Journal of Travel Medicine, 2018, 1–7 doi: 10.1093/jtm/tay040 Perspective Perspective Drivers of migration: why do people move? Francesco Castelli * † University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy and UNESCO Chair ‘Training and Empowering Human Resources for Health Development in Resource-Limited Countries’, University of Brescia, Italy *To whom correspondence should be addressed. Email: francesco.castelli@unibs.it Submitted 17 March 2018; Editorial decision 15 May 2018; Accepted 16 May 2018 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 According to the International Organization for Migration (IOM), as many as 244 million people were international migrants in 2015 1 and the UN Department of Economics and Social Affairs estimates that the figure is as high as 257.7 million in 2017. 2 Importantly, out of the 244 million claimed by IOM in 2015, 90.2 million moved from a south- ern country to another southern country, while only 85.3 million were people migrating from the south to the north, the remaining being individuals from the north migrating to † UNESCO disclaimer: The Author is responsible for the views con- tained in this article and for opinions expressed therein, which are not necessarily those of UNESCO and do not commit the Organization. © International Society of Travel Medicine 2018. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com Downloaded from https://academic.oup.com/jtm/article-abstract/25/1/tay040/5056445 by guest on 14 June 2020