Introduction

MARC B. SCHENKER

This book is intended to address a large and growing global health challenge—the health of migrant people around the world. It was written with the belief that the global health community can decrease the substantial health disparities that exist between migrant and nonmigrant populations by recognizing the unique needs of migrant populations and using the right tools to understand and improve their health. The primary goal of the book is to summarize in one reference the many methods available for health research on migrant populations and to address the unique issues involved in conducting research on health among migrants. Our focus in the book is on health outcomes, although the methods are applicable to other outcomes (e.g., economic, environmental, social). A secondary goal of the book is to increase attention to the health disparities and lack of health services available to migrants. Ultimately, we hope that the methods learned and applied will be used in research and public health programs to improve the health and quality of life of migrants around the world.

Existing books on global and public health generally have very little or no discussion of the association between human migration and health; or if they do consider the topic, their review is often limited to a narrow focus, such as the migration of health care workers. Similarly, books on specific diseases and health outcomes (e.g., tuberculosis, AIDS) generally address migration, if it is considered at all, as a cofactor in disease transmission risk and not as a characteristic defining a population at risk for multiple diseases. We believe that if we are to conduct valid research and develop effective intervention programs, migrants need to be viewed as a vulnerable population at risk for multiple diseases and a population needing unique approaches. This would make migrants similar to other vulnerable populations such as certain ethnic groups, women, children, and the elderly.

THE MAGNITUDE OF GLOBAL MIGRATION

The largest numbers of international migrants move from developing to developed countries, but a surprisingly large number (over 40%) migrate from one developing to another developing country. Geographically, migration from developing to developed countries is often realized as south-to-north migration and migration from one developing country to another is seen in south-to-south migration. Women represent almost half of global migrants. This is a marked change from a few years ago, when they were a distinct minority of global migrants.

The number of internal migrants (those who move from one region within a country to another region within the same country) dwarfs the global total of transnational migrants. The United Nations estimated that in 2010 there were 740 million internal migrants in the world (UNDP 2009); this number includes mostly internally displaced people and rural-to-urban migration. The number of internal migrants in China alone is nearly as large as the total number of international migrants in the world, and this trend of rural-to-urban internal migration shows no signs of slowing. Since many of the health and health care delivery issues affecting internal migrants are similar to those facing international migrants, and since there are similar considerations in studying these populations, they are considered together in this book.

Addressing migrant health, therefore, is not an academic exercise affecting a small number of people in the US and around the world. The percentage of the total US population that are immigrants is now approaching 13%, with eight states having over 15% of their population born outside of the country (US Department of Commerce 2010). California leads the nation in this regard, with 27.2% of its population foreign-born. The percentage of international migrants is expected to continue to increase as a greater percentage of population growth is made up of immigrants. Already some states are showing a 100–200% increase in their immigrant populations. In addition, there is a shift of immigrant populations from the traditional high immigrant states (California, New York, Texas, Florida, Illinois, and New Jersey) to other parts of the country. Around the world the percentages of immigrants in some countries and regions far eclipse the percentages seen in the US. In the Middle East, for example, the percentage of foreign-born people ranges from 27.8% in Saudi Arabia to 40.4% in Israel to a high of 86.5% in Qatar (Koser et al. 2010).

INTENDED AUDIENCES

We envision this book achieving these broad goals by reaching several different audiences. First, it is intended for academic researchers at universities around the world, who may be in public health or medical schools or in other disciplines. In the health sciences such researchers would most commonly be located in epidemiology or community health departments, but multiple other health-related departments could have a focus on migration and health research. For example, health policy and management and environmental science researchers may consider migrants as one focus of their research. Beyond the health sciences, there are diverse nonmedical departments and research institutions for which migration and health is a subject of research....