Migration, Health and Ethnicity in the Modern World ed. by Catherine Cox and Hilary Marland (review)

That migration has always involved politics, economics, and culture, as well as health status, means that Migration, Health and Ethnicity in the Modern World ranges widely in its review of the topic. Using case studies of particular Anglophone countries and Israel, and confined historically to, roughly, the past 200 years, the book touches on the ways in which official attitudes to health and health behavior, race, ethnicity, eugenics, and the financial and political bases of public health services have long affected immigration policies.

The book begins with a perceptive introduction by the editors that offers a substantive overview of what is to follow, and a scholarly discussion of its implications. Like the majority of the case studies, the introduction avoids facile allegations of racial stereotyping and cultural myopia as the major determinate of the regulation of immigration. Instead, the editors offer a clear-eyed recognition of the realities that host countries have faced in accepting newcomers—endemic health problems in the originating countries, a variety of cultural attitudes toward health behavior and health care that may pose real problems for migrants and the accepting populations, and the significant costs associated with the medical and social needs of immigrants that must be balanced against their economic and cultural contributions. The introduction forecasts the conclusion that policies concerning health and immigration were more often grounded in local conditions and facts than irrational preconceptions about race and ethnicity.

In the case-study chapters, mental disorders receive special attention since they involve incapacitating symptoms, threats to the good order of communities, economic dependency, and the considerable expense of treatment in public facilities. Because of the need for confinement, they also raise legal and political questions concerning civil rights. One chapter focuses on the formal immigration restriction of mentally ill and mentally retarded individuals in Canada and the United States. Diagnostic dilemmas had to be faced by governmental policymakers, and by officers on the front line making judgments about would-be immigrants. Distinguishing “lunatics and idiots” from nondisabling eccentricity and behavior—including variations in mood and language ability—posed serious problems, leading to wide swings in admission policies and procedures in both countries.

Another case study describes nineteenth-century Liverpool’s response to the torrent of Irish immigrants fleeing the potato famine who had to be screened and accommodated or rejected. Particularly hard-hit were the facilities for treatment of mental illness. Although physicians recognized that many of these Irish immigrants needed treatment because of the catastrophic disruption of their previous lives in Ireland, some people were still inclined to attribute their mental conditions to Irish folkways and vulnerabilities.

Other cases discuss various dilemmas in the vaccination of immigrants, including the role of vaccinated children as semi-official transporters of variola vaccine to be offered to residents of host countries. Later chapters cover the confusion engendered by the prevalence of tuberculosis in Irish nurses who immigrated to England from 1930 to 1960, and the complicated problems faced by Israel in its role as a refuge for Jews from widely differing racial and cultural backgrounds. In the British Caribbean, the task of dealing with mentally ill laborers imported to replace recently freed slaves was complicated by the paucity of treatment facilities and by the inexperience of the medical workers recruited from England. Because migrants often start out with limited opportunities and live in poverty and unhealthy environments, the characteristics and dynamics of the underclass are given thorough consideration in the final chapter.

Migration, Health and Ethnicity in the Modern World is a valuable resource for scholars with a particular interest in the case-study areas, and, more generally, for anyone interested in the complex history of immigration policies and practices as related to health.