The relationships between disease, travel and migration have deep historical roots that continue to influence the entire spectrum of modern medical practice and healthcare. Traditional medical approaches dealing with migrant health have focused on the recognition, identification, and management of specific diseases, illnesses, and health concerns in mobile populations at the time and place of their arrival. These activities have often been based on the principles of protecting the recipient population through policies of exclusion directed at the migrant or arriving traveler. Derived from the historical practices of quarantine, similar processes continue in a modern context through immigration medical screening and border control practices intended to reduce threats to public health or to mitigate potential impacts on healthcare services.
The epidemiological analysis of illnesses and disease in migrants is most commonly approached in one of two ways in receiving countries. The first is to consider the status of the health issue at the time of migration into the receiving country, while the second is to study the evolution of the health characteristic over time. The reference population for the first analytical approach is normally the host or receiving population, while the reference group for the second approach can be either the host population or a comparison cohort at the migrants’ place of origin.
The historical basis of quarantine-associated migration health practices has ensured that much of the interest in health and migration has been directed towards communicable diseases. Commonly, migrant medical screening focuses on conditions differentially prevalent between the migrant and host population, such as tuberculosis, leprosy, or syphilis. Medical screening has been used to quantify and document aspects of health and disease in migrant cohorts, most often in relation to national public health statistics. Over time, these studies have described some of the immediate and long-term impacts of population movement in individual migrant receiving nations.
Recently, the growing international importance of migration has stimulated new interest in other aspects of migrant health. In addition to communicable diseases, attention is now focused on pre-existing, non-infectious diseases and other health domains, including behavior, morality and genetic or ethnic profiles in migrant populations. Epidemiological studies now involve chronic illnesses such as malignancies, renal failure, and severe cardiac disease, as well as mental and psychosocial health and maternal and child health. Lifestyle-associated health issues, including tobacco use, alcohol consumption, and substance abuse, are also being examined in relation to the process of migration in some migrant receiving countries.
As migrant demographics often vary between receiving nations, international comparisons involving the pooled analysis of several host nations would be challenging in interpretation and of questionable utility. However, interest in the global implications of the epidemiological aspects of migration is growing. The increasing desire for improved information is, however, complicated by the greater diversity now manifest in modern migrant populations. In addition to traditional immigrants, current mobile populations are often comprised of several other cohorts that are not similarly distributed between migrant receiving nations. Those other groups include refugees and asylum seekers, temporary migrants such as international students and migrant workers, and complex groups of irregular or illegal migrants, including those who have arrived through smuggling or trafficking.
The current volume and diversity in migration often exceed the scope and intent of the traditional methods used to assess and manage health issues in immigrants. Because of this more diverse demographic and fluid environment, the perspectives derived solely from traditional immigrant medical screening practices are limited and must change. It is for this reason that we must apply the principles of population health to the study of migration and the development of national immigration policy.
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