It is now generally accepted that the human race originated in North East Africa and subsequently spread around the world. Assuming this is true, we are all migrants or the descendants of migrants, with the dubious exceptions of the Berber and Coptic peoples living around the original area. Those first migrants would, of course, have faced considerable risks in what might be termed occupational health hazards and nutritional problems, though their numbers were probably too small to provide a reservoir for most of the infectious diseases that affect modern human communities. There is some slight evidence of cultural differentiation at quite an early stage in human development – particular groups of prey animals being exploited or even different styles of flint knapping. By and large however, it can be assumed that all the migratory hordes of early humans were culturally and racially very similar. The real stimulus for human differentiation would have come with the development of agriculture and pastoralism. To benefit from the work put into growing a crop it would have to be defended from passing hunter‐gatherers, by violence if necessary. The Bible got it right: it was Cain, the farmer, who slew the hunter‐gatherer. Isolated in‐bred agricultural communities would have developed different cultural practices and racial characteristics. They would also, as their numbers increased, be exposed to different diseases and health hazards. It is arguable that we are now reaching the end of the agricultural revolution: the majority of the world's population now lives in towns, and even of those who do not, only a small proportion are employed in agriculture – an English village of 800 people, which a century ago would have been occupied almost entirely by agricultural labourers, might very easily now only have one or two farming families.
Coincidentally with the disappearance of agriculture as the main human occupation, the cultural and racial differences between isolated groups of humans are beginning to fade and disappear. The monstrous development of the media over the past half‐century has had some odd effects: when there was very little in the way of mass communication, local cultures thrived. When there were a few radio and television channels broadcasting a standard fare, local cultures started to wither. Technology has now reached the stage where “narrowcasting” is feasible, making it possible to maintain different cultures. When I went to Stoke‐on‐Trent in 1961, many of the inhabitants got their news from the daily Sentinel not from a national paper. They had grown up without television. It was possible, even for an outsider, to learn to tell which part of the town people came from by picking out micro differences in the local accent. The few immigrants had to pick up the local accent and culture in order to survive. Visiting now, the news all comes from London. Local differences in accent have completely disappeared and the regional accent is less noticeable. On the other hand there are a considerable number of immigrants, who can watch Pakistani television online, can download Kashmiri songs and music, speak and text continuously every day to relatives in Srinagar, about anything from first aid to midwifery, and hardly need to interrelate with the locals at all. By and large however, the net effect of the internet is to move us towards a single world‐wide culture.
More relevantly, technology has made the movement of people much easier. Our Cro‐Magnon ancestors spread themselves around the world on foot. The nineteenth century mass migrations from Europe to America or Australia involved weeks at sea. It is now possible to travel anywhere in the world in a few hours, and large numbers of people can afford to do so. From a public health point of view it is feasible for someone to go and eat bush‐meat in West Africa, get a tattoo in Manila, go on to have unprotected sex in Mexico and then get back to New York in a matter of days.
Mass migrations have always been with us, and the forces driving them have remained the same. Julius Caesar's descriptions of the irruptions of wandering tribes into Gaul, driven by over‐population in their previous homes, aggression from other tribes behind them, poverty, and male unemployment still hold good today. The Roman Empire was a cultural magnet for the Goths just as the US is for South Americans today. The numbers involved are however, far greater today, as the world's population swells to near unbearable limits. This book quotes an estimate of 214 million international migrants as of 2010 – just over 3 per cent of the estimated human population. The real figure is, obviously, unknown and is probably very much higher. These figures exclude internal migrants: a Pathan refugee from Afghanistan to Pakistan counts, but a member perhaps of the same family whose grazing grounds were just this side of the notional border, fleeing from the same conflict, will not. A peasant from rural Sinkiang moving to be a day labourer in Shanghai will face far more cultural, linguistic and health‐related problems than someone moving from Ottawa to Boston, or even from England to New Zealand, but will not be counted here. The proportion of immigrants to native‐born varies widely. Within the European Union the estimate is around 8 per cent. Qatar forms the extreme case with over 86 per cent of the population being immigrants, mostly on short‐term labour contracts! Immigrants tend, obviously, to be poorer than native‐born, and to take on poorly‐paid or more hazardous jobs. They may be traumatised by their past, by their journey, or by their reception – in virtually every country the incidence of mental disorder among immigrants is higher than that among native‐born people. They tend to congregate in poor urban areas rather than be spread evenly across a country, and “environmental factors have a strong influence on the incidence of mental disorders” (Guha, 2012). Their family and social connections are inevitably disrupted, and the balance of the sexes and of age distribution tends to be altered. They tend to be unaware of local legislation and of local health practices, and to have cultural habits based on rural practices that may not fit into an urban setting. There are therefore an enormous number of people in the world with major health problems, which this encyclopedia sets out to redress.
These two massive magnificently‐bound volumes were edited by two American professors – an epidemiologist and a psychiatrist. There are just less than 400 contributors and editorial board members, mostly American academics and clinicians with a sprinkling of others, mainly from the UK, Canada and Western Europe. The first 150 pages are made up of nine longer essays, setting the scene of the global context; a chapter specifically on the American context; and others on culture‐specific diagnosis, methodological issues, and ethical issues. These are followed by the main bulk of the encyclopedia: signed entries ranging from one paragraph to two or three pages in length, arranged in English alphabetical order. There is no index or analytical list of contents, but there are see references and each entry includes lists of related topics. The entries are well‐referenced, mainly to printed sources, and also carry suggestions for further reading, including useful websites. All the websites I sampled appear, at the time of writing, to be effective. The references and web sample dates mostly seem to go up to 2010, which is good going for such a complex book as this. We have had occasion to criticise some recent Springer publications for the odd choice of headings – useful information tucked away under headings that are unlikely to be sought terms. I should mention therefore that the choice of headings here seems sensible. There are a few oddities: a useful half‐page on second‐hand tobacco smoke under the heading Housing partly duplicates the information under the more likely heading Smoking but is not cross‐referenced to it, for example. All the entries which I am capable of checking appear to me to be accurate, and to give sensible advice.
One minor criticism: is it really necessary to repeat the lists of editors, contributors etc. in both volumes, and then to give the contributors' full institutional affiliations etc. again, at nearly an inch of space, for every entry? Someone who contributed half a dozen entries will, in effect, have taken up a page of space with this repeated information. The book could have been made lighter and cheaper.
The main problem in compiling an encyclopedia of immigrant health is obviously the choice of topics to include. Most of the health problems faced by immigrants are also faced by other marginalised groups. Thus, for example, the lengthy entry on Blacks is largely devoted to the serious problems faced by black people in America who are by no means immigrants. Diseases are no respecters of persons: people living in similar conditions are likely to develop similar disorders, whether they are immigrants or not.
My main criticism of this book is its extreme bias towards the developed countries of the world, and, most particularly towards the US. It is worth emphasising that most immigrants not only come from underdeveloped countries but also go to underdeveloped countries. Thus, for example, the two‐and‐a‐half page entry on Pakistan discusses the Pakistani diaspora in the UK and more recently, the US, but does not even mention the Pakistani camps crammed with a million or more Afghans, with their horrendous health problems. There are devoted clinicians working with refugees and migrants in atrocious conditions all around the world. This encyclopedia is unlikely to be of much direct use to them, even if they could afford it.
Affording it is in fact is my chief concern. Compiling and publishing such a work is obviously a very expensive procedure so it is hard to accuse the publisher of profiteering, but over $1,000 dollars for two volumes! I took a hasty unscientific straw poll of medical librarians working in south east London. The unanimous reaction when I described the book was “an important topic”. “There are a lot of migrants in our area, with specific health problems”. “My customers would certainly be interested”. The unanimous reaction when I mentioned the price however, was “We cannot afford to pay so much for one minor printed information source like that”. “Possibly if it was bundled up cheaply with a number of other e‐reference books my committee might wear it”. London is one of the world's more affluent cities, and the librarians I spoke to include those of some major medical institutions. If they cannot afford it, it does not seem likely that the book will achieve major sales, at least in the current austerity‐driven European market.
There is a growing interest in the health, and particularly mental health problems of migrants. The president of the Royal College of Psychiatrists has recently followed up his excellent Textbook of Cultural Psychiatry (Bhugra and Bhui, 2007) with Migration and Mental Health (Bhugra and Gupta, 2011). The well‐established Journal of Immigrant and Minority Health (Kluwer 1999‐) has more recently been joined, among others, by the International Journal of Migration Health and Social Care (Pavilion 2005‐) and there are numerous websites covering specialist areas of work, ranging from dentistry to drug abuse. This encyclopedia can be recommended as a useful back‐up to these for nursing, social service and medical libraries, most particularly in America but also in other developed countries, but only if their budgets run to it.
