Professional Documents
Culture Documents
doi: 10.1093/jtm/tay040
Perspective
Perspective
Abstract
More than 244 million international migrants were estimated to live in a foreign country in 2015, leaving apart the mas-
sive number of people that have been relocated in their own country. Furthermore, a substantial proportion of inter-
national migrants from southern countries do not reach western nations but resettle in neighbouring low-income
countries in the same geographical area. Migration is a complex phenomenon, where ‘macro’-, ‘meso’- and ‘micro’-fac-
tors act together to inform the final individual decision to migrate, integrating the simpler previous push–pull theory.
Among the ‘macro-factors’, the political, demographic, socio-economic and environmental situations are major
contributors to migration. These are the main drivers of forced migration, either international or internal, and
largely out of individuals’ control.
Among the ‘meso-factors’, communication technology, land grabbing and diasporic links play an important
role. In particular, social media attract people out of their origin countries by raising awareness of living condi-
tions in the affluent world, albeit often grossly exaggerated, with the diaspora link also acting as an attractor.
However, ‘micro-factors’ such as education, religion, marital status and personal attitude to migration also
have a key role in making the final decision to migrate an individual choice. The stereotype of the illiterate,
poor and rural migrant reaching the borders of affluent countries has to be abandoned. The poorest people
simply do not have the means to escape war and poverty and remain trapped in their country or in the neigh-
bouring one.
Once in the destination country, migrants have to undergo a difficult and often conflictive integration process in
the hosting community. From the health standpoint, newly arrived migrants are mostly healthy (healthy migrant
effect), but they may harbour latent infections that need appropriate screening policies. Cultural barriers may some-
times hamper the relation between the migrant patient and the health care provider. The acquisition of western
lifestyles is leading to an increase of non-communicable chronic diseases that require attention.
Destination countries have to reconsider the positive medium/long-term potential of migration and need to be
prepared to receive migrants for the benefit of the migrants themselves and their native population.
Key words: Migration, drivers, push and pull factors
Foreword
migrants in 2015 1 and the UN Department of Economics
According to the International Organization for Migration
and Social Affairs estimates that the figure is as high as
(IOM), as many as 244 million people were international
257.7 million in 2017. 2 Importantly, out of the 244 million
†
claimed by IOM in 2015, 90.2 million moved from a south-
UNESCO disclaimer: The Author is responsible for the views con- ern country to another southern country, while only 85.3
tained in this article and for opinions expressed therein, which
are not necessarily those of UNESCO and do not commit the million were people migrating from the south to the north,
Organization. the remaining being individuals from the north migrating to
© International Society of Travel Medicine 2018. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com
2 Journal of Travel Medicine
the south (13.6 million) or from the north to the north (55.1 Definition of migrants
million). At present, most international migrants are of
According to the International Organization for Migration
working-age and live in Europe, Asia and North America
(IOM), a migrant is ‘any person who is moving or has moved
(Figure 1). Apart from international migrants, an astonish-
across an international border or within a State away from his/
ing figure of 740 million people is estimated to have
her habitual place of residence, regardless of (1) the person’s
migrated internally within their origin country. 1
legal status; (2) whether the movement is voluntary or involun-
Migration is as old as humankind. People have always
tary; (3) what the causes for the movement are; or (4) what the
moved in search of better living conditions for themselves and
length of the stay is’, a broad definition indeed. Under such def-
for their loved ones or escaping dramatic situations in their
inition, and strictly limiting our analysis to south-to-north
homeland. These two major drivers were the fundamentals of
migrants, two major broad categories may be identified:
the ‘push and pull’ theory that was first proposed by Lee in
1966,3 encompassing economic, environmental, social and polit- (a) Labour (or economic) migrants (and family reunification) and
ical factors pushing out from the individual homeland and (b) Forced migrants (asylum seekers and refugees);
developing countries is rapidly increasing. The African continent but also indirectly changing the economic, political, social and
offers a striking example. From 493 million in 1990, the demographic context with very complex interrelationships.20
African population grew to 1 billion in 2015 and it is expected The ‘climatic migrants’, as they are sometime called, might
to rise to 2.2 billion in 2050 and to 4 billion in 2100!12 possibly reach the astonishing figure of 200 million by the year
With particular regard to the African continent, the increas- 2050, according to the IOM.21 However, forecasts are difficult
ingly young population will probably exceed by far the other- to make because sound scientific data on this topic are
wise improving—but not equitably distributed—economy, extremely scarce and do not permit reliable estimates.22 The
giving origin to the so-called ‘jobless generation’ phenomenon. assessment of the real impact of worsening environmental con-
This means that the increasing global wealth is not mirrored by ditions, albeit logical, would greatly benefit from sound research
a proportional number of jobs to satisfy the increasing expecta- studies.
tions of the growing skilled young generation, at least in the
short-medium term.13
As a matter of fact, the flow of migration in relation to Wars and dictatorship
linguistic barriers leading to potential medical errors. The to receive migrants for the benefit of the migrants themselves
knowledge of culturally sensitive medical issues, such as genital and their native population.
mutilations, is generally poor in western physicians, requiring
specific training and research.39
Conflict of Interest
None declared.
Conclusions
References
In conclusion, the migration flow is now a structural phenom-
1. International Organization for Migration (IOM). World Migration
enon that is likely to continue in the next decades. While many
Report, 2018. http://www.iom.int/wmr/chapter-1
migrants from low-income countries aim to reach more affluent
2. United Nations Department of Economics and Social Affairs (UN-
areas of the world, it is to be appreciated that a similar, or even
DESA), 2017a. http://migrationdataportal.org/?i=stock_abs_&t=
bigger, mass of people migrates to neighbouring low-income 2017 (31 December 2017, date last accessed).
countries in the same geographical area.
18. Levy BS, Patz JA. Climate change, human rights, and social justice. 30. Fargues P. International Migration and Education - A Web of
Ann Glob Health 2015; 81:310–22. Mutual Causation. Paper commissioned for the Global Education
19. International Organization for Migration (IOM). World Migration Monitoring Report 2019 Consultation on Migration. UNESCO,
Report, 2008: managing labour mobility in the evolving global Paris 2018.
economy. Geneva, 2008. 31. Goldin I, Cameron G, Balarajan M. Exceptional People; How
20. Black R, Adger WN, Arnell NW, Dercon S, Geddes A, Thomas D. Migration Shaped Our World and Will Define Our Future.
The effect of environmental change on human migration. Glob Princeton: Princeton University Press, 2011.
Environ Change 2011; 21:S3–S11. 32. Carling J, Collins F. Aspiration, desire and drivers of migration.
21. Laczko F, Aghazarm C. (eds). Migration, Environment and Climate J Ethn Migr Stud 2017. DOI:10.1080/1369183X.2017.1384134.
Change: Assessing the Evidence. Geneva: International Organization 33. Pavli A, Maltezou H. Health problems of newly arrived migrants
for Migration, 2009. and refugees in Europe. J Travel Med 2017; 24(4), doi:10.1093/jtm/
22. Bie Lilleør H, Van den Broeck K. Economic drivers of migration and tax016.
climate change in LDCs. Glob Environ Change 2011; 21:S70–81. 34. Lesens O, Baud O, Henquell C, Lhermet A, Beytout J. Varicella out-
23. Internal Displacement Monitoring Centre. Norwegian Refugee Council. break in Sudanese refugees from Calais. J Travel Med 2016: 23(5).
Global Report on Internal Displacement, 2017. Geneva, 2017. 1–3. doi:10.1093/jtm/taw042.