Migration and health: a review of the international literature

Abstract

BP was apparent in the males.Irrespective of where they were born, men living in Southern England showed lower mean BP than those living in Scotland.Studies in the US are often based on known differences in mortality/morbidity between Southern and Northern States.Striking differences in cancer mortality were found between southern-born blacks who moved to New Jersey (NJ) and those born in NJ (Greenberg and Schneider, 1995).Southern-born black male and female migrants had an all-cancer mortality rate 31% and 10% higher, respectively, than their NJ counterparts.The Southern-born showed significantly higher rates for cancer of the cervix, oesophagus, male lung, prostate and stomach than the NJ-born.In contrast, low rates were evident among foreign-born blacks in NJ.Similarly, a study of Ohio residents by place of birth identified an increased cancer risk among black migrants born in the South compared with Ohio-born Blacks.The author maintains that genetics and poverty and malnutrition endemic in the early years of life, provided Southern-born individuals with the basis for increased susceptibility to ill health (Mancuso, 1977).Various studies have investigated movements between rural or traditional areas and urban areas within a country.These rural-to-urban migration studies often focus upon the potential negative effect, physically and/or emotionally, not only of the stress of movement and adaptation to a new and very different lifestyle, but of movement to an area with more health damaging exposures.The area may be less healthy in terms of factors relating to the physical environment, socio-cultural environment, and health behaviours.Verheij et al. (1988) suggests that urban populations in the Netherlands reported more health problems, suffered more frequently from chronic conditions, and more often considered their health status to be "less than good".Although change is common to all kinds of internal migration, it is particularly pronounced in rural to urban movement.Luo tribe members moving from rural land in Western Kenya to urban Nairobi, displayed an increase in mean systolic Blood Pressure (BP) after migration, and exhibited a greater prevalence of hypertension, than tribe members who did not migrate (Poulter et al., 1990).Similarly, migrants moving from South Western rural China to the urban area of Xichang City showed an increase in serum total cholesterol lipid levels which could lead to elevated coronary heart disease risk (He et al., 1996).This increase may result from a diet higher in saturated fats and lower in fibre, combined with alcohol consumption, cigarette smoking and physical inactivity.Torun et al. found that high proportions of young Guatemalan women in rural and urban areas are overweight and sedentary, and that migration to a city further augments sedentarism and undesirable eating habits among both men and women.Moreover, rural-to-urban migrants in developing countries experience higher child mortality after settling in cities, than do lifelong urban residents.This may be due to concentration of migrants in low-quality housing, and specific fertility patterns (Brockerhoff et al., 1995).'Selective migration' is an important factor which may influence mortality or morbidity rates.It entails the movement of a 'select group' of healthy or unhealthy migrants.The group possess special characteristics and may differ sharply from their non-migrant counterparts back home.The movement of healthier individuals is known as the "healthy migrant" phenomenon, and can be seen amongst elderly US blacks who migrated from the South (Kington et al., 1998).Overall, blacks reported worse function and health than whites, and whites born outside of the south had the best function and health of all the groups.There was no difference in function between southern-born whites who migrated and those who stayed in the south.On the other hand, blacks who were born in the South and remained there tended to report the worst function among blacks, while those who migrated tended to report better function and health.This could be explained by the "healthy migrant" phenomenon and the selective survival of relatively "healthier and hardier" black migrants.It may be thus selective migration and selective survival which accounts for the complex patterns of racial differences in geographic distributions of function and health.On the other hand, sick individuals may be involved in 'return migration', for example, to be nearer to family or care-giving institutions.Brimblecombe et al. (2000) found that short distance migrants tended to show higher mortality than long distant migrants.They suggested that this resulted from short distant migrants being a select group moving because of illness so they could be nearer to family or an institution.Similarly, selective migration could explain 5. References

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