalization increases, so too does the international community’s interest in the health effects of globalizing processes, for example, regarding emerging and re-emerging infectious diseases like malaria, tuberculosis, and HIV/AIDS. This broad overview summarizes migration-related health issues relating to past, current, and future foreign policy initiatives.

Mladovsky P, Ingleby D, McKee M, Rechel B. Good practices in migrant health: the European experience. Clin Med. 2012 Jun;12(3):248-52.

Summarizes a list of good practices based on a review of European healthservices for migrants. Strategies relevant to policymaker include: targeting access, language, social, and cultural barriers; and going further to address the importance of appropriate monitoring to identify inequities.

Overcoming barriers: human mobility and development 2009. New York (NY): HumanDevelopment Reports; 2009. Available at: http://hdr.undp.org/en/media/HDR_2009_EN_Complete.pdf (accessed 2013 Jul 1).

United Nations Development Programme report that focuses on migration. Describes the growing and substantial number of international and internal migrants worldwide and demonstrates that these mobile populations often have difficulty accessing basic health and social services.

San Martin C, Ross N. Experiencing difficulties accessing first-contact healthservices in Canada. Health Care Policy 2006;1:103-19.

Study identifying factors associated with difficulties accessing first-contact healthcare services in Canada, and demonstrating that new immigrants are nearly two and a half times more likely to report difficulties accessing immediate care when compared to the Canadian-bornpopulation.

Steele LS, Lemieux C, Clark J, et al. The impact of policy changes on the health of recent immigrants and refugees in the inner city. Can J Public Health 2002; 93:118-22.

Ontario-based study identifying policy changes that have been perceived to have had a negative impact on the health of recent immigrants and refugees.

PRIMARY HEALTH CARE RESOURCESSeveral practical resources have emerged to support health professionals working with immigrant and refugee populations. The Canadian Collaboration for Immigrant and Refugee Health (CCIRH) has published an open access, web-based global health educational primer. The CCIRH, the U.K. Health ProtectionAgency, the Canadian Pediatric Society and the U.S. Centers for Disease

Control have all published online guidance for primary care practitioners in immigrant and refugee health. Front-line emergency refugee health workers canlook to the Medecins Sans Frontieres publication on refugee health.

*Canadian Collaboration for Immigrant and Refugee Health: Refugees and Global Health e-Learning Program[Available at: http://www.ccirhken.ca/eLearning/]*Accessed 25 Jun 2013.

Primer for students and health professionals interested in migrant health and the related global health competencies. Eight open access modules with companion quizzes.

*Evidence-Based Preventive Care Checklist for New Immigrants and Refugees[Available at: http://www.ccirhken.ca/News-Events.html ]* Accessed 29 Jun 2013

An open access, geographic region-specific collection of evidence-based,preventive care recommendations using an e-checklist format. Practical tool to help practitioners integrate preventive care gguidelines into general practice.

*HPA Migrant health guide[http://www.hpa.org.uk/MigrantHealthGuide/]*. Health Protection Agency, United Kingdom; 2011. Accessed 28 June 2013.

A guide for U.K. practitioners serving migrant populations. Contains practical information on assessing migrant patients and assisting migrants in navigating the UK health care system. Relevant health information, including helpful summaries of key points, is also provided, and covers the topics of infectious diseases, immunizations, and non-infectious health conditions.

Medecins Sans Frontieres. 1997. Rufugee Health an approach to emergency situations. Medecins Sans Frontieres

Practical guide for professionals involved in public health assistance to refugees and internally displaced persons. It provides guidelines on a wide variety of special refugee health issues with special attention to setting medical priorities and attending to sociocultural aspects.

Stauffer W. *Migration Health Resources[http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-9-health-considerations-newly-arrived/migrant-health-resources.htm]*. In: Chapter 9: Health Considerations for Newly Arrived Immigrants & Refugees, CDC Yellow Book. Centers for Disease Control. Accessed 28 June 2013.

A section of the CDC Yellow Book (historically used to address travel health issues for US residents traveling abroad) that lists resources for health care practitioners serving immigrant and refugee populations.In addition to listing various guidelines, textbooks, and reference websites, this section also provides links to educational opportunities and organizations outside the CDC.

Caring for Kids New to Canada. Canadian Pediatric Society (2013) http://www.cps.ca/en/ (available in English and French, accessed 28 June 2013)

This practical web-based resource is useful for health professionals caring for immigrant and refugee children, youth and families. It explores health promotion, culture and health and diseases.

CLINICAL PRACTICE GUIDELINESThese resources provide practical guidance for health practitioners serving migrant populations. Pottie et al 2011 and Stauffer et al 2002 present evidence-based clinical guidelines for new immigrants and refugees to Canada and the U.S., respectively. The Australasian Society for Infectious Diseases provides infectious disease screening guidelines for newly arriving refugees.

Australasian Society for Infectious Diseases. Draft guidelines for diagnosis, management and prevention of infection in recently arrived refugees. Sydney (Australia): The Society; 2007.

A comprehensive series of guidelines for infectious disease screening for refugees arriving in Australia. Focus exclusively on infectious diseases.

Pottie, Kevin, Greenaway, Christina, Welch Vivian et al. 2011. Evidence Based Guidelines for New Immigrants and Refugees. Canadian Medical Association Journal. E824-E8925 DOI:10.1503/cmaj.090313.

Evidence-based clinical recommendations related to 20 selected diseases for for which potential health interventions exist: TB, vaccine preventable diseases, Hepatitis B, Hepatitis C, HIV, intestinal parasites and malaria; depression, PTSD, child maltreatment, intimate partner violence, diabetes, vision disorders, dental disorders, iron deficiency anemia, contraception, pregnancy, cervical cancer. Linked toa practical web-based checklist tool for health practitioners.

Stauffer WM, Karnat D, Walker PF. Screening of international immigrants, refugees, and adoptees. Prim Care 2002;29:879-905.

Practical expert-based recommendations useful to residents and health professionals for screening migrants and adoptees.

PRIORITY AREAS FOR FUTURE WORK ON MIGRANT HEALTHMigration is a historic process but, as Zimmerman (2011) points out, the scaleand scope of migration has increased dramatically with globalization and communications, inexpensive travel, and push and pull factors such international programs that support permanent resettlement and temporary migrant workers. Acevedo-Garcia & Almeida (2012) examine the measures and role of place within modern migration. The International Organization for Migration (2013) suggests international migration could reach 405 million by 2050, and how high- and middle-income governments have begun to cut healthcarefor vulnerable migrants despite international and national commitments to universal healthcare coverage. These migrant restrictions along with local

economic constraints are contributing to anti-migrant sentiments, more deportations, and more fear-based barriers among migrants to seek health care.WHO 2010 highlights the need to consider the right to health for all migrants,and the International Labour Organization 2004 presents health and human rights recommendations targeting skilled migrants and temporary migrant workers. Undocumented and mobile migrants in transit and destination countriesremain among the most vulnerable and there is an urgent need for funding, research, and programs for these women, men, and children.

Special issue introduction: Place, migration and health. Acevedo-Garcia D, Almeida J. Soc Sci Med. 2012 Dec;75(12):2055-9. doi: 10.1016/j.socscimed.2012.09.008. Epub 2012 Sep 16.

Series of articles on place, migration and health that discuss the dynamism of migration, the limitations of income, education and self-rated health in migrant research, and outlines a role for place and policy research. Ideal of for graduate students and academics.

Zimmerman C, Kiss L, Hossain M (2011) Migration and Health: A Framework for 21st Century Policy-Making. PLoS Med 8(5): e1001034. doi:10.1371/journal.pmed.1001034

Overview of human migration and global estimates of populations of various migration categories.

Discusses the push and pull factors of shifting capital, effects of climate change, and periodic political upheaval, including armed conflict. As a result, migrant networks that facilitate mobility and circular migration, in particular, have expanded in unprecedented ways.

International Organization for Migration (2013). Position Paper on Health in Post-2015 Development Framework Health in the post-2015 development agenda. International Organization for Migration, Geneva. Available at http://www.iom.int/files/live/sites/iom/files/What-We-Do/docs/Health-in-the-Post-2015-Development-Agenda.pdf (accessed 28 June 2013)

Analyses recent migration trends and gaps in national and international policy. Suggests the post-2015 development agenda must address migrant health and public health coverage in a systematic and coherent way. Aligns with the WHO (2010) report and recommends priorities: monitoring migrant health, policy and legal frameworks, migrant sensitive health systems and multicounty health systems.

World Health Organization. Health of migrants: The way forward. 2010. Available at: http://www.who.int/entity/hac/events/consultation_report_health_migrants_colour_web.pdf (accessed 28 June 2013)

Summary of the 2010 Global Consultation on Migrant Health convened in response to the 2008 World Health Assembly Resolution on the Health of Migrants. Describes key issues and controversies in migration and

proposes an operational framework for further action on migrant health with a focus on four priority areas: monitoring migrant health, policy and legal frameworks, migrant sensitive health systems, and partnerships, networks and multi-country frameworks.

International Labor Organization. Towards a fair deal for migrant workers in the global economy. Report from the International Labour Conference, 92nd Session, 2004. Available at: http://www.ilo.org/public/english/standards/relm/ilc/ilc92/pdf/rep-vi.pdf. Accessed 25 Jun 2013.

Analyses research and data on global migration, synthesizes lessons learned from the experiences of origin and host countries, and presents recommendations and insights aimed at protecting human rights of migrantworkers, managing flow of migration, maximizing migration’s contributionto growth and development, and preventing illicit flows and trafficking.