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Radford, J., & Connor, P. (2019). Canada now leads the world in refugee resettlement, surpassing the US

Evaluation

Authority: Jynnah Radford is a former research assistant, while Phillip Connor is also a former senior researcher. Therefore, the two authors of the online article are well experienced in research and article delivery skills.

Reliability: The article uses data from the United Nations High Commissioner for refugees.

Currency: The article is recent and uses data that dates back from 2004 to 2018 to develop a sense of the trend in the last two decades.

Objectivity: The article explores the trends of immigration in the USA and Canada, highlighting the changes that have seen Canada rise to take more immigrants in the recent past than the USA.

Academic Conventions: The article is not academic.

Usage Implications: The article explores the current trend of immigration n Canada and the factors leading to the rise in Immigration in Canada.

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Canada resettled more refugees than the United States in 2018, the first time the U.S. did not lead the world on this measure since the adoption of the Refugee Act in 1980, according to a Pew Research Center analysis of new data from the United Nations High Commissioner for Refugees (UNHCR).

Canada resettled 28,000 refugees last year, similar to its total in 2017. Meanwhile, the U.S. resettled 23,000, down from 33,000 the previous year - and a recent high of 97,000 in 2016. Several other leading countries for refugee resettlement, including Australia and the United Kingdom, also saw declines last year.

Globally, 92,000 refugees were resettled in 2018, down from 103,000 in 2017 and a peak of 189,000 in 2016. The decrease occurred despite an increase in the world's total refugee population in 2018, when it reached a record 20.4 million, according to UNHCR.

The sharp drop in U.S. refugee resettlement is in part due to the Trump administration's decision to set a considerably lower cap on the number of refugees allowed into the U.S. than in previous years. In the U.S., the number of refugees admitted for resettlement is set by the president.

Until 2017, the U.S. resettled more refugees each year than the rest of the world's countries combined. Since 1980, the U.S. has resettled millions more refugees than other countries - a total of about 3 million. The next two countries, Canada (658,000) and Australia (486,000), have resettled fewer than a million each over the same period.

Refugee resettlement numbers per capita also differ across countries. The U.S. resettled about 70 refugees for every million of its own residents in 2018, lower than the rate in many other nations. Canada led the world on this measure by resettling 756 refugees per million residents. Australia (510), Sweden (493) and Norway (465) also had much higher resettlement figures per million than the U.S.

Resettled refugees do not enter their destination country until they have legal permission to do so, because they apply for refugee status while in another country. Refugees are referred by UNHCR and other nongovernmental organizations. The refugee approval process for the U.S. can take several months or years while security checks on prospective refugees are completed. Resettled refugees differ from those seeking asylum; asylum seekers are people who migrate and cross a border without first having received legal permission to enter their destination country.

In 2018, nearly half (47%) of the world's resettled refugees were from Middle Eastern countries, while almost one-third (32%) were from Africa. People from Middle Eastern countries - mostly Syria and Iraq - accounted for 49% of resettled refugees in Australia, 55% in Canada and 85% in the UK. By contrast, fewer than 1% of refugees resettled in the U.S. in 2018 were from the Middle East, in part due to shifting regional caps. Most resettled refugees in the U.S. were from countries in Africa (51%) or Asia (27%).
Correction: This post has been updated to include the correct share of global resettled refugees from Middle Eastern countries in 2018. Note: See details on our regional grouping of countries here.

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Canada now leads the world in refugee resettlement, surpassing the U.S.

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Canada resettled more refugees than the United States in 2018, the first time the U.S. did not lead the world on this measure since the adoption of the Refugee Act in 1980, according to a Pew Research Center analysis of new data from the United Nations High Commissioner for Refugees (UNHCR).

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BBC. (2019). Canada resettled more refugees than any other country in 2018.

Evaluation

Authority: The article was published by BBC News, a well-known news website. The articles posted by BBC News are usually probed and edited by in-house editors who are certainly experienced.

Reliability: The article uses data records from the UN's refugee agency. Therefore, the data used to make the ascertains made in the article is reliable.

Currency: The article was published in 2019 and used data that dates back from 2018 and 2017. However, data gives a clear impression of Canada's longer interests and intentions regarding handling immigrants.

Objectivity: The article presents data intending to give a comparison of the trend of immigrants into Canada. Based on the data comparisons, the article has deduced that Canada resettled the largest number of refugees in 2018.

Academic Conventions: The article is not academic.

Usage Implications: The article presents a clear trend in recent immigrants to Canada. The trend can help to understand the perception of the Canadian government towards immigrants in the foreseeable future.

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Canada resettled the largest number of refugees out of 25 countries in 2018, according to the UN's refugee agency.

The country accepted just over 28,000 refugees last year, with the United States coming in second with 22,900.

Some 92,400 refugees were resettled globally in 2018, fewer than 7% of those awaiting resettlement worldwide.

This figures were contained in a newly released UN Refugee Agency report looking into the global refugee trends last year.

According to the US-based Pew Research Center, which looked the the UNHCR data, 2018 was the first time the US did not lead the world in refugee resettlement since 1980.

Pew noted that until 2017, the US resettled more refugees on an annual basis than the rest of the world's countries combined.

"The sharp drop in US refugee resettlement is in part due to the Trump administration's decision to set a considerably lower cap on the number of refugees allowed into the US than in previous years," said the research organisation.

The number of refugees Canada resettled last year was in line with 2017 figures, while the US numbers dropped. In 2017, the US accepted some 33,000 refugees.

Australia, the UK, and France also resettled high numbers out of the 25 countries that resettled refugees in 2018, according to UN figures.

The number of people fleeing war, persecution and conflict exceeded 70 million globally last year - the highest number in the UN refugee agency's almost 70 years of operations.

More than two thirds of all refugees worldwide came from Syria, Afghanistan, South Sudan, Myanmar and Somalia.

The UN report identifies three main groups in that global count, which include refugees, or people forced to leave their country because of conflict, war or persecution. In 2018, the number of refugees reached 25.9 million worldwide.

The second group is designated as internally displaced persons (IDPs). These people are displaced within their country and amount to 41.3 million globally.

Another group is 3.5 million asylum seekers. These are people outside their country of birth who are under international protection, but are yet to be granted refugee status.

The US is the world's major recipient of new asylum applications, registering 254,300 applications in 2018.

Canada was ninth on the list of new asylum claims with 55,400 registered in 2018, behind the US, Peru, Germany, France, Turkey, Brazil, Greece and Spain.

An influx of asylum seekers crossing at the US-Canada border has become a political issue after approximately 40,000 people "irregularly" crossed into Canada between 2017 and 2018.

Canada currently is struggling with a backlog of almost 74,000 asylum claims with applicants waiting almost two years for a hearing.

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Canada resettled more refugees than any other country in 2018

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Canada resettled the largest number of refugees out of 25 countries in 2018, according to the UN's refugee agency. The country accepted just over 28,000 refugees last year, with the United States coming in second with 22,900. Some 92,400 refugees were resettled globally in 2018, fewer than 7% of those awaiting resettlement worldwide.

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Anderson, S. (2020). Immigrants Flock To Canada, While US Declines.

Evaluation

Authority: The article was posted by Forbes, a well-known online news website. Stuart Anderson is a well-known editor in the issues to do with globalization, technology, and immigration.

Reliability: The article is based on inferences from data records regarding immigration.

Currency: The article was published late last year, making it an accurate source of up to date immigration information.

Objectivity: The article focuses on the current data record and synthesizes Canada's migration data and its neighboring US. The comparison offers a clear insight into the position of Canada towards immigrants.

Academic Conventions: the article is not academic, and therefore, not peer review.

Usage Implications: this news article is a definitive source of information regarding Canada's position towards immigrants. The political insight is important, for it compares the country to the neighboring US to offer even more insight into the country's perspective stand towards immigrants.

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This article is concerned with the economic effects of immigration. The emphasis is on Britain, but extensive material is also provided on other countries. Since 1997 a new British immigration policy has displaced previous policy aims, which were focused on minimizing settlement. Large-scale immigration is now seen as essential for Britain's economic well-being, and measures have been introduced to increase inflows. The benefits claimed include fiscal advantages, increased prosperity, a ready supply of labor, and improvements to the age structure. Fears that large-scale immigration might damage the interests of unskilled workers are discounted. This article examines these claims. It concludes that the economic consequences of large-scale immigration are mostly minor, negative, or transient, that the interests of more vulnerable sections of the domestic population may well be damaged, and that any economic benefits are unlikely to bear comparison with immigration's probable substantial and permanent demographic and environmental impact. Our claims are in line with those from other developed countries. Copyright 2004 The Population Council, Inc..

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(PDF) The Economic Effect of Immigration to the United Kingdom

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This article is concerned with the economic effects of immigration. The emphasis is on Britain, but extensive material is also provided on other countries. Since 1997 a new British immigration policy has displaced previous policy aims, which were focused on minimizing settlement.

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The end of an era in British migration statistics | UK in a changing Europe

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The latest migration statistics are the UK's last official estimates to be based on the International Passenger Survey (IPS), which has been the bedrock of our migration statistics since 1964. As such, these latest figures represent the end of an era in the statistical effort to chart migration to our shores.

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Net migration to the UK was estimated to be 270,000 in 2019, down from a peak of 331,000 in the year ending March 2015

The headline net migration statistic includes people of all citizenships, including British citizens. As shown in Figure 1, net migration rose from -13,000 in 1992 to 163,000 in 1999. In the mid-2000s, there was a significant increase in net migration that coincided with the 2004 enlargement of the EU.

Net migration fell between 2010 and 2012, from 256,000 to 161,000. This period coincided with several policy measures designed to restrict study, work and family migration, as part of the Conservative Party's goal to reduce net migration to the "tens of thousands". The lowest estimate of net migration during this period was 161,000 in the year ending December 2012.

Net migration started to increase again from 2013 onwards. This increase took place at a time when the UK economy was starting to recover from the economic crisis while some of the key origin countries of migrants to the UK (particularly in southern Europe) were still experiencing high unemployment.

The highest level of net migration on record is 331,000, reached in the year ending March 2015. The provisional estimate of net migration in 2019 was 270,000.

Figure 1

ONS also produces estimates of long-term international migration at the local-authority level, which can be found in the Migration Observatory's Local Data Guide.
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Net migration of EU citizens rose substantially from 2012 onwards, then fell sharply after the June 2016 EU referendum

Figure 2 shows net migration for EU and non-EU citizens, as well as total net migration, which includes British citizens.

Before 2004, net migration of EU citizens fluctuated but remained below 35,000 each year. It saw a sharp increase from 2004 to 2007, after EU enlargement, although the figures for this period are underestimates due to a problem with the measurement of net migration at this time (see 'Understanding the Evidence' above). EU net migration was estimated at 127,000 in 2007, then fell around the time of the financial crisis, from 2008 to 2012. A second increase in EU net migration took place from 2013 onwards, peaking at 219,000 in the year ending March 2015. EU net migration then fell sharply following the EU referendum.

The decline in EU net migration from the year ending June 2016 to the year ending December 2019 was spread across all of the three main EU origin groups - EU-15, EU-8 and EU-2. During this period, the net migration of EU-15 citizens fell from 84,000 to 44,000, from 42,000 to -12,000 for EU-8 citizens, and from 62,000 to 18,000 for EU-2 citizens. These estimates are subject to significant margins of error and this means that the negative net migration estimate for EU-8 citizens was not statistically different from zero.

Figure 2

Adding together the net migration of EU and non-EU citizens does not lead to total net migration, because total net migration includes British citizens. British citizens are the only group with continuous net emigration since 1991 (i.e., negative net migration). Peaks in British net emigration occurred in 2004 (104,000) and 2006 (124,000). In 2019, provisional estimates suggest that there were 60,000 more British citizens moving abroad than coming to live in the UK.

For more information on EU migration in the UK, see the Migration Observatory briefing, EU Migration to and From the UK.
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Estimated non-EU net migration averaged around 175,000 per year from 2012 to 2019, but the accuracy of this estimate is uncertain and it is possible that the true figure is lower

In 2019, estimated net migration of non-EU citizens was 282,000. This figure has fluctuated over time (Figure 2, above), averaging around 175,000 per year over the eight-year period from 2012 to 2019.

Although this suggests that the net migration of non-EU citizens in 2019 was over five times the net migration of EU citizens - despite policies introduced from 2010 onwards to restrict non-EU migration - there is reason to be cautious about making this comparison.

In August 2019, ONS started to adjust its official estimates of both EU and non-EU net migration to address a problem identified in the IPS figures, namely that it was overestimating non-EU net migration and underestimating EU net migration. Comparisons with other data sources had suggested that the population of non-EU migrants in the UK had not grown as much as one would expect given the levels of net migration that ONS was estimating, and that the overestimate was primarily due to difficulties measuring the emigration of non-EU students (Office for National Statistics, 2018; Office for National Statistics, 2019b).

However, there is still an unexplained gap between data sources, even after the 2019 revisions. According to the Annual Population Survey (APS), the non-EU born population of the UK increased by an estimated 696,000 from 2012 to 2019 - an average of only 99,000 per year (Office for National Statistics, 2020b). This data source also has limitations so it is not currently possible to say which data source paints the more accurate picture of change in the non-EU migrant population. ONS continues to adjust its methodology for producing the net migration estimates, so it is possible that further revisions will take place.
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Study and work are the most common reasons for immigration to the UK, but their contribution to net migration cannot currently be accurately calculated

As people often migrate for a variety of reasons, it can be difficult to categorise migrants based on their reasons for moving to the UK (for a discussion of mixed migration motivations see our primer Mixed Migration: Policy Challenges). For example, someone might move to the UK to join their spouse, work, study, or work part-time and study. It is therefore important to keep in mind that while ONS records the categories discussed below as mutually exclusive, this will not always be the case in practice.

In 2019, an estimated 219,000 people or 32% of long-term migrants moved to the UK for work-related reasons (including British citizens) (Figure 3). These people either had a definite job - 25% of all immigrants - or came to look for a job - 8% of all long-term arrivals. The sharp decline in work-related migration from 2016 to 2018 was a result of a fall in EU migration after the 2016 referendum. For more information on work-related migration, see the Migration Observatory briefing, Work Visas and Migrant Workers in the UK.

In 2019, 35% of long-term migrants said they were coming to the UK for study. Study migration is driven by non-EU citizens, while work migrants are more likely to be EU citizens. For more information about EU and non-EU students, see the Migration Observatory briefing, International Student Migration to the UK.

The number of people who came to accompany or join a family member in 2019 was substantially lower, at an estimated 68,000 people, or 10% of total long-term immigration. For more information about family migration, see the Migration Observatory briefing, Family Migration to the UK.

Figure 3

Since 2012, ONS has collected data on emigration from the UK by initial reason for migration. In theory, this should make it possible to understand which categories of migration - work, family, study, or other - have contributed most to net migration.

However, as noted above, estimates of the number of non-EU students who subsequently emigrate are now recognised to be inaccurate (Office for National Statistics, 2018). It is not yet clear to what extent this means that other categories of net migration (e.g. people arriving for work or family) are also inaccurate.

These problems with the data make it important to not draw strong policy conclusions from the net migration figures for specific routes.

Evidence Gaps and Limitations

Due to the suspension of the IPS because of Covid-19, ONS has brought forward its plan to produce new migration statistics based on administrative data. The new statistics will be published for the first time in November's Migration Statistics Quarterly Report and be based on such data as visa records, exit checks, HRMC tax records, and data from the NHs and DWP. This will be a complex exercise, because different sources of data are collected in different ways and often measure different things. As a result, the IPS, on which the net migration figures in this briefing are based, could play a smaller role in future estimates of UK migration - or no role at all.

In the meantime, it is not advisable to use the IPS-based net migration figures for detailed scrutiny of different categories of migration and their contribution to net migration overall. Using these data to draw policy conclusions about how to treat different types of migration would be misguided.

It is also important to note that the IPS estimates of immigration and emigration are not designed to account for short-term migration. This is one reason why immigration figures from the IPS are, for some nationalities, smaller than the number of National Insurance Number registrations.

The International Passenger Survey asks individuals about their intended length of stay in the UK and abroad. People are classified as 'long-term migrants' if they state that they intend to move for 12 months or longer. However, migrants' plans for the future, such as the intention to stay in the UK for a year or more, may or may not be realised. To address this, ONS adjusts the data for 'visitor switchers' - those whose original intention was to stay for less than one year but who subsequently stay longer - and for 'migrant switchers' - those who intended to stay for a year or more but left within a year. However, making these adjustments is methodologically challenging, and with currently available data sources it is not possible to be certain about how much switching is actually taking place and what the implications are of this for the overall net migration figures (Office for National Statistics, 2018a).
Thanks to Ann Singleton for helpful comments and suggestions on an earlier draft, and to Peter William Walsh for help updating the briefing in 2020. This briefing draws on analysis supported by the University of Oxford's John Fell Fund.
References

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Net migration to the UK - Migration Observatory

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The headline net migration statistic includes people of all citizenships, including British citizens. As shown in Figure 1, net migration rose from -13,000 in 1992 to 163,000 in 1999. In the mid-2000s, there was a significant increase in net migration that coincided with the 2004 enlargement of the EU.

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We have already observed that Canada was a net exporter of people from 1867-1896. Newcomers arrived, but they were very often just passing through. The end to free land in the American West in the 1890s was one factor in redirecting the tide of emigrants from Europe toward the north. Another, from 1896, were the new approaches taken by the Laurier administration under the leadership of Clifford Sifton (see Sections 4.4 and 5.4).

This is not to say that the immigration that was recorded from 1867-1896 did not matter. Hundreds of thousands were added to the mix and the composition of Canadian settler society changed significantly. British immigrants were the most numerous, but people who described themselves as German in origin increased by a third from 203,000 in 1871 to 310,000 in 1901. Three immigrant groups stand out in particular through to 1901: Chinese numbers reached 17,312 (increasing from 4,400 in 1881 to 17,000 in 1901); Russians at 19,825; and Scandinavians (Norwegians, Swedes, Icelanders, and Finns grouped together) at about 31,000. None of these groups had much of a presence in Canada prior to Confederation (although there were Chinese in British Columbia in significant numbers before 1871).

Tables 5.1 and 5.2, respectively, show the growth in population generally and the numbers of immigrants arriving yearly between 1867-1920. What may be seen immediately is: 1) the slowness of immigration's growth before the 1890s (notwithstanding a couple of spurts); 2) the fact that it was actually in retreat through most of the 1880s and into the 1890s; and 3) the great take-off of immigration as Canada moves into the 20th century. The peak on the eve of the Great War is also unmistakable, in that it is followed by a near-collapse as the conflict rages. In the years 1911, 1912, and 1913 between 300,000 and 400,000 immigrants arrived each year, most of them from Britain and continental Europe.

The complexion of the population in aggregate changed dramatically. On the eve of Confederation, fewer than one-in-five Canadians were born somewhere else, principally in the British Isles or the United States. That share started to decline almost immediately until 1911 when it pushed back through the 22% mark; as a result, a very different country was created. In 1871 there was a significant German community in Canada but otherwise French and English were the norms. By 1911, a quarter of the immigrant tide was coming from continental Europe and most of that from central, eastern, and southern Europe. By 1921, the main "ethnic" immigrant groups constituted more than one-in-eight of the population. The majority (just over half) of the foreign-born to 1931 came from Britain and Ireland; another 20% or more were born in the United States. Regardless of point of origin, as of 1921 the immigrant population in Canada was proportionally larger than in the United States.

We know as well that immigrants in the pre-Great War period were overwhelmingly male. Men are over-represented in every age category from 10 to 14 years and up (after 65 years, the ratio of men to women nearly balanced out). This suggests that either boys were demonstrating a particular determination to emigrate from Europe and Asia or that they were preferred to daughters when it came time to move (principally because their prospective job prospects were better). In other words, families with more sons than daughters might be more inclined to emigrate than those with more daughters. As to young adults, these sex ratio imbalances had serious ramifications. In the 20 to 34 age cohorts, there were more than twice as many men as women in 1911. Women and daughters might be sent for later, but this pattern of maleness persists throughout much of the 20th century. The sex ratio among the foreign-born reaches a peak of 1.68 men to every woman in 1911 and among certain immigrant groups it could be much higher. Among the Chinese it hovered around 200:1 for decades, and among the Scandinavians in 1931 it was 268:1. These last examples are very definitely outliers, but the implications of a distorted sex ratio for marital fertility ought to be obvious.

What is more, we know that the immigrant population was young but adult. The foreign-born on the eve of the Great War were mostly under 40 years of age and 20-somethings was the largest cohort. Despite photogenic images of immigrant families, surprisingly few foreign-born children appear in these statistics. Having said that, the arrival of immigrants brought higher fertility rates, so much so that they slowed and, in places, reversed a significant downward trend in Canadian fertility rates. The estimated annual average number of births per 1,000 population in Canada in 1851-61 was 45; in 1901-11 it fell to 31 and slid to 29 between 1911-1921. Without the high fertility of immigrant communities these numbers would have been more depressed.

Distribution of immigrants provides a different sense of this change. The Maritime provinces and Quebec experienced little demographic change arising from immigration. Lebanese Christians were an important addition to Prince Edward Island, but there were few other ethnic enclaves in the region by the Great War. The share of population that was foreign born in the Maritimes was only 5.2% in 1901, rising to a little more than 6% in 1911 - a level that held nearly steady for 30 years. Quebec was similarly mostly native-born in 1901 - a comparable 5.4% of the population was foreign - but from there the share increased more markedly to 7.3% in 1911 and more than 8% in the Interwar years. West of the Ottawa River, however, 15% of Ontarians were foreign-born in 1901 and that passed the 20% mark before the Great War and continued to rise to nearly 25% in 1931. The Prairie provinces taken as a region began the century with a quarter of the population born abroad, rising to 49% in 1911. The share dropped to 21% in 1921 but that reflected the impact of immigrant fertility - the newcomers were adding significant native-born children to the population and thus shrinking their own share of the total. Still, the renewal of immigration in the 1920s created a second surge and by 1931 nearly 37% of Prairie Canadians were born elsewhere. British Columbia behaved differently from the rest of Canada in this respect, being the least native-born population of the lot. Foreigners constituted 44% of the population in 1901, rising to 57% in 1911 and only tapering slightly to 50% in 1921. From 1901 to 1961, British Columbia's population was, proportionately, the most foreign-born of all regions. Of all the regions, only the North-West Territories reversed the trend. Starting at 37% in 1901, the share of Northerners born abroad fell to 20% 10 years later and then 15% in 1921, where it stayed for the next two decades.

Studies of immigrants in Canada tend to focus on their experiences as newcomers adjusting to new circumstances, or as outsiders to which the established population reacts, or as ethnic enclaves whose cultural resilience and change is subject to examination. As a demographic phenomenon, however, their profound impact is often too quickly forgotten. Within little more than a generation, post-Confederation immigrants had fundamentally transformed the population's main features while changing in significant ways its fertility, family size, and nuptial patterns. In each of these regards, they had a lasting impact.

Key Points

Immigrants in the post-Confederation period rapidly changed the ethnic and age composition of the population, as well as the gender ratio in many regions.

Immigration was slow to take off but it did so between 1896-1914, and again in the 1920s, making Canada more foreign-born than the United States.

The distribution of immigrants was wildly uneven, barely impacting the Maritimes and Quebec.

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We have already observed that Canada was a net exporter of people from 1867-1896. Newcomers arrived, but they were very often just passing through. The end to free land in the American West in the 1890s was one factor in redirecting the tide of emigrants from Europe toward the north.

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From 1783 until 1812 the most important source of immigrants to British North America was the United States. Movement across the border was easy and the host community was, outside of Lower Canada, overwhelmingly and increasingly North American in its accents and values. That ended with the War of 1812.

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Thompson, J. H., & Weinfeld, M. (1995). Entry and exit: Canadian immigration policy in context. The Annals of the American Academy of Political and Social Science, 538(1), 185-198.

Evaluation

Authority: Thompson was a Duke historian who had authority over Canadian history. Weinfeld is a professor and chair in Canadian Ethnic studies. Therefore, the two authors are experts in their respective fields.

Reliability: The authors explore the Canadian immigration policy based on the trends of immigration in the country.

Currency: the paper was published in 1995. However, its value to immigration history into Canada is critical, especially across the 20th century.

Objectivity: the authors attempt to explain the trends of Immigration into Canada and their impact on economic and political aspects.

Academic Conventions: The article is academic.

Usage Implications:  The article explores the major trends of Immigration into Canada and their impact on the country. As a result, immigration's historical impact can be compared to immigration's current impact in Canada, and compared to the UK’s records.

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Immigration and the multicultural population that results from it are contentious issues in contemporary Canada. Canada accepts more than twice as many immigrants per capita as does the United States, and a majority of immigrants now comes from nontraditional sources in Asia, the Caribbean, and Central America. Critics of a liberal immigration policy charge that these newcomers threaten Canada's social harmony and challenge its cultural identity and that the country faces unprecedented economic and security problems because of uncontrolled immigration. Historical and contemporary evidence suggests, however, that the situation is neither unprecedented nor a crisis. Canada needs immigrants for the compelling reasons it has always sought them: for economic growth and to replace population lost by emigration to the United States. By any comparative yardstick, the Canadian experiments in immigration and multiculturalism have been a resounding success.

1. Immigration to Canada has also been a recurring item on the scholarly agenda of The Annals of the American Academy of Political and Social Science.

Google ScholarIt was the subject of articles in 1913, 1923, 1947, and 1958. See The Annals of the American Academy of Political and Social Science, vol. 45, Canadian National Problems, ed. Ellery C. Stowell (Jan. 1913);

Google Scholar The Annals of the American Academy of Political and Social Science, vol. 107, Social and Economic Conditions in the Dominion of Canada, ed. W.P.M. Kennedy (May 1923);

Google Scholar The Annals of the American Academy of Political and Social Science, vol. 253, Features of Present-Day Canada, ed. Robert Hamilton Coats (Sept. 1947);

Google Scholar Helen F. Eckerson , "United States and Canada: Magnets for Immigration," The Annals of the American Academy of Political and Social Science, vol. 253, Features of Present-Day Canada, ed. Robert Hamilton Coats , 316:34-42 (Mar. 1958).
Google Scholar

6. Smith , "Metaphor and Nationality in North America," Canadian Historical Review, 51(3):273 (Sept. 1971).
Google Scholar

7. Michael D. Behiels , Quebec and the Question of Immigration: From Ethnocentrism to Ethnic Pluralism, 1900-1985 (Ottawa: Canadian Historical Association, 1991), pp. 4-5.

Google ScholarSince the 1970s, however, Quebec governments have pursued policies of "cultural convergence," or the assimilation of immigrants to the majoritarian francophone culture. Google Scholar

9. G. E. Jackson , "Emigration of Canadians to the United States," The Annals of the American Academy of Political and Social Science, 107:25-34 (May 1923). |
Google Scholar SAGE Journals

10. H. F. Angus , "Need for an Immigration Policy," The Annals of the American Academy of Political and Social Science, 253:20-21 (Sept. 1947).
Google Scholar

17. Economic Council of Canada , Economic and Social Impacts of Immigration (Ottawa: Economic Council of Canada, 1991);

Ottawa: Google Scholar Health and Welfare Canada , Charting Canada's Economic Future: A Report of the Demographic Review (Health and Welfare Canada, 1989).
Google Scholar

18. U.S., Department of Justice, Immigration and Naturalization Service , Immigration Profiles: Canada, p. 8.
Google Scholar

20. Philip Martin , "Migration and Development," International Migration Review, 26:3 (1992).
Google Scholar

22. Harold Troper , "The Creek-Negroes of Oklahoma and Canadian Immigration, 1909-11," Canadian Historical Review, 52:3 (Sept. 1972);

Montreal: McGill-Queen's University Press, 1978); Google Scholar W. Peter Ward , White Canada Forever: Popular Attitudes and Public Policy toward Orientals in British Columbia (

Vancouver: University of British Columbia Press, 1990).
Google Scholar Patricia Roy , A White Man's Province: British Columbia Politicians and Chinese and Japanese Immigrants, 1858-1914 ( Google Scholar

23. The policies of Euro-Canadians toward the First Nations must be noted as an exception to our generalization about racism in Canadian history.
Google Scholar

27. Angus Reid Group , "Attitudes about Multiculturalism and Citizenship" (Survey conducted for Multiculturalism and Citizenship Canada, June-July 1991);

Google Scholaridem, "Immigration to Canada: Aspects of Public Opinion" (Survey conducted for Employment and Immigration Canada, 1989);

Ottawa: Google Scholar Economic Council of Canada , The Economic and Social Impact of Immigration (Economic Council of Canada, 1991), chaps. 9-10;

Ottawa: Multiculturalism and Citizenship Canada, 1984), passim.
Google Scholar Karim H. Karim , "Perceptions about Multiculturalism: A Content Analysis of Newspapers, Academic Papers, Ethnocultural Organization Briefs, Attitude Surveys, and Ministerial Correspondence" ( Google Scholar

33. U.N. figures reported in L'Actualité, 15 Sept. 1993, p. 76.
Google Scholar

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Entry and Exit: Canadian Immigration Policy in Context - JOHN HERD THOMPSON, MORTON WEINFELD, 1995

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Immigration and the multicultural population that results from it are contentious issues in contemporary Canada. Canada accepts more than twice as many immigrants per capita as does the United States, and a majority of immigrants now comes from nontraditional sources in Asia, the Caribbean, and Central America.

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Taylor, B. (2016). "Their only words of English were thanking you'”: rights, gratitude, and ‘Deserving’Hungarian Refugees to Britain in 1956. Journal of British Studies, 55(1), 120-144.

Evaluation

Authority: Becky Tylor is a History researcher and lecturer at Birbeck College University of London.

Reliability: The article explores how the British government treats refugees based on UN Conventions. He UN Conventions policy records is a good source of information to use for an analysis.

Currency: the article was published in 2006 and therefore, it gives a relevant and updated perception of the local people towards refugees in England.

Objectivity: The article explores the kind of reception that refugees get in Britain as they settle in the country. The reception of the refugees implies the attitude of the local people towards the refugees.

Academic Conventions: This article is Academic.

Usage Implications: The article explores the potential marginalization that refugees may encounter if they do not conform to the nation's culture in time.

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Nelson, S., Verma, S., Hall, L. M., Gastaldo, D., & Janjua, M. (2011). The shifting landscape of immigration policy in Canada: Implications for health human resources. Healthcare Policy, 7(2), 60-67.

Evaluation

Authority: Nelson is the Dean and Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, while Verma is Deputy Dean, Professor of Family Medicine, Associate Vice Provost, Health Professions Education, Faculty of Medicine, University of Toronto. Their professional prowess inputs in the authority of the paper was well researched and deeply attached to the healthcare professionals in Canada.

Reliability: the article explores the topic using government-provided records that indicate the number of healthcare professionals who have immigrated into the country and integrated with the local nurses in the country.

Currency: the article was published in 2011, but the information shared and the policies evaluated seems to be in effect for a considerable amount of time. Therefore, the paper is reliable and current.

Objectivity: The journal article explores the current policies established by various government agencies and levels to ensure that some of the immigrants who are healthcare experts integrate with the local healthcare officers n the country.

Academic Conventions: The article is academic.

Usage Implications: This indicates a few notable policies that are put in place to help the immigrant as they integrate with the local professionals in the country.

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Language: English | French

Abstract

For many years, Canada has relied on international migration to compensate for cyclical shortages in its skilled labour force. This paper reports on recent changes in Canadian immigration policy, namely, the introduction of new immigration programs focused on skilled workers, along with the implementation of domestic mobility agreements. With specific reference to the case of nursing, the paper highlights the necessity for integrated policy across multiple government levels and stakeholder groups, as well as the need to promote the development of evidence-based policy in the fields of immigration and health human resources.

Résumé

Pendant plusieurs années, le Canada a compté sur la migration internationale pour compenser les pénuries cycliques de main-d'œuvre qualifiée. Cet article porte sur les récents changements dans les politiques d'immigration au Canada, en particulier l'introduction de nouveaux programmes d'immigration centrés sur les travailleurs qualifiés, de même que la mise en place d'accords de mobilité domestique. L'article, qui traite spécifiquement du cas des soins infirmiers, souligne le besoin de politiques intégrées entre les multiples niveaux de gouvernement et les groupes d'intervenants, ainsi que le besoin de promouvoir le développement de politiques fondées sur les données probantes dans le domaine de l'immigration et des ressources humaines en santé.

Historically, Canada's immigration policy has been premised on the view that building the stock of human capital strengthens the economy, regardless of economic cycles ( Green and Green 1999; Hawthorne 2006). This model is informed by the assumption that generally competent individuals will adapt and find adequate employment in some sector. As a result, all degrees are considered equal and no additional screening for charter language proficiency is mandatory, irrespective of where education was obtained ( Hawthorne 2008). This policy carries potentially detrimental consequences for labour market integration of immigrant populations, as credentials of migrants may be incongruent with those sought by industry. In the last two years, these problems have been compounded by a global recession and the rise in unemployment worldwide.

In 2008, Prime Minister Stephen Harper acknowledged the need for a more efficient selection process for economic migrants that maximizes both economic and human resources ( Phythian et al. 2009). To attract more skilled workers and avoid labour market displacement, the Canadian government implemented the Canadian Experience Class (CEC) Program in 2008 and the Foreign Credential Recognition (FCR) Program in 2009 ( CIC 2008; HRSDC 2009). These programs prioritize skilled migrant selection based on domestic labour market needs and attempt to tackle Canada's chronic "brain waste" problem. The FCR was created to accelerate the foreign qualifications assessment process and workforce integration of internationally trained immigrants in regulated occupations, such as health services ( HRSDC 2009).

Competitor countries for global talent, such as Australia, have in recent years revised their immigration policies. In 1999, the Australian government expanded its recruitment of skilled migrants through a two-step migration process that expedited the transition of temporary migrants and international students to permanent resident status. This process is efficient and cost-effective for the host country because education of international students is self-financed and, with host-country degrees, these individuals are ready for labour market integration ( Hawthorne 2008). Compelling Australian evidence indicates that this policy has improved not only the labour market integration system, but also the general long-term economic success of immigrants ( Hawthorne 2006, 2008). Census data for 2001 show that Australia has low unemployment rates of degree-qualified migrants - 7.8% - in contrast with Canada's rate of 14.7% for the same period ( Hawthorne 2006). According to Australian data, such programs may have a strong impact on human health resources (HHR): in 2009 around 70% of all international medical students moved directly into Australia's medical workforce, along with an estimated 35% of international nursing students qualifying as registered nurses. This two-step migration strategy was included in the Canadian government's CEC Program ( CIC 2008).

Canadian Mobility Legislation and Policy

The recent legislative changes affecting HHR in Canada began in 1995 with the Canadian Agreement on Internal Trade (AIT), established to "reduce barriers to the movement of persons, goods, services and investments within Canada" (Industry Canada 2009). The Labour Mobility Act of AIT targets barriers specific to national workforce migration within regulated professions: residency requirements; occupation-specific certification, licensing and registration practices; and differences in occupational standards ( HRSDC 2009). This Act ensures that qualifications earned in one jurisdiction are recognized in another, and establishes occupational competency as the ideal assessment criteria of professionals. With the 2010 consolidation of the AIT, mobility legislation has been enacted in each province to comply with the federal Act. Mobility provisions specifically related to healthcare workers are now legislated, with exemptions listed and justified. Thus registered nurses, physicians, dentists, pharmacists, physiotherapists and a number of other health professionals educated in any province in Canada can become registered in another province without undergoing additional testing or assessment. Under the AIT, foreign qualifications of health professionals that are recognized in one province are valid across all jurisdictions in Canada.

To assist in this process of mutual recognition of qualifications among Canadian jurisdictions, the Pan-Canadian Framework for the Assessment and Recognition of Foreign Qualifications, a joint initiative of national, provincial and territorial governments in collaboration with regulatory bodies, was announced in December 2009. This framework aims to address three issues: "accelerating the assessment and recognition of foreign credentials; implementing Enhanced Language Training and Bridge to Work initiatives; and providing up-to-date and pertinent labour market information" ( HRSDC 2009). The framework led to the development of a national program, the Foreign Credential Recognition (FCR) Program, whose main objective is to complete each applicant's credential assessment process within one year while remaining fair, transparent and rigorous. The healthcare professions currently included in the FCR Program are medical laboratory technologists, occupational therapists, pharmacists, physiotherapists, registered nurses, dentists, licensed practical nurses, medical radiation technologists and physicians.

Despite the economic downturn, the federal government announced that immigration would not be affected. In fact, the FCR Program was implemented partly in response to the recent global recession. Record numbers of permanent residents were admitted to the country - 247,243 in 2008 ( CIC 2009a) - and target immigration levels remained between 240,000 and 265,000 for 2009 and 2010, with a focus on economic class migration to meet long-term labour workforce demands and to help the country recover ( CIC 2009b).

The CEC Immigration Program, as in the Australian model, expressly targets international students and temporary workers who seek to obtain residency. This program enables immigration policy to be highly responsive to shifting labour market requirements and provides the quickest and most direct pathway for would-be immigrants, avoiding the lengthy process of the skilled worker migration path and the nominee process of the Provincial Nominee Program (PNP). Under the CEC program, a small number of these workers and international students are eligible to apply to remain.

Provinces also moved to harness immigrant labour as part of an economic stimulus plan. The PNP allows the provinces to develop immigration strategies tailored to local labour market needs. Initially developed as a limited program to attract doctors and nurses in 2001, its expanded version offers qualified immigrants an accelerated pathway to permanent residence ( Ministry of Advanced Education and Labour Market Development 2009). PNP 2011 figures are set to eclipse previous records, with 40,000 immigrants to be accepted under this program ( CIC 2011). In line with these burgeoning opportunities for labour force growth, provinces have developed economic strategies, such as Open Ontario, to create jobs and attract and retain foreign workers and students ( Ontario Office of the Premier 2010).

Table summarizes the relevant legislation and policy initiatives.

TABLE 1.

Policy Relevance for Healthcare Workers

Under changes in immigration policy in response to the recession, only those within the 38 qualifying occupations may be considered for permanent resident status under the skilled worker category. Workers in 10 healthcare occupations (managers in healthcare, specialist physicians, general practitioners and family physicians, audiologists and speech language pathologists, physiotherapists, occupational therapists, head nurses and supervisors, registered nurses, medical radiation technologists and licensed practical nurses) ( CIC 2010) remain eligible. Furthermore, as with the Australian policy, in-country international students are now targeted as a source of future skilled workers. For instance, the Open Ontario Plan proposed by the McGuinty government aims to add 20,000 spaces in colleges and universities in Ontario. Part of this plan is to "increase international enrolment by 50 per cent" ( Ontario Office of the Premier 2010), or over 12,000 spaces ( CIC 2009a). With more foreign students in Ontario, the number of job-ready immigrants eligible for permanent residency through the CEC would increase. Because the premier did not specify the disciplines in which these new spaces will be created, the direct impact of the plan on the healthcare workforce is unknown. If, however, universities are to train more health professionals, immigration and workforce integration will be facilitated only for individuals who are pursuing post-secondary education and can afford to pay international tuition fees. Although this strategy would contribute to building a bigger foreign-born, domestically trained health workforce, it would not solve Canada's problem of "brain waste" of those who suffer the disconnect between migration policy and the active recruitment of skilled workers and domestic employment opportunities. Despite being in high demand, many healthcare professionals who migrate face serious accreditation barriers and are often unable to secure employment in their profession.

Nursing Human Resources and Migration

Currently, only 7% to 8% of Canada's nursing workforce was trained abroad, compared to an average of 11% among all OECD countries ( MacDonald-Rencz 2009). Blythe and Baumann (2009) found that workforce uptake of internationally trained nurses is related to barriers faced during the migration process, regulatory procedures and licensing examinations in Canada. Most of Canada's foreign-educated nurses immigrated under the standard point system, live-in caregiver program or as dependents for reasons other than pursuit of career opportunities. Moreover, family priorities and social obligations may cause a delay in seeking employment, compounding the challenges associated with nursing certification and labour force integration ( Papademetriou 2009). Furthermore, Canada's net migration of nurses is negative ( Little 2007). The HHR personnel shortage in Canada is an effect not only of an aging workforce, but also of out-migration. The 1990s tax cuts and healthcare reform caused layoffs and cuts in both education and employment of nurses, creating a decline in available nursing positions ( Aiken 2007). Then, under the North American Free Trade Agreement, the movement of goods and human capital across North American borders was facilitated. Pull factors such as exemption from taking the National Council Licensure Examination and active recruitment by US hospitals have motivated many Canadian nurses to seek employment in the United States ( McGillis Hall et al. 2009). Since the 1990s, the ongoing depletion of the nursing workforce in Canada highlights a dire need for policy reform that improves recruitment, transition to practice and retention of trained nurses ( CNA 2007). However, based on the immigration trends of the past decade, qualified nurses will continue to migrate to Canada as dependents rather than economic immigrants, as well as through the rapidly increasing temporary categories such as the live-in caregiver program, and thus require considerable support for successful transition to the workforce.

Meanwhile, the regulated professions continue to move towards the adoption of common licensure standards across all Canadian provinces in accordance with the requirements of the AIT. The situation, however, is problematic. Some provinces rely heavily on international migration to replace domestic graduates lost to interprovincial migration ( Silversides 2009). Under the PNP, a number of provinces have been quick to mount independent international recruitment programs for nurses, such as that launched by the Government of Saskatchewan (2008). These local initiatives risk creating a "back door" entry to the Canadian workforce and undermining the national moves to create a single Canadian standard for credential recognition in each of the health professions. Variation in entry requirements has raised concerns, most particularly in the case of medicine. As Dove (2009) contends, with easier interprovincial mobility of physicians under the AIT, the retention of doctors and other health workers in certain provinces and territories could prove to be a challenge. Although immigrants sponsored under the PNP gain priority for permanent residency over other applicants, new and stricter national standards for accreditation and licensure of health workers would create greater barriers to workforce integration.

Although relying on immigration to fill the gaps in the domestic labour force is not a long-term solution to Canada's HHR shortage, neither is reducing migration of health professionals realistic in a globalized world ( Papademetriou 2009). HHR is particularly challenging in a labour market that is deeply dependent on skilled migrants, such as Canada's. The mobility of workers and the portability of credentials have set the stage for locally driven initiatives that attract skilled workers who are then free to move within the country. Meanwhile, as immigration policy focuses on attracting more skilled workers, the ability of Canadian professional associations and regulators to manage the challenges of skill recognition, mobility agreements and workplace integration remains to be seen. Policy discussions become even more complex in light of intense ethical debates over health worker migration in general.

These mobility and skill recognition challenges are uniquely Canadian, and Australia provides a marked contrast to Canada in this context. While the PNP is Canada's fastest-growing immigration pathway, Australia has largely maintained federal control of immigration policy, so the "back door" issue is less of a concern. Secondly, Australia recently eliminated cross-jurisdictional credential challenges by dissolving state-based regulatory boards and, in 2010, creating a national health professional regulation agency that regulates all health professionals in the country ( AHPRA 2011).

Unlike their Australian counterparts, Canadian policy makers, regulators and employers meanwhile need to respond to these challenges in an increasingly devolved, as opposed to a centralized, system. There is therefore all the more need for all stakeholders to come together to create an integrated policy framework to ensure that recent initiatives to bring skilled workers more easily into Canada do not undermine the development of long-awaited national standards and mobility agreements. The further development of evidence-based policy in the fields of immigration, credential and competency recognition, and health human resources will be critical for Canada to meet this challenge. A national and provincial alignment of policy in immigration, internal mobility and HHR planning is now imperative.

Acknowledgements

This paper grew out of discussions generated at the International Workforce Symposium held at the University of Toronto in September 2008 at the Bloomberg Faculty of Nursing and Faculty of Medicine, funded by the MOHLTC and the Connaught Fund, University of Toronto.

Contributor Information

Sioban Nelson, Dean and Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.

Sarita Verma, Deputy Dean, Professor of Family Medicine, Associate Vice Provost, Health Professions Education, Faculty of Medicine, University of Toronto, Toronto, ON.

Linda McGillis Hall, Professor, Associate Dean of Research & External Relations, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.

Denise Gastaldo, Associate Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON.

Martyna Janjua, Dalla Lana School of Public Health, University of Toronto, Toronto, ON.

References

Australian Health Professional Regulation Agency (AHPRA) 2011. Retrieved October 12, 2011. <http://www.ahpra.gov.au/About-AHPRA/Who-We-Are.aspx>.

Blythe B., Baumann A. 2009. Internationally Educated Nurses: Profiling Workforce Diversity. International Nursing Review 56(2): 191-197 [[PubMed] Google Scholar]

Citizenship and Immigration Canada (CIC). 2009a. Annual Report to Parliament on Immigration, Citizenship and Immigration Canada. Ottawa: Author [Google Scholar]

Dove N. 2009. "Can International Medical Graduates Help Solve Canada's Shortage of Rural Physicians?" Canadian Journal of Rural Medicine 14(3): 120-23 [[PubMed] Google Scholar]

Green A.G., Green D.A. 1999. The Economic Goals of Canada's Immigration Policy: Past and Present. Canadian Public Policy 25(4): 425-51 [Google Scholar]

Hawthorne L. 2006. Labour Market Outcomes for Migrant Professionals: Canada and Australia Compared. Executive Summary. Mimeo, University of Melbourne, Australia [Google Scholar]

Hawthorne L. 2008, The Impact of Economic Selection Policy on Labour Market Outcomes for Degree-Qualified Migrants in Canada and Australia. IRPP Choices 14(5): 1-52 [Google Scholar]

MacDonald-Rencz S. 2009. Canadian Strategies to Stabilize the Work Force. Canadian Journal of Nursing Leadership 22(1): 53-55 [[PubMed] Google Scholar]

Papademetriou D. 2009. (September). International Migration and Health Professionals. Keynote address. Health Human Resources Migration International Policy Symposium, University of Toronto [Google Scholar]

Phythian K., Walters D., Anisef P. 2009. Entry Class and the Early Employment Experience of Immigrants in Canada. Canadian Studies in Population 36(3-4): 363-82 [Google Scholar]

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The Shifting Landscape of Immigration Policy in Canada: Implications for Health Human Resources

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Language: English | French For many years, Canada has relied on international migration to compensate for cyclical shortages in its skilled labour force. This paper reports on recent changes in Canadian immigration policy, namely, the introduction of new immigration programs focused on skilled workers, along with the implementation of domestic mobility agreements.

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Lowe, K. (2020). Five times immigration changed the UK. BBC.

Evaluation

Authority: Keith Lowe is a historian and an editor at BBC.

Reliability: The article evaluates the trends of the population of the UK based on the available data from government records.

Currency:  The article was published in 2020 and offers valuable information about the factors of immigration into the UK from the early 20th century.

Objectivity: the article aims to establish the trend and explore the various crisis that have predisposed migration into the UK.

Academic Conventions: The article is not academic.

Usage Implications: The article adds value to the trends of immigration to the UK and how the current migrations into the country compare.

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Since the end of World War Two, immigration has transformed the UK.

Many moments have contributed to this transformation in net migration. Here are five key turning points.

1948: The Windrush Generation

In the aftermath of the war, the UK saw huge investment in public infrastructure. Bombed cities were rebuilt, transport systems expanded and new institutions, such as the NHS, had to be staffed.

Employment opportunities abounded, and people from all over the Commonwealth came to the UK to help fill the labour shortage.

Alongside those from the Caribbean came some 300,000 people from India, 140,000 from Pakistan, and more than 170,000 from various parts of Africa.

Windrush in numbers

Immigrants from the Republic of Ireland had the same rights, and also flocked to the UK. Between 1948 and 1971, one-third of 18 to 30-year-olds left the country in search of work, about half a million people. The overwhelming majority of them were bound for the UK.

In the 1940s and 50s, none of these people required visas; as "citizens of the United Kingdom and Colonies", they were automatically given the right to reside in the UK.

1956: The Hungarian Revolution

The end of World War Two also brought huge political changes in eastern and central Europe.

After liberating the region, the Soviet Union installed Communist regimes here that were deeply unpopular with many people. It also annexed the Baltic States and parts of Poland.

In reaction, hundreds of thousands of refugees fled to the West. The first to arrive in the UK were about 120,000 Poles, who arrived in 1945; the substantial Polish communities in Manchester, Bradford and west London date from this time. About 100,000 people from Ukraine and the Baltic States also came to the UK for similar reasons.

At the time, these population movements were considered the final consequences of World War Two. In fact, they were the symptom of a new Cold War.

This was confirmed in 1956, when the people of Hungary rose up against their Communist rulers. After Soviet tanks drove into Budapest to crush the uprising, almost 200,000 Hungarians fled the country.

Britain took in 30,000 of these political refugees, setting a precedent for the years to come. From 1956 onwards, political dissidents from eastern Europe were routinely accepted and integrated into British society.

Some of the data in this article is drawn from BBC Briefing, a mini-series of downloadable in-depth guides to the big issues in the news, with input from academics, researchers and journalists. It is the BBC's response to audiences demanding better explanation of the facts behind the headlines.

1971: Immigration Act

The post-war boom in immigration from Commonwealth countries was not welcomed by everyone.

Under considerable pressure, the British government eventually cracked down on all forms of racial discrimination.

The most important of these was the Immigration Act of 1971, which decreed Commonwealth immigrants did not have any more rights than those from other parts of the world. This effectively marked the end of the Windrush generation.

More like this:

1972: The Ugandan Asian Crisis

Prime Minister Edward Heath declared the country had a moral and legal responsibility to take in those who had UK passports. Of the 60,000 people expelled, a little under half came to the UK.

This highlighted a change of emphasis in immigration policy. The UK was now wary of people coming in search of jobs, but it would continue to welcome those coming in search of asylum.

Throughout the 1970s and 1980s, fewer than 5,000 asylum seekers came to the UK each year, on average. But in 1990, after the fall of the Berlin Wall, applications for asylum rose suddenly to more than 16,000 people. In the following two years this figure doubled, and then doubled again.

This trend would continue over the following decade, as instability in countries like Yugoslavia, Somalia and Iraq brought more refugees to the UK's door.

1992: The EU expansion

In the following decade, tens of thousands of EU citizens came to live and work in Britain.

Few people protested, possibly because these newcomers were balanced out by the tens of thousands of British people who moved away to other parts of the EU.

Nevertheless a new principle had been set. Just as the country had once held an open door to the Commonwealth, so it now held an open door to the European Union.

Unlike Germany or France, the UK put no temporary restrictions on arrivals from these new member states.

Tony Blair's Labour government had a positive stance on immigration: it argued a growing economy required a larger workforce and, as in the 1950s, people from other countries were considered a good source of new labour.

In any case, the government predicted that EU enlargement would only cause a rise of up to 13,000 people a year in immigration.

In the event, more than a million people from these countries arrived and stayed over the next decade. It was one of the biggest influxes in British history.

You can download the whole of the BBC Briefing on immigration here.

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Over the past century many groups have left and entered the country, changing the shape of the nation.

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Leblanc, Y., Bourgeault, I. L., & Neiterman, E. (2013). Comparing approaches to integrating refugee and asylum-seeking healthcare professionals in Canada and the UK. Healthcare Policy, 9(SP), 126.

Evaluation

Authority: Leblanc is an instructor in the department of health, aging and society at McMaster University. Bourgeault is a Professor at the Faculty of Health Sciences, University of Ottawa, while Neiterman is a Postdoctoral Fellow at the Department of Sociology, University of Toronto, Toronto, ON.

Reliability: The article uses data of the government employed healthcare professional who are immigrants. Therefore the data is reliable and a good source of information to analyze.

Currency: the paper was published in 2013. However, the various aspects of immigration and integration that are discussed in the paper are current and effective.

Objectivity: The journal article attempts to explore the barriers that impede the integration of refugees in a country.

Academic Conventions: The article is academic.

Usage Implications: The article explores the difficulties of integration of the refugees and immigrants and how it affects the trends of Immigration in the UK and Canada.

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Language: English | French

Abstract

In this paper, we examine barriers to the integration of refugee doctors and nurses in Canada and the United Kingdom. Key obstacles impeding the integration of internationally trained health professionals are well documented, but less attention has been paid to the integration of refugee health professionals, particularly in Canada. Based on documentary analysis and semi-structured interviews with 46 Canadian and 34 UK stakeholders, our research shows that there are no simple solutions to mitigating the core obstacles that prohibit the professional integration of refugee doctors and nurses into host countries. The targeted approach adopted in parts of the UK does provide some promising practices for Canada, which has yet to develop policies and initiatives specific to health professional refugees. This study is intended to contribute to our understanding of how immigration and health human resources policies have shaped the economic integration of refugee healthcare professionals in the UK and Canada in distinct ways.

Résumé

Dans cet article, nous examinons les obstacles à l'intégration des médecins et infirmières réfugiés au Canada et au Royaume-Uni. Les principaux obstacles à l'intégration de professionnels de la santé formés à l'étranger sont bien documentés, mais il y a peu d'études portant sur l'intégration des professionnels de la santé ayant le statut de réfugiés, en particulier au Canada. À l'aide d'une analyse de documents et d'entrevues semi-structurées menées auprès de 46 personnes concernées au Canada et 34 au Royaume-Uni, notre recherche fait voir qu'il n'existe pas de solution simple pour atténuer les principaux obstacles à l'intégration profession-nelle des médecins et infirmières ayant le statut de réfugiés dans leur pays d'accueil. L'approche ciblée adoptée dans certaines régions du Royaume-Uni fournit des éléments de pratiques prometteuses pour le Canada, qui n'a pas encore développé de politiques ou initiatives visant précisément les professionnels de la santé ayant le statut de réfugiés. Cette étude entend contribuer à la compréhension des rôles distincts que jouent, respectivement au Canada et au Royaume-Uni, les politiques en matière d'immigration et de ressources humaines en santé dans l'intégration économique des professionnels ayant le statut de réfugiés.

Similar to other countries, immigrants come to canada and the UK for both economic and humanitarian reasons ( Castles and Miller 2003; Salt and Millar 2006). An economic migrant, one that is attracted to a host country primarily for the purpose of gainful employment ( Salt and Millar 2006), differs from a refugee, who is forced from his or her country of origin owing to fear of persecution ( UNHCR 2011). What sets refugees apart from other immigrants in host countries is not only their forced migration and associated need for protection, but their ability to "establish economic potential" ( Yu et al. 2007).

In this paper, we consider the fundamental challenges to the integration that refugee doctors and nurses in the UK and Canada face as they attempt to pursue careers in their chosen professions. Whereas the UK offers examples of a more targeted approach, relatively little specific attention has been paid in Canada to this group of refugees, even though research shows that when refugees are successfully integrated they become a significant asset to local healthcare systems ( NHS Employers 2009). Although we argue that there are no simple solutions to eliminating or mitigating the many barriers that prohibit the integration of health professional refugees into host countries, a targeted approach seems promising. Through greater awareness, sensitivity and continued commitment, the economic integration of refugee healthcare professionals can be more fully realized. Whether this is likely remains nebulous. This paper contributes to our understanding of how immigration and health human resources (HHR) policies have shaped the economic integration of refugee healthcare professionals in the UK and Canada in distinct ways.

Immigrant Health Professionals

The literature shows that although refugees coming to host countries are relatively well educated, they also tend to have limited employment opportunities ( Bloch 2007; Charlaff et al. 2004; Krahn et al. 2000; Yu et al. 2007). Structural and individual constraints impede the integration of refugees and asylum seekers. For example, studies in the UK have highlighted how asylum seekers are economically compromised owing to restrictions on their residential mobility and access to paid employment ( Charlaff et al. 2004; Clements 2007; Hubbard 2005; Smith et al. 2007; Wren 2007; Zetter and Pearl 2000). Similarly, in Canada, research indicates that current immigration policies can impede refugee and asylum seekers' eligibility to attend integration programs and to receive services, while tightened security measures delay applications and leave individuals with little or no financial support ( Yu et al. 2007). Gender has also been found to affect employment opportunities, with women refugees being more disadvantaged than men ( Adams and Kennedy 2006; Bloch 2007; Kofman et al. 2005; Refugee Council 2005). Fuelled by public discourse decrying refugees as a "threat," some resistance towards the settlement of refugees has arisen in various communities in the UK ( Lewis 2006). Biography also matters. Difficulties in accessing the labour market are further hindered through experiences of torture, loss of family members, trauma and various health problems ( Charlaff et al. 2004).

Over the past decade, the UK has embraced a coordinated, top-down approach to the integration of refugees and asylum seekers, with collaborative efforts at both the local and national levels. The policies shaping the integration of refugees and asylum seekers in the UK are detailed in a number of Home Office documents (see Home Office 2000, 2002, 2005, 2006). HHR policies, concerned with workforce planning, have complemented immigration policies. As a result, a number of mentorship, financial assistance and orientation programs were designed to improve language proficiency and to prepare refugee health professionals to enter and adapt to the UK workforce ( Department of Health 2003).

Similarly in Canada, immigrant health professionals are supported through various initiatives. In contrast to the UK, however, current HHR policies - which are, for the most part, provincially or regionally controlled - are not coordinated with immigration policies, which are largely directed federally. Researchers recognize that there is much work to be done to improve integration policies and initiatives so that the diverse circumstances and potentials of "newcomers" to Canada may be more adequately addressed (see Pressé and Thomson 2007; Walsh et al. 2008).

Despite these efforts, there are recognized obstacles that impede and prolong the integration of refugee health professionals. These include lack of information, language proficiency, credential documentation, references, support networks and financial resources, as well as interruptions in training ( Adams and Kennedy 2006; Overseas Doctors Sub-Group 2000; Stewart 2003, 2005; Winkelmann-Gleed 2006).

Employability: An Analytical Concept

In this research, we draw on the theorization of integration as a two-way process ( Raghuram 2007: 2247) wherein humanitarian rights are provided and individual identity is preserved within the economic, cultural and civic parameters of the host country. We use the term "employability" to capture the barriers discussed by representatives of the various policy communities with respect to health professional refugee and asylum-seeker integration (see Bloch 2007: 21). Employability encompasses those obstacles that deter refugee doctors and nurses from practising in their chosen fields, and is inclusive of pertinent aspects of social and cultural integration that influence the career paths of refugee and asylum-seeking health professionals (adapted from Raghuram 2007). Social integration refers to relational social characteristics, such as gender and ethnicity, and cultural integration includes factors intended to ease or enhance adaptation into the host country, for example, ethnic community support or mentorship programs.

In utilizing "employability" as an analytical concept, we found that initial obstacles to integration include the professional registration process and the career path directions open to refugee and asylum-seeking health professionals. These barriers intersect with refugee status, professional status, gender and ethnic community support, and are further implicated in the policies, initiatives and programs that fluidly enhance or constrain integration. Our analysis demonstrates that refugee integration in the UK has been framed as a "win--win" situation, whereas Canadian policy makers have yet to specifically target the issue of integrating refugee health professionals.

Methodology

We examine the barriers to employment that refugee doctors and nurses face in host countries with data derived from structured interviews with 46 Canadian and 34 UK stakeholders involved in the integration of healthcare professionals. The interviews, conducted in 2007, were completed largely via telephone and included representatives from immigration, health professional regulation, health human resources planning, health professional associations, educational training, and program development policy communities in both countries. Intensive documentary analysis of federal and provincial official websites and reports began in 2006 and continued until 2009. Periodic reviews ensued in 2010, 2011 and 2012.

The interview data were analyzed using the computer-assisted management systems NUD*IST 6 and NVivo 7. The systematic comparative analysis involved a constant iterative process of going back and forth between documents and interviews. Key segments from the documents were excerpted and organized according to common themes that began to emerge from the data. Relationships between themes and between the responses of different participants were then identified. Integration was a particularly salient theme within the UK data but emerged less frequently in Canada.

Barriers to Employability of Refugee and Asylum-Seeking Health Professionals

The following analysis highlights the response of key stakeholders in the UK and Canada with respect to the integration of health professional refugees. The comments emphasize how language proficiency is measured, how language courses are taught and the dilemma that lack of proof of credentials poses for both refugees and regulators. These conditions are often coupled with uncertainty over residency, legal restrictions that in some instances limit access to paid employment, and financial hardship. These issues have a cumulative impact on one's career path. For many, the quest ends here. Even for those who are able to prove their professional competency, limited options with respect to retraining, difficulty in finding orientation placements, lack of support, underemployment and discrimination further deter refugee health professionals from their chosen professions. The following accounts demonstrate the complexity and cumulative impact of these intersecting barriers.

Stakeholders in the UK and Canada stressed first and foremost that language proficiency is fundamental to moving through the registration process. Notably, passing the exam does not guarantee that one has reached a level of proficiency that satisfies employment requirements. Similarly, in the UK, the barriers associated with becoming linguistically proficient are reflected in the skill level of the individual refugee, the availability of training and mentorship, and the generic design of the assessment tool. In some instances, it was not the program but rather the assessment tool that stakeholders considered unsuitable and in need of redesign. They stressed the importance of tailoring language programs to better meet the needs of those they serve. This is no simple matter, as it may require increased personnel and greater financial investment than more traditionally designed orientation approaches.

We have included language tutors completely within our academic program and ... it's relatively expensive to run. Because we realized we were trying to teach nursing to people who we don't understand how you learn in a different language. If you're learning a subject in a different language, you need to be taught in a different way because you're constantly translating and retranslating. And we needed to look at how we were teaching because our traditional teaching methods weren't working that effectively. (UK Nursing Stakeholder S2)

Both countries have invested only in a limited way in the advanced language training necessary to meet employment requirements or to redesign programs.

While language proficiency influences many aspects of integration, credentialing issues are central obstacles to acquiring professional registration. These encompass program recognition as well as individual proof of credentials:

One of the things that we've had is, in a lot of situations, they're refugees and therefore they've got no documentation and therefore they can't provide a lot of the paraphernalia that we demand, you know, voluntary migrants to provide. They sometimes can't provide, you know, their references from the school of primary medical qualification. They haven't got the sort of portfolios of evidence to demonstrate specialist training. They may have been out of clinical work for a sustained period of time while they've been going through the whole refugee process and therefore ... they do actually have to be treated rather uniquely. (UK Medical Stakeholder 1)

This situation closely resembles that in Canada, where difficulty in gaining recognition for foreign educational credentials and professional experience is common. The variation in training in different countries also poses a challenge for regulators and is summed up in a comment made by a Canadian stakeholder:

So the policy issue is to figure out kind of how do we take a candidate and credentials that seem very foreign to us and how do we plug them into our system in a meaningful way to figure out what they really are. ... [T]o figure out how to measure them is the huge challenge right now. (CA Government Stakeholder 1)

Hence, the refugee's ability to prove his or her professional competence is coupled with the receiving country's way of measuring proficiency. Further barriers to health professional employment may be related but are not limited to the registration process. There are other career path obstacles that may impede a refugee's chances of acquiring employment as a healthcare professional.

Career path

Career path obstacles are an extension of the previously described barriers and involve difficulties associated with not being able to pursue one's chosen profession, the inability to attain an entry-level position that reflects former career status and the problems associated with achieving career promotion. These hurdles were more widely and explicitly acknowledged in the UK context. Without proof of qualifications, one of the few options involves retraining within the same profession:

I had a guy who was a plumber and a nurse. And we looked into getting his qualifications from Iraq and were basically told that ... they're not worth anything. He's going to have to requalify. And similarly, I worked with a lady who was a nurse in Zimbabwe and she's now just about to finish her degree here in nursing. She went back and requalified. And I mean, obviously, I think it would depend on what country you came from, you know, how your qualifications would be accepted. You know, in my experience they tend to be advised to go back and start again. (UK Integration Stakeholder S1)

Stakeholders also recognized that refugee and asylum-seeking health professionals face greater disadvantages due to law-enforced restrictions on their employment, mobility and lack of finances. Such barriers further preclude the integration process for asylum seekers:

But also in terms of whether they are legally permitted to work or get paid work because of the restrictions ... if you're recognized as a refugee it's okay, but if you're seeking work on an asylum-seekers basis, then there are all sorts of problems about both being able to work and accessing benefits which are quite complex, and god knows how they understand them. (UK Nursing Stakeholder 2)

Severe financial hardship is a salient deterrent both to obtaining registration and to retraining:

Indeed, they don't have very much money in the first place. They're really very poor. Some of them may even be on benefits. (UK Nursing Stakeholder 1)

This situation was also acknowledged by some stakeholders in Canada:

It's intensely emotional for some of the people who are involved because you know that people are literally, like, don't have enough money, like, they're making choices because they don't have enough money. You know, they can't get gas in their car to drive to their practicum. (CA Employer Stakeholder 1)

Retraining is additionally problematic because it is time-consuming and places added burden on individuals. Such scenarios contribute to the difficulties of refugees as they try to rebuild their former careers. Many are forced to abandon such hope, and integration workers are obliged to impress upon individuals that it may not be possible to continue in their chosen profession:

The most important thing with people is not necessarily training to pass exams, but career advice and having somebody having a very good relationship with them so they are able to say after a period of assessment okay, here's the situation. You can try for another year or however long to pass this exam but let me tell you, you probably won't get a job at the end of it because you're either too old, have been out of practice for too long, you're in a field that is highly competitive. ... You're not going to make it as a doctor here. It doesn't mean you're not a good doctor. It just means the system is such that you won't make it through. (UK Nursing Stakeholder 3)

Impressing this "reality" on refugees applies to nurses as well as doctors:

It's about being able to offer some hope in relation to utilizing existing skills and knowledge in an alternative health career, and the same goes for nurses. There are some who won't be able to register and can be supported to develop in a different direction. So alternative health careers are also an issue that we're trying to address in terms of managing expectations. (UK Nursing Stakeholder 1)

Although refugee health professionals face similar obstacles in the UK and Canada, the policy responses are framed in contrasting ways.

Responses to Refugee Health Professional Employability Barriers

There is a striking difference in the way that issues facing refugees and asylum-seekers have been framed in the UK and Canada. In the UK, the reasons provided by stakeholders for increased support for refugees relate to the obvious, "because we have huge numbers of refugees" (UK Academic Stakeholder 2). Perhaps because there is "some kind of tradition or some event [that] occurred in the UK and so people are more aware" (UK Nursing Stakeholder 4). Still others pointed to the mutual benefit, or the "win--win" situation, that accommodating refugees had for the UK during a time when there were workforce shortages:

I think it's partly because we've got such large numbers of refugees per se that there is an awareness that they should be ... that it's better for the UK economy and for integration and all the social reasons if they can be enabled to get back into their professions, whatever those professions are. (UK Medical Stakeholder 1)

"Making use" of refugee health professionals was also seen as a convenient way to provide care for other non--English-speaking refugees:

I think the reason why the NHS or the Department of Health or the UK Home Office is trying to promote the development of the refugee nurses in particular is that they can get employed in different trusts in the long-term future so that if local non-- English-speaking refugees come and use the service, then they would tap into that particular knowledge as well. (UK Nursing Stakeholder 6)

Although the benefit is claimed to be reciprocal, if the refugee does not get permanent residential status the local health authority still profits from the volunteer labour provided by the refugee and comes out the "winner" in the situation:

When we have a captivated group of people who have skills, so why are we not using them? ... So they volunteer their time, and in a way they benefit by retaining their skills and eventually, if they do get the status, it would give them the opportunity to access the job market because they would ... know how the system works and, you know, ... the health system would be familiar to them. So we would employ people that we're familiar with. ... So yes, it is a win--win situation if everything adds up at the end of the day. (UK Nursing Stakeholder S1)

Alternatively, in Canada, some stakeholders tended to dismiss the idea that refugee health professionals should be considered separately from internationally educated health professionals in general because of their small numbers: "When I look at the breakdown of what we see with the clients, I think it would be fairly small in comparison to those coming through as independent class" (CA Integration Stakeholder 2). Secondly, a notion of targeted support is not considered because it remains outside the boundaries of specific policy departments:

I won't be able to give you a turn on refugees either, because we have a different refugees group here that deals with that. My focus is more on the labour market integration side generally, and we tend not to think of refugees in the main. (CA Government Stakeholder 1)

Other stakeholders argued that there is no need to treat refugees differently than other migrants because it is unfair to give them an advantage over economic migrants:

Well, I don't even know if you can [differentiate between those two groups of immigrants]. I mean, why would it be fair to make it easier for refugees to become a doctor than someone who has done this through the processes that we have in place? (CA Government Stakeholder P2)

The notion of a "refugee advantage" is one that was also expressed by a stakeholder in Scotland as a result of recent changes in immigration rules affecting overseas doctors in the UK:

There's been a big huge change ... in the permit-free training and regulations in the UK, which has caused huge problems for overseas doctors who want to come and work in the UK or train in the UK. And that really has created a big issue, and probably we're still to feel the full repercussions of that. So you know, obviously for the refugee doctors it's not a problem because if they're refugee status, they have the same rights as a British citizen; so they don't need a work permit, so it's not a problem. But for other overseas qualified doctors it's now much, much more difficult to get in and get a training post in this country. (UK Government Stakeholder S1)

Fairness takes on a different dimension when the situation of refugees is considered:

When we talk to refugee doctors and you ask them "Is it fair?" I mean, that's one of the questions I actually do ask them. ... And they'll say, "Of course it's fair," and it's the fundamental reason about why they fled their home countries. You know, "They haven't been through what we've been through," you know, "They can go home," you know, "They don't worry about families they've left behind." ... So basically, it's a psychosocial element of being a refugee versus being an economic migrant. (UK Government Stakeholder 3)

Undoubtedly, tension and competition occur between and within groups when competing for scarce resources. Nevertheless, this dynamic exacerbates the precarious position of refugees and further fuels resentment and discrimination:

What's very clear is the whole stigma of being known as a refugee doctor is very high, and so there's kind of like - again, this decision about when you use the refugee card and when you don't. You know, sometimes it opens doors and sometimes it doesn't. (UK Government Stakeholder 3)

The importance of context cannot be overstated. In the UK there have been some unintended consequences despite good intentions. Owing to a variety of circumstances involving changes to medical training, coupled with an underestimation of the number of applicants applying for medical training positions and an overabundance of entry-level doctors in the UK, there has been stiff competition for entry-level jobs. This situation has exacerbated the difficulties facing refugee doctors, undermined the accomplishments of integration initiatives and programs, and culminated in the creation of the "unemployed box" where "a lot of these people got a huge amount of help. But at the end of the day what it didn't give them was jobs. It made them job-ready." (UK Medical Stakeholder 3)

Discussion

Overall, the central barriers to integration are illustrative of those identified by other scholars who have examined the employability of refugees ( Ager and Strang 2008; Beiser and Johnson 2003; Bloch 2007; Charlaff et al. 2004; Krahn et al. 2000; Lamba 2003) and, more specifically, refugee and asylum-seeking internationally educated health professionals ( Baumann et al. 2006; Blythe and Baumann 2009; Jeans et al. 2005; Krahn et al. 2000). Unlike previous studies, this comparative analysis emphasizes how two destination countries confront and manage the economic integration of refugees in distinctly different ways. Economic integration is not only fundamental to successful overall integration; it is the first step in the initial phase of integration, as employment influences "economic independence, future plans, socialization, language skill development, self-esteem and self-reliance" ( Ager and Strang 2008: 166).

Also crucial to integration is language proficiency, but it remains one of the most formidable barriers to employability ( Bloch 2007; Henin and Bennet 2002; Hyndman and Walton-Roberts 2000; Krahn et al. 2000). Although language proficiency ultimately rests with the individual, how proficiency is attained and to what degree, and how such competence is determined is more complex. This study supports research indicating that professionals often need to improve profession-specific language competency ( Bloch 2007; Krahn et al. 2000; Blythe and Baumann 2009) and that although some refugee doctors and nurses may have completed their training in the host country's official language ( Stewart 2003) this instruction may not make them proficient ( Blythe and Baumann 2009; Smith et al. 2007).

Recognition and proof of credentials are essential to moving through the registration process, and for refugees, this is where the process is particularly challenging. Stakeholders in both countries recognize the barriers facing refugee doctors and nurses, the limitations of existing initiatives and programs, and ways to assess competencies. There is a stark contrast in the way that the UK has politicized and explicitly confronted the integration of refugee and asylum-seeking health professionals ( Athwal and Bourne 2007; Hubbard 2005) and Canada's relatively silent response (see Blythe and Baumann 2009).

In the UK, government investment in health and immigration infrastructure through a nationally directed effort contributed to the notion of a "win--win" situation, although there is less evidence to support the notion of "win" on the part of the refugees. Alternatively, Canada has lagged behind in explicitly acknowledging the potential of refugee health professionals apart from other internationally educated health professionals. Unlike the UK trajectory, there are no infrastructure changes on the horizon and no injection of federal or provincial funds in this regard in the foreseeable future.

These conditions are coupled with signs of insensitivity or neglect on the part of some policy communities with respect to the unique circumstances facing refugees. Internationally, the humanitarian responsibilities of both countries are undermined through increasingly restrictive immigration policies. At the national and local levels such policy serves to isolate rather than integrate refugee health professionals. Certainly there is more work to be done in this area, but broader contingencies - such as the current global recession and continued political unrest - further jeopardize what has already been achieved.

Overall, this paper contributes to our substantive understanding of how immigration and HHR policies do or do not intersect to shape the economic integration of refugee healthcare professionals in the UK and Canada in distinct ways. Such cross-national comparisons are lacking in the current literature. Conceptually, broadening the analytical concept of "employability" contributes to a more comprehensive understanding of not merely the initial but rather the fundamental and complex challenges impeding the successful economic integration of refugee healthcare professionals and, indeed, immigrant refugees more generally.

In conclusion, recognizing that refugees have unique issues and may need different and additional forms of support poses further challenges to policy developers and service providers. As a number of stakeholders have pointed out, reforming and implementing innovative initiatives may require program redesign, increased personnel, greater financial investment and a move away from traditional ways of teaching and testing skills and knowledge toward more refugee-tailored approaches. "Managing" the expectations of refugees and streaming those who are unable to meet system requirements towards a "realistic" career path translates into directing refugee health professionals into underemployment. Greater sensitivity regarding refugees, as well as commitment with respect to improving how early integration is handled, is necessary. Early intervention, along with sustained effort, can improve refugees' chances of economic integration.

Contributor Information

Yvonne Leblanc, Instructor, Department of Health, Aging, and Society, McMaster University, Hamilton, ON Instructor, Department of Sociology, Wilfrid Laurier University, Waterloo, ON.

Ivy L. Bourgeault,, Professor, Faculty of Health Sciences, University of Ottawa, Scientific Director, Population Health Improvement Research Network University of Ottawa, Ottawa, ON.

Elena Neiterman,, Postdoctoral Fellow, Department of Sociology, University of Toronto, Toronto, ON.

References

Adams, E., Kennedy A. "Positive Practice Environments Key Considerations for the Development of a Framework to Support the Integration of International Nurses." International Centre on Nurse Migration. 2006:1-67. [Google Scholar]

Athwal, H., Bourne J. "Driven to Despair: Asylum Deaths in the UK." Race & Class. 2007;48(4):106-14. [Google Scholar]

Blythe, J., Baumann A. "Nurse Migration to Canada: Pathways and Pitfalls of Workforce Integration." Journal of Transcultural Nursing. 2009;20(2):202-10. [[PubMed] Google Scholar]

Charlaff, L., Ibrani, K., Lowe, M., Marsden R., Turney L.2004Refugees and Asylum Seekers in Scotland: A Skills and Aspirations Audit Edinburgh: Scottish Executive and Scottish Refugee Council; Retrieved July 16, 2013. <[http://www.scotland.gov.uk/Publications/2004/03/19169/35275> Google Scholar]

Clements, L.M. "Asylum in Crisis, an Assessment of UK Asylum Law and Policy Since 2002: Fear of Terrorism or Economic Efficiency?" Web Journal of Current Legal Issues. 2007:1-26. [Google Scholar]

Raghuram, P. "Interrogating the Language of Integration: The Case of Internationally Recruited Nurses." Journal of Clinical Nursing. 2007;16:2246-51. [[PubMed] Google Scholar]

Stewart, E.2003"A Bitter Pill to Swallow: Obstacles Facing Refugee and Overseas Doctors in the UK." New Issues in Refugee Research 96Geneva: UNHCR Evaluation and Policy Analysis Unit; Retrieved July 16, 2013. <[http://www.unhcr.org/3fbb94a32.html> Google Scholar]

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Comparing Approaches to Integrating Refugee and Asylum-Seeking Healthcare Professionals in Canada and the UK

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Language: English | French In this paper, we examine barriers to the integration of refugee doctors and nurses in Canada and the United Kingdom. Key obstacles impeding the integration of internationally trained health professionals are well documented, but less attention has been paid to the integration of refugee health professionals, particularly in Canada.

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Hatton, T. J. (2005). Explaining trends in UK immigration. Journal of Population Economics, 18(4), 719-740.

Evaluation

Authority:  Hatton is a lecturer at the University of Essex in the faculty of Economics. Based on the author's area of speciality, the paper highlights some of the causes of UK change from not emigration to net immigration.

Reliability: The research involved in the article is an economic model that compared the income home of some of the immigrants and what they earn when they come to the UK.

Currency: Even though the article was published in 2005, it presents crucial information on immigration trends in the country.

Objectivity: The article helps to understand the cause of net immigration into the country. The overall changes are explained using economic forces that attract more people into the UK.

Academic Conventions: The article is academic

Usage Implications: the article gives a differing sense of the factors that prompt migration into the UK compared to the rest of the country.

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Green, L. (2017). The History of Immigration to the UK. Migration Watch.

Evaluation

Authority: The newsletter was published by Green, an expert in migration issues in the UK.

Reliability: The publication uses data from public records that detail the trends in migration into the UK. For this newsletter, the migration into the U is dated back to during the Roman Empire and compared to the more accurate records of the 20th century.

Currency: The newsletter was published in 2017, and even though it does not offer the most recent immigrating data dating a year or less, it offers valuable information based on immigration history.

Objectivity: The newsletter offers valuable insights into immigration trends in the UK that can help to understand the current situation in the country. The trends help in comparing the UK immigration history with that of Canada.

Academic Conventions: The Newsletter is not academic.

Usage Implications: The trend and history of the UK's immigration help in comparing the UK immigration history with that of Canada.

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The claim that the UK is a 'nation of immigrants' is misleading. For nearly a thousand years there has been relatively little net migration to the UK.

The huge scale of non-British immigration in the past two decades or so (running at over 500,000 per year, of which about 300,000 per annum have been long-term net arrivals) is totally unprecedented in our very long history.

In 1951 less than 4% of the population of England and Wales were foreign-born. This proportion had doubled to 8% by 2001 and nearly doubled again to 15% in 2016. Far from being in our DNA, mass immigration is a very recent phenomenon.

Previous episodes of immigration have been on a relatively small scale by comparison - in the 17th and 18th centuries about 50,000 French Huguenots arrived in Britain over a 40-50 year period.

Jewish refugees fleeing Russia, Eastern Europe and Germany arrived in Britain during the 19th and 20th centuries. Around 200,000 arrived over a 50-year period, averaging 4,000 per year.

The turning point was a major change in policy by the Labour government in the late 1990s. In the 13 years that they were in office, between 1997 and 2010, net migration to the UK by non-Britons totalled over three million.

Since the Conservatives took office in 2010, net migration to the UK by non-Britons has totalled 2.7 million.

Today, the non-UK born population stands at 9.4 million (2018/19, Office for National Statistics).

In 2018, the BBC withdrew a video on the history of immigration, which was aimed at teaching 14 to 16 year olds, after we wrote to them pointing out a number of problems with it (see our piece).

1. From the first millennium until the Second World War, episodes of immigration were quite small and usually demographically insignificant. Britain is certainly not "a nation of immigrants" as some claim and immigration on the recent and current scale is a new phenomenon.

2. We can measure historic immigration by looking at Census records. The Census first began to record people's country of birth in 1851. Estimating the size of the foreign-born population before that is much more difficult. However historical records do give us some idea as to the scale of immigration.

3. In 1964 the International Passenger Survey was established and, in 1991, a more sophisticated measurement of immigration called the Long Term International Passenger Migration estimate was put in place. These allowed migration to and from the UK to be monitored on an annual basis.

Pre-History

4. The history of Britain before the Roman invasion is known as pre-history as we lack written records before the Roman invasion. However we know from archaeological and palaeontological evidence that the area now known as Britain has been inhabited for almost one million years. Those early populations of hunters were small and transient, as successive ice ages made the land periodically uninhabitable. Britain may only have been continuously inhabited for the last 12,000 years.

5. About 10,000 years ago the inhabitants of Britain began using the land for agriculture; some theorise that this was as the result of a migration. During the Roman Occupation, which began 2,000 years ago, the population of Britain was about 4-5 million. While there was undoubtedly some migration to the UK, it is probable that the population remained overwhelmingly indigenous. There were probably about 125,000 migrants in the UK during the Roman Occupation, or about 3% of the overall population.

Post Roman Occupation

6. After the end of the Roman Occupation, Britain's population fell markedly, perhaps to as little as 1.25 million. In this period, Britain experienced invasions and settlement by Germanic tribes but their size and scale are contested. Some historians believe that the number of Anglo Saxons that came to the UK was relatively small, while others argue that there was a large-scale migration of Germanic people. The modern view is that the numbers were relatively large. Subsequent settlements from Viking invasions may have made up as much as 4%-8% of the total population. Some historians argue that the Norman Conquest of 1066 resulted in little migration to Britain, while others believe that Norman settlers eventually made up as much as 5% of the population.

7. The Middle Ages saw very small migrations; one of these was of Jewish people, who were later expelled from England in 1290. Quite sizable numbers of Flemings also came at this time. England's rise as a trading power in the sixteenth century was arguably the start of contemporary migration to Britain. However, this did not result in large-scale migration as we know it today; in 1610 it was estimated that only 10,000 of London's 300,000 people were born abroad.

8. Over the next couple of centuries, small numbers of Europeans, Africans and Asians came to Britain. For example, it is estimated that there were about 10,000-20,000 Africans living in Britain in the eighteenth century, with some outlying estimates of 30,000. Jews returned to Britain under the Protectorate (1653-1659), when England and Wales, Ireland, Scotland, and the English overseas possessions were governed by a Lord Protector as a republic. By 1734, it was estimated that there were around 6,000 Jewish people living in England and in 1800 around 15,000-20,000. This population was joined by other migrations over time. At the end of the 19th century a larger wave came from Tsarist Russia and Eastern Europe. Another wave from Nazi Germany came in the 1930s - with perhaps as many as 100,000 coming.

9. It is estimated that by 1700, about 50,000 Huguenots (French Protestants) had settled in England making up as much as 1% of England's total population in 1700. The eighteenth century also saw German refugees known as 'Poor Palatines' arrive in Britain, with perhaps as many as 13,000 arriving.

10. By the 1901 Census there were 82,844 Eastern Europeans living in Britain. Small numbers of people came from Asia to Britain - there were perhaps a few hundred at the start of the 20th Century. The 1901 census showed that there were just 387 Chinese nationals in Britain. There was also some movement to and from Britain's colonial Empire. Many of those that came to live in Britain were the decedandnts of British settlers to Australia, New Zealand, Canada and South Africa. In the eighty years between 1851 and 1931, the population born abroad increased by only about one million.

Post World War Two

11. After the Second World War, the pace of immigration increased considerably. For example, thousands of Poles, many of whom had fought for Britain in the Second World War, were offered British citizenship in 1947. The 1951 census recorded 162,339 Poles living in Britain. Britain also introduced a guest workers scheme after the war that enabled quite large numbers of other Eastern Europeans to come to Britain.

12. The Government introduced the British Nationality Act of 1948, which granted subjects of the British Empire the right to live and work in the UK. This was primarily intended to strengthen ties with the Dominions. The view of the government was that labour needs were mainly to be satisfied by those from Ireland and by 'European Voluntary Workers' - the closest thing to 'guest workers' that the UK has ever had. The Attlee government actually looked for ways of stopping the Empire Windrush or diverting it elsewhere. Direct recruitment from the West Indies came a bit later, on the initiative of the NHS, London Transport and others. Only about one in ten new Commonwealth migrants came to a specific job. From 1962, tighter restrictions were put in place, but migrants from the Commonwealth continued to come.

13. In the eighty years between 1851 and 1931, the population born abroad increased by only about one million. It increased slowly after the Second World War, growing by less than two million in the forty years between 1951 and 1991. As Figure 1 below shows the annual level of net migration since the 1960s.

Figure 1: Level of annual net migration to the UK (thousands) - Office for National Statistics (Figures incorporate latest adjustment as of February 2020 - see ONS note).

1997 to the present day

14. In the late 1990s the pace and scale of migration increased to a level without historical precedent. Indeed, between 2001 and 2018 the foreign-born population doubled from 4.6 million to more than nine million. Part of the reason for this huge upturn in migration is that under the Labour Government of 1997-2010 immigration controls were relaxed. Over that period, net foreign migration totalled 3.6 million. This was the result of deliberate policy changes rather than changing patterns of migration or globalisation. The massive increase in the level of migration after 1997 is totally unprecedented in the country's history, dwarfing the scale of anything that went before.

15. Ahead of the 2010 general election the Conservatives campaigned on a pledge to reduce net migration to the tens of thousands. However, immigration reached record levels under the Conservatives. A Conservative-Liberal Democrat coalition was formed and during David Cameron's period in office the system of non-EU migration underwent significant reform in an attempt to reduce its level. However, migration from the EU continued beyond the control of the UK government. Despite lacklustre efforts to reform the non-EU system and restrictions on benefit provision for newly arrived EU workers, net migration continued at very high levels. Since 2010, 2.2 million long-term net migrants have come to the UK from overseas.

16. The UK left the EU on 31 January 2020. This gives the power to the government to end free movement from the EU. While its published immigration plan may reduce low-skilled migration from Europe, there is also a strong risk that it will significantly increase work immigration from outside the EU. This is something that should be avoided in the context of the economic shock and rising unemployment resulting from the Coronavirus lockdown.

17. The graphs below show the change in the share and number of non-UK born in the total population since 1851.

Figure 2: Share of UK population that was born abroad. Details from Census 1851-2011 (no census carried out in 1941) and Office for National Statistics.

18. To explore this topic in more depth please see our full History of Immigration paper. To read more about the Labour Government of 1997-2010's impact on immigration click here for an analysis of the Conservative government's record on immigration between 2010 and 2015.

Updated 23 April, 2020

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The claim that the UK is a 'nation of immigrants' is misleading. For nearly a thousand years there has been relatively little net migration to the UK. The huge scale of non-British immigration in the past two decades or so (running at over 500,000 per year, of which about 300,000 per annum have been long-term net arrivals) is totally unprecedented in our very long history.

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Dempster, H., Leach, A., & Hargrave, K. (2020). Public attitudes towards immigration and immigrants. ODI: Working Paper 588.

Evaluation

Authority: Amy Leach is a senior communications officer at the ODI Organization in the UK. In collaboration with other senior editors at the organization, their work to unearth the public attitude towards refugees and migrants is important.

Reliability: The online article captures the public attitude among people living in the UK. Therefore, the article uses credible sources of information on how the UK people treat immigrants and refugees in the country.
Currency: The online article was published in 2020, making it an up to date source of the attitude of the UK local people towards the refugees in the country.

Objectivity: The article gives some valuable information on why the local people in the UK react differently to different immigrants.

Academic Conventions: the article is not academic and is published on a website.

Usage Implications: The article helps to understand varying views of the local people and what makes some of the local hate or love some of the immigrants.

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Boyd, M. (1976). Immigration policies and trends: A comparison of Canada and the United States. Demography, 13(1), 83-104.

Evaluation

Authority: The journal article was authored by Monica Byd, an expert working in the department of sociology/anthropology at Carleton University in Canada. The article was also published by Duke University Press, to warrant its validity as a credible source of information.

Reliability: The article discusses migration into Canada and the US and compares the data to establish some of the notable trends that were imminent back in the 1960s. Arguably, the trends have continued in the recent past, and the policies regulating immigration have remained in play over the years.
Currency: Even though the paper was published in 1976, the paper offers valuable insights into the trends of migration to Canada during that time.

Objectivity: There was a need to evaluate the history of immigration into Canada. Such information would help establish the immigration trends at the time and how it has changed in the following years. Therefore, the information offered by the article is helpful in establishing the immigration trends into Canada.

Academic Conventions: The paper is an academic journal article.

Usage Implications: The paper offers great value in the history of immigration into Canada. Therefore, the article will help to understand the trends of immigration into Canada map out some of the factors that have predisposed the current immigration policies set by the government.

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Immigration Policies and Trends: A Comparison of Canada and the United States on JSTOR

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This paper discusses recent migration to North America with reference to the 1962 and 1967 Canadian immigration regulations and the 1965 United States Immigration and Nationality Act.

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Blinder, s., & Richards, L. (2021). UK Public Opinion toward Immigration: Overall Attitudes and Level of Concern. Migration Observatory.

Evaluation

Authority: The publication was prepared by the Migration Observatory at the University of Oxford. Therefore, the publication is supported by research conducted by the university research branch.

Reliability: The briefing is based on a survey conducted in Britain, where four questions were involved. Therefore, the briefing is not based on speculation but on a conducted inquiry.

Currency: The report was published in 2021, and it addresses some of the more recent aspects of migration, such as immigration data as of 2019. Therefore, the information is up to date and relevant to the current paper.

Objectivity: The paper provides detailed insights into the perceptive and view of adults in Great Britain. Therefore, the data provided gives an objective insight into the views of the local people in the UK.

Academic Conventions: The briefing is not academic.

Usage Implications: Understanding the view of the local adults in Great Britain in matters regarding immigration is important for it helps understand some of the policies that the country's government has made towards immigration.

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Public opinion on migration in the United Kingdom is divided

Existing evidence shows that public opinion is divided when it comes to migration. However, the level of opposition is remarkably different depending on whether we ask respondents if they think that immigration is a good or a bad thing for Britain compared to when they are asked whether the migration inflows to the UK should be increased, reduced or remain the same. In April 2023, 32% thought immigration was a very bad or a bad thing, while 52% thought their numbers should be reduced (a little or a lot) (Figure 1). These differences likely reflect the fact that people are thinking about different phenomena (current immigration inflows vs. overall impact of immigration) for each of the two questions.

Figure 1
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Preferences for reduced migration are not new but appear to have softened in recent years

Opposition to the arrival of immigrants in the UK is not new. Rising concern about 'New Commonwealth' immigration prompted the British Election Study (BES) to begin asking the public about immigration as far back as 1964, although in those early years, it did not ask the question to ethnic minority respondents. Throughout this period, the majority of people in Britain agreed that there were too many immigrants in the UK.

Figure 2 looks at trends in opposition to immigrants/immigration; however, the variety of available data sources and the changes to question-wording over the years mean this cannot be seen as one coherent continuum. The data points derived from BES show that opposition to immigration was high in 1964, 1966 and 1979, with 85-86% of people at each of those times reporting that there were too many immigrants in Britain. The data points from 1983 and 1987 were based on slightly different question wording to the rest ('Do you think that immigration has gone too far?'), so we need to consider these with caution. However, the earlier question ('Do you think that too many immigrants have been let into this country or not?') was brought back in 2015 when the percentage agreeing that there are too many immigrants had dropped to 71%, then to 66% in 2017, and by the most recent general election in 2019, it had dropped further to 52%.

The series from Ipsos data goes back to 1989. Here too, we have reason to be cautious in interpreting some of the results as the response options in most years included a 'neither agree nor disagree' answer category, but for some years, it did not. Answers tend to be less favourable where there is no neutral answer option, and this may explain the spike in 2012, for example. Nonetheless, consistent question wording from 2013 to 2017 suggests that there was a change of attitudes over this period, with just 45% agreeing that there were too many immigrants in 2017 compared to 64% just four years earlier. We include a second series using Ipsos data, which runs from 2015 to 2022, and Kantar data for 2023. Both Ipsos and Kantar asked the public whether they thought that the number of immigrants coming to Britain should be increased or reduced. Data shows that there was a softening of attitudes from 2015 to 2022, with the percentage saying that immigration should be reduced dropping from 65% to 42% over these seven years. However, there has been a recent increase in the share of people saying that immigration should be reduced (from 42% in 2022 to 52% in 2023), which may be the result of the increase in political salience of immigration-related issues, as discussed further below.

Finally, Figure 2 also shows the trend from the European Social Survey, which asked a rather different question about whether people of a different race or ethnicity should be allowed to come and live in Britain. This series provides corroborating evidence for the softening of attitudes we observed in the other data series. While the level allowing only 'a few' or 'none' was consistently hovering at around 50% between 2002 and 2012, it had dropped to 43% in 2014, 32% in 2016, 26% in 2018, and 19% by 2021.

Figure 2
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Concern about immigration declined after the 2016 Brexit Referendum, but salience may be on the rise again

Another way to monitor public views on immigration is by asking people to name the 'most important issue' or 'issues' facing the nation. This approach assesses the salience of immigration as an issue rather than directly measuring people's attitudes toward immigration. Ipsos conducts a monthly poll asking respondents first to name the most important issue, and after they reply, they are asked to name any 'other important issues'. Unlike the other survey questions reported here, respondents are not prompted with particular topics they simply reply with whatever comes to mind. After assigning each response to one of 47 categories, Ipsos reports how many respondents chose each of these categories for each monthly sample.

Figure 3 tracks the percentage of respondents naming 'race relations' or immigration as one of the most important issues facing Britain relative to five other frequently named (and long-running) issues. These other issues are presented as six-month moving averages to make the chart easier to visually interpret.

In the year before the EU referendum, between June 2015 and June 2016, immigration was consistently named as the most salient issue facing the country, peaking at 56% in September 2015. In 1994, which was the starting point of this data series, less than 5% of respondents thought of immigration as a concern, and it remained rarely mentioned prior to 2000. The increasing rate of immigration from the EU since the accession of the "A8 countries" to the EU was accompanied by a clear change in public mood between 2001 and 2016.

During the month of the EU Referendum in June 2016, 48% of people mentioned immigration as an important issue; however, immigration steadily declined in salience and was mentioned by increasingly fewer people in the years that followed. There was a corresponding spike of concern about Europe, but this also declined steeply after the transition period came to an end. By mid-2018 and for all of 2019, immigration was mentioned by fewer than 20% of respondents. It is perhaps not surprising that by April 2020, people were mainly concerned about the coronavirus pandemic and immigration was mentioned by just 5% of participants. Concern about the pandemic (which we do not show in the graph due to its relatively short-lived salience) displaced other concerns throughout 2020 and 2021.

From the second half of 2022, however, immigration has been gaining salience once more, with 21% mentioning immigration in June 2023. During this period, immigration has been prominent in the news, with record net migration figures hitting the headlines as well as irregular immigration and the issue of housing asylum seekers featuring large in the political agenda.

Other recent trends include a spike in the share of people mentioning defence coinciding with the onset of war in Ukraine and over 40% mentioning the economy as the cost-of-living crisis made itself felt during the winter of 2022/23. Note that respondents can name more than one issue if they want to, and the totals come to more than 100%.

Figure 3
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How do British attitudes towards immigration compare to elsewhere?

Figure 4 shows two different measures from the European Social Survey for 12 countries: the first shows the percentage of people saying that a few or no immigrants of a different race/ethnicity should be allowed. At 19%, the UK was among the least anti-immigration of these 12 countries in 2021, and only the public opinion from Norway was more favourable. The least favourable views towards immigrants of a different race/ethnicity are seen in Hungary and the Czech Republic. Note, however, that this question combines attitudes to immigration and 'race relations'.

Figure 4

As a further way of characterising countries, we include a second measure based on people's views on whether immigration 'makes the country a better or worse place to live'. However, is less optimistic about the impact of immigration than the public opinion of other countries such as Iceland (5%), Norway (11%), Switzerland (12%), and Ireland (13%). It is similar in its average views to the Netherlands and more favourable than the Eastern European countries.

These two measures can be thought of as capturing opinions on future migration flows and current population stocks. In all 12 countries, it appears that people are more negative towards the idea of continuing flows than about the immigrants already present. Finland, for example, is a country where 48% of the public would prefer few/no immigrants of another race coming to live there, whilst, at the same time, just 19% think immigrants make the country a worse place to live.
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Preferences for different types of migrant: origin, similarity, skill level

More specific questions in surveys have revealed that preferences depend on the type of immigrant in question. The 'type' of immigrant can be considered in terms of country of origin (which implicitly provides information on religion, language, culture and other indicators of 'social distance') but also in terms of the migrants' skill levels.

British people make clear distinctions between migrants based on their country of origin - see Figure 5. In 2017, just 10% said that no Australians should be allowed to come and live in Britain, compared to 37% saying that no Nigerians should be allowed. In between are migrants from France (similar to Australia), Poland (more middling), and Romania and Pakistan (more similar to Nigeria). Such patterns have sometimes been described as an 'ethnic hierarchy' [2]. At the preferred end of the scale are those who are white, English-speaking and from European and Christian countries, while the least preferred are non-white migrants from non-European or Muslim countries. Romania is an interesting anomaly. Despite being a European and Christian country, opposition to immigration from Romania is at similar levels to opposition to immigration from Pakistan. This may reflect an association with the Roma minority [3].

Figure 5

Country of origin is not the only factor that people take into account when considering preferences on immigration. In the European Social Survey 2014, British respondents reported how many immigrants should be allowed based on a question that specified both the country of origin (Poland or India) and the skill level (professional or unskilled labourer). The results revealed that when migrants are professionals, opposition is low, and when migrants are unskilled, opposition is high (Figure 5). Research has shown that people's general preference for high-skilled over low-skilled migrants is mainly driven by perceptions of their higher economic contribution [4].

Further, when asked about professional migrants, British people do not appear to distinguish between countries of origin. Just 5% say 'allow no professionals' from India and 6% for Poland. When it comes to unskilled labour migration, there is a slight preference for people from Poland (35% 'allow none') over people from India (42% 'allow none'). Therefore, figures showing average opposition towards immigration from Poland (21%) mask variation depending on skill level (6% for skilled, 35% for unskilled).

The preference among the British public for highly skilled migrants aligns with previous research indicating that, when questioned about the criteria for incoming migrants, skills are considered more important than other factors such as race/ethnicity and religion [5]. People also make distinctions based on specific occupations and on asylum seeker status - although here, too, the public distinguish by country of origin, as we show below.
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As of April 2023, 37% of people thought that the arrival of asylum seekers should be made more difficult, but only 14% wanted to do so for Ukrainians fleeing conflict

Attitudes towards asylum seekers tend to be more restrictive compared to other groups of people moving to the UK. In April 2023, 37% of the British public said that migration to the UK should be made more difficult for asylum seekers, while this share was lower for Ukrainians (14%), Hong Kongers (21%) and Afghans (30%) (Figure 6). The UK Government's policy towards Ukrainians fleeing war and Hong Kongers leaving Hong Kong after the passing of China's National Security Law is more generous than towards other people escaping conflict, including Afghans. People from Ukraine and Hong Kong can freely apply to bespoke visa schemes, while people seeking asylum must first cross to the UK, often irregularly, to be able to apply for asylum.

Admission preferences towards international students, EU nationals and people coming on family visas are relatively liberal, with more people in favour of making their migration to the UK easier rather than difficult (Figure 6).

Figure 6
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Over a third of people (36%) think that the migration of low-skilled workers to the UK should be made more difficult, but people have more liberal views when asked about migrants in specific jobs that are considered low-skilled, including care, farm and construction workers

As discussed above, research has shown that public opinion is generally more positive towards migrants with high levels of education or who work in occupations considered high-skilled than towards migrants with lower levels of education or who work in low-skilled jobs [6]. In April 2023, over a quarter of the British public thought that the migration of low-skilled workers should be made more difficult, while this share was of 8% for high-skilled migrant workers (Figure 7).

When people are asked about their preferences for the admission of migrants coming to specific low- and high-skilled jobs, the picture is more complex. The share of people in favour of easing the migration of care, agricultural and construction workers was 54%, 45%, and 38%, respectively, despite the fact that these jobs are often considered low-skilled. By contrast, the share of people in favour of easing the migration of financial sector workers was only 27% despite the fact that these are high-skilled migrants. People's views about the skill level required to perform a particular job do not necessarily match those of governments and research agencies. Government policies, including labour immigration policies, mostly consider the credentials or level of education required to perform a certain job as the main criteria to classify occupations as low, medium or high-skilled. That is why jobs such as care and agricultural workers are considered low-skilled. In addition, people may consider factors other than skill level, including the social value of workers in certain jobs, such as doctors or teachers.

Figure 7
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Younger people and people with university degrees tend to express more positive attitudes towards immigration than older people and people with lower levels of education

Finally, we focus on how attitudes towards immigration vary between different types of people. We show, in Figures 8 and 9, how opinions vary by age, education, and political preferences. Compared to people over age 45, younger people are less likely to say that immigration is a bad or very bad thing for Britain (25% vs. 4) and that the number of immigrants should be reduced (40% vs. 58%) (Figure 8). Research shows that people do not become more negative towards immigration as they age, as attitudes are quite stable over adulthood [7]. Differences between older and younger people more likely reflect different historical and social contexts in which people have been socialised. For a discussion about the relationship between immigration attitudes and ageing, see Drazanova (2021) [8].

People with university degrees are more likely to think that immigration is a good or very good thing (50%) compared to people with lower levels of education (22%). University-educated people are also less likely to think that immigration should be reduced (37%) than people with lower levels of education (59%). Multiple factors explain why highly educated people tend to express more liberal attitudes towards immigration in surveys, including holding more cosmopolitan [9] or nationalistic views [10], being more susceptible to social desirability bias (that is, hiding their views when these are not socially acceptable) [11] [12], or being less affected by labour market competition with migrants [11]. Note that there is some overlap between people's age and level of education; for example, among those above 54, 24% have a university degree, while this share is higher (37%) among younger people.

Figure 8

Labour voters tend to express more positive attitudes towards immigration than Conservative voters

People who voted Labour in the 2019 General Election are more likely to say that immigration is a good or very good thing for Britain (48%) compared to Conservative voters (19%) (Figure 9). Labour voters are also less likely to say that immigration numbers should be reduced (37%) than people who voted Conservative (74%). There is a correlation between age -- which, as discussed earlier, is one of the main factors associated with immigration attitudes -- and voting behaviour. Conservative voters are, on average, older than Labour voters, and older people are more likely to vote Conservative than younger people.

Brexit is still a major divide in British Society. Leave voters and remain voters had different visions for the future of the United Kingdom, and immigration played a key role in those visions. People who voted remain in the EU Referendum are, on average, more socially liberal and pro-immigration, while leave voters are more socially conservative and anti-immigration. It is now also well established that older people tend to be less favourable towards immigration and more likely to have voted for Britain to leave the EU, while those with more education are more pro-immigration and more likely to have voted remain [12]. Based on the Migration Observatory's 2023 online survey with Kantar, there is a substantial overlap between voting patterns at the 2019 General Elections and the EU Referendum in 2016. For example, 63% of Labour voters voted for Remain, while 23% of Conservative voters did so (note this is based on self-reported data on past voting behaviour).

Figure 9

Evidence gaps and limitations

Some of the evidence base comes from questions about 'immigrants' or 'immigration', terms which are defined vaguely or not at all and likely to be envisioned differently in the minds of different respondents [1]. While official government statistics on net migration define a long-term international migrant as anyone who comes to the UK to stay for at least one year, it is not clear whether or how the public distinguishes migrants from others such as short-term visitors, naturalised British citizens, children of migrants who are native-born British, and ethnic or religious minorities generally. Furthermore, in a media environment that often conflates categories such as refugees, asylum seekers, and migrants [13], there is a danger that survey respondents' expressed opinions are based on an image of immigration that highlights only a subset of the full array of migrants to the UK.

Endnotes

[1] Blinder, S. (2015). Imagined immigration: The impact of different meanings of 'immigrants' in public opinion and policy debates in Britain. Political Studies, 63(1), 80-100.

[2] Ford, R. (2011). Acceptable and unacceptable immigrants: How opposition to immigration in Britain is affected by migrants' region of origin. Journal of Ethnic and Migration studies, 37(7), 1017-1037.

[3] Allen, W. (2014). Bulgarians and Romanians in the British National Press, Migration Observatory Report, University of Oxford.

[4] Igarashi, A., Miwa, H., & Ono, Y. (2022). Why do citizens prefer high-skilled immigrants to low-skilled immigrants? Identifying causal mechanisms of immigration preferences with a survey experiment. Research & Politics, 9(2).

[5] Heath A and Richards L. (2018). Contested boundaries: consensus and dissensus in European attitudes to immigration, Journal of Ethnic and Migration Studies, 46:3, 489-511.

[6] Ford, R., and Mellon, J. (2020). The skills premium and the ethnic premium: a cross-national experiment on European attitudes to immigrants. Journal of Ethnic and Migration Studies, 46(3), 512-532

[7] Kustov, A., Laaker, D., & Reller, C. (2021). The stability of immigration attitudes: Evidence and implications. The Journal of Politics, 83(4), 1478-1494.

[8] Drazanova, L. (2021). Are older people more hostile towards immigrants? Migration Policy Centre Blog, EUI Robert Schumann Centre.

[9] Igarashi, H., & Saito, H. (2014). Cosmopolitanism as cultural capital: Exploring the intersection of globalization, education and stratification. Cultural Sociology, 8(3), 222-239.

[10] Lee, B. (2023). Educational Content, Exclusive National Identity, and Anti-Immigrant Attitudes. Journal of Politics. Available online

[11] Hainmueller, J., & Hopkins, D. J. (2014). Public attitudes toward immigration. Annual review of political science, 17, 225-249.

[12] Hobolt, Sara B. (2016). The Brexit vote: a divided nation, a divided continent. Journal of European Public Policy, 23 (9), 1259-77.

[13] Baker, P., Gabrielatos, C., Khosravinik, M., Krzyżanowski, M., McEnery, T., & Wodak, R. (2008). A useful methodological synergy? Combining critical discourse analysis and corpus linguistics to examine discourses of refugees and asylum seekers in the UK press. Discourse & Society, 19(3), 273-306.

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UK Public Opinion toward Immigration: Overall Attitudes and Level of Concern - Migration Observatory

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This briefing provides an overview of attitudes toward immigration in Britain.

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Bhugra, D., & Becker, M. A. (2005). Migration, cultural bereavement, and cultural identity. World Psychiatry, 4(1), 18-24.

Evaluation

Authority: The article was published by Dinesh Bhugra1, a member of the Section of Cultural Psychiatry, Institute of Psychiatry, De Crespigny Park, London, UK, and Matthew Becker, Department of Psychiatry, Southern California Permanente Medical Group, San Diego, CA, USA. The two authors are recognized psychiatrists who have explored the impact of migration on immigrants' culture.

Reliability: The article uses data from other research works done by authors all over the world. However, their unique perceptive towards immigrants' plight as they attempt to adjust to new life is a valid problem that deserves in-depth analysis.

Currency: The article was published back in 2005. However, the issues raised in the articles are relevant to the current migrators.

Objectivity: The article looks into the various ways in which immigrants are affected by changing their cultural environment.

Academic Conventions: The paper is a special academic article

Usage Implications: The article highlights the immigrants' problems as they settle in a new nation. Therefore, the article offers valuable insights into the various ways that the host nation may help immigrants as they settle.

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Abstract

Migration has contributed to the richness in diversity of cultures, ethnicities and races in developed countries. Individuals who migrate experience multiple stresses that can impact their mental well being, including the loss of cultural norms, religious customs, and social support systems, adjustment to a new culture and changes in identity and concept of self. Indeed, the rates of mental illness are increased in some migrant groups. Mental health practitioners need to be attuned to the unique stresses and cultural aspects that affect immigrants and refugees in order to best address the needs of this increasing and vulnerable population. This paper will review the concepts of migration, cultural bereavement and cultural identity, and explore the interrelationship between these three aspects of the migrant's experience and cultural congruity. The complex interplay of the migration process, cultural bereavement, cultural identity, and cultural congruity, along with biological, psychological and social factors, is hypothesized as playing a major role in the increased rates of mental illness in affected migrant groups.

Keywords: Migration, cultural bereavement, cultural identity, cultural congruity, ethnic density

Mental health practitioners work in an increasingly multicultural world, shaped by the migrations of people of many different cultural, racial and ethnic backgrounds. People migrate for many reasons, including broadly political, socioeconomic and educational. The richness of this diversity of cultures, ethnicity, races and reasons for migration can make understanding experiences and diagnosis of illness challenging in people whose background and experience differ significantly from the clinician. Culture has an important role in the presentation of illness, and cultural differences impact upon the diagnosis and treatment of migrant populations in part due to linguistic, religious and social variation from the clinician providing care. Additionally, it appears that the incidence and prevalence of psychiatric disorders varies among people of different cultural backgrounds due to an interplay of biological, psychological and social factors.

The provision of healthcare is necessarily influenced by the demands of people of many different cultures, but relies on economic, social and political factors, and it is important that cultural differences be appreciated and understood to arrive at a correct diagnostic impression and treatment plan. The migration process itself can be stressful, depending upon the type and cause of migration, and can affect the mental health of migrating individuals and their families. Issues of cultural bereavement and identity occur with increased frequency among migrants and their families. This paper will review these concepts and how they impinge upon mental health and psychiatric care and, by so doing, help the clinician to identify and address these issues in a culturally sensitive way.

MIGRATION

The history of migration to Britain highlights some of the reasons why people migrate. Significant migration to Britain started in the nineteenth century. Irish immigration has been marked by periods of influx and efflux to and from Britain, as people have come to either settle permanently or work temporarily with ultimate return to Ireland as a goal. Eastern European Jews came at the latter part of the nineteenth century to escape both religious persecution and poverty, with additional numbers arriving in Britain both before and after World War II. In the 1960s, employers, especially in urban areas, recruited people from the West Indies to fill low paying jobs which were less attractive to the local population. People from the Indian subcontinent migrated to Britain for educational and economic reasons, the peak of which occurred about the same time as the West Indian migration. Asian people expelled by Idi Amin's government came from Uganda in the late 1970s. The 1980s saw a change in the immigration laws limiting the numbers of people allowed to relocate to Britain ( 4). Today, people from around the globe choose to migrate to the UK as well as other developed countries, both legally and illegally, for better educational and employment opportunities, to escape persecution, to relocate after catastrophic events, including terrorism, disasters and war, and/or to join relatives who migrated at an earlier time.

Migration can be classified in a number of ways; e.g., by the reasons for the migration, the social class and education of the migrating people, the duration of relocation and the geographic distribution of the resettlement. Further, a distinction can be made in the classification of migrants according to whether their contact with the 'majority' or 'dominant' culture is deemed voluntary. Migrants can be classified as immigrants and sojourners when the change in their location results in contact voluntarily, whereas refugees are deemed to change their location involuntarily ( 5). For example, immigrants choose to migrate, and thus be in increased and regular contact with the 'majority' culture in preparation for migration, for potential economic and/or educational advancement, whereas refugees are forced to migrate, and thus be in contact with the 'majority' population involuntarily, to escape persecution. Additionally, rural-urban migration has been associated with economic and educational reasons for relocation, whereas migration across nations has been associated with economic, educational, social and political reasons ( 6).

The process of migration has been described as occurring in broadly three stages. The first stage is pre-migration, involving the decision and preparation to move. The second stage, migration, is the physical relocation of individuals from one place to another. The third stage, postmigration, is defined as the "absorption of the immigrant within the social and cultural framework of the new society". Social and cultural rules and new roles may be learnt at this stage ( 4). The initial stage of migration may have comparatively lower rates of mental illness and health problems than the latter stages, due to the younger age at the initial stage of migration and the problems with acculturation and the potential discrepancy between attainment of goals and actual achievement in the latter stages ( 7). It is worth noting that the stages are often not discrete and merge into one another.

CULTURAL BEREAVEMENT

The DSM-IV notes that the "duration and expression of 'normal' bereavement vary considerably among different cultural groups". A major depressive episode is diagnosed, instead of bereavement, if symptoms of depression are present two or more months after the loss or the following symptoms are present: a) guilt about things other than actions taken or not taken by the survivor at the time of the death; b) thoughts of death other than the survivor feeling that he or she would be better off dead or should have died with the deceased person; c) morbid preoccupation with worthlessness; d) marked psychomotor retardation; e) prolonged and marked functional impairment; and f) hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person. These symptoms are based on a Western construct for the diagnosis of abnormal grief and as such do not take into account different cultural expressions of grief. In many cultures, it is normal to be visited by spirits and ghosts, and people of non-Western culture may describe conversations with supernatural spirits. The importance of placing these expressions of grief in the appropriate cultural context is essential in differentiating between abnormal and normal reactions to loss. Inappropriate diagnoses of psychotic disorders, post-traumatic stress disorder (PTSD) and mood disorders have been made in people of non-Western backgrounds when clinicians ignore cultural differences in the expression of grief. The misdiagnosis and subsequent inappropriate treatment will at best not address the issue for the affected person and, at worst, cause harm.

Bereavement has been associated with psychotic, anxiety and mood disorders; however, this association is complicated due to the misinterpretation of the cultural expressions of grief by Western trained clinicians and the Western diagnostic criteria of psychiatric disorders that may not be applicable in people of different cultural backgrounds. Undoubtedly, people who have migrated due to political upheaval or war may have witnessed or participated in combat and torture; thus, affected individuals may have PTSD and bereavement, as these diagnoses are not mutually exclusive. Culturally appropriate mani- festations and expressions of bereavement may include Western constructs of PTSD and psychosis, including hearing voices, seeing ghosts and feeling the presence of the dead; therefore, it is important to recognize the symptoms of bereavement within the cultural constructs of the affected individual and be open to the possibility of additional psychiatric disorders. Cultural bereavement is an important aspect in the understanding of the migrant's experience. Our hypothesis is that such an experience will be mediated through and influenced by cultural identity. The concepts of individual identity are likely to affect the understanding as well as working through the bereavement process.

CULTURAL IDENTITY

It is important to define basic sociologic terms of identity to understand cultural identity. Culture is learned and passed through generations and includes the beliefs and value system of a society. Culture has been described as features that are shared and bind people together into a community ( 17). Identity is the totality of one's perception of self, or how we as individuals view ourselves as unique from others. Bhugra ( 6, 7) notes that racial, cultural and ethnic identities form part of one's identity, and identity will change with development at a personal as well as at a social level along with migration and acculturation. Social identity can be thought of as the culturally defined personality characteristics, which are ascribed to social roles, such as the role of being a father, mother, friend, employer, employee, etc. Ethnicity is a source of social identity. Ethnic groups are composed of people who may or may not share the same race but do share common cultural characteristics, including history, beliefs, values, food and entertainment preferences, religion and language. Ethnicity typically incorporates both race and culture ( 17). Race is based on biologic constructs, such as sharing certain physical attributes; it may or not be also a social and political construct ( 17). For example, people from the West Indies, Africa and parts of North and South America may share the same race but have different beliefs, value systems, social norms and idioms of distress.

Psychosocial changes experienced by immigrants include assimilation, which can be viewed as a process by which cultural differences disappear as immigrant communities adapt to the majority or host culture and value system. An individual's cultural identity may be lost during the assimilation process as he or she moves within the host society. Acculturation, a process that may be voluntary or forced, requires contact between culturally divergent groups of people and results in the assimilation of cultural values, customs, beliefs and language by a minority group within a majority community ( 8). During the acculturation process, both the immigrant and host cultures may change. Changes in attitudes, family values, generational status and social affiliations can occur in both the majority and minority cultures as the two interact; however, typically one culture dominates ( 7).

Acculturation may help the culturally bereaved individual to gain a semblance of equilibrium. Migrants who experience the loss of their culture and guilt over leaving their homeland may find that, as the acculturation process proceeds, a sense of belonging in their new homeland occurs. The majority culture may seem less threatening and more inviting as the individual becomes more linguistically and socially fluent in this new culture. Social sup- port can ensue in the forms of friendships, employment opportunities, and medical care. Integration and assimilation can help reduce feelings of loss and grief as the migrant starts to incorporate aspects of the majority culture. In acculturation, the interaction of the migrant's culture with the majority culture of the new homeland is a dynamic and reciprocal process that can result in changes in the broader cultural group, enhancing the ability of people of the dominant culture to better appreciate and understand aspects of the immigrant's culture and recognize some of the needs of those who have migrated.

CULTURAL CONGRUITY

Ethnic density, the size of a particular ethnic group in proportion to the total population in a specified area, may be a factor that influences the rates of mental illness in ethnic minorities. Additionally, a sense of alienation may occur if the cultural and social characteristics of an individual differ from those of the surrounding population, whereas a sense of belonging tends to occur if the individual and surrounding population have similar cultural and social characteristics. Bhugra ( 6) writes of the importance of ethnic and cultural congruity, interaction patterns and cultural identity in the genesis and maintenance of mental distress in migrants. Cultural congruity may be thought of as the congruence or dissonance of an individual's culture, beliefs and expectations with the surrounding population. The surrounding population may be made up predominantly of people from the same or different cultural background compared to the migrant. An increase in ethnic density may improve the social support and the adjustment of some individuals who have migrated, yet increase distress in others, in particular if there exists a cultural conflict between the individual and his culture of origin ( 9). This may account for some of the conflicting results from studies of the relationship between ethnic density and the incidence of mental illness in ethnic minority groups. For example, an inverse correlation between the incidence of schizophrenia in non-white ethnic minorities in London and the proportion of those minorities in the local population was found; it was hypothesized that increased exposure to or a lack of protection from stress may increase the rate of schizophrenia in non-white ethnic minorities ( 19); however, a previous study failed to support the ethnic density hypothesis for the increased incidence of schizophrenia in immigrant groups to England ( 20).

In a review of multiple studies, Shah ( 17) found that common mental disorders were more prevalent in people of ethnic minority groups who lived in areas of low density of their own ethnic group. His findings showed that common mental disorders were at least as prevalent in ethnic minority groups as in the indigenous population and, in some ethnic minority groups, more prevalent. Depression may be more prevalent in the Caribbean and African populations compared to the majority population, with phobias more common in Asian groups. Risk factors for common mental disorders in ethnic minority groups include poverty, unemployment, migration before the age of 11, racism, a perceived lack of social support, social isolation, absence of a confidante and absence of parents in law ( 17). The incidence of schizophrenia was higher in an urban area of south-east London compared to rural areas in south-west Scotland, due to the larger proportion of non-white ethnic minority groups living in the urban area compared to the rural area ( 21), with an overall increase in the incidence of schizophrenia in south-east London between 1965 and 1997 ( 22).

It is important to consider the nature of the society an individual has migrated from and to, and the social characteristics of the individual who has migrated, in determining how well a person will adjust during the migration process. Socio-centric, or collectivistic, societies stress cohesiveness, strong ties between individuals, group solidarity, emotional inter-dependence, traditionalism and a collective identity. Egocentric, or individualistic, societies stress independence, loose ties between individuals, emotional independence, liberalism, self-sufficiency, individual initiative, and autonomy. Bhugra ( 6) has hypothesized that individuals who migrate from predominately sociocentric, or collectivistic, societies into a society that is predominately egocentric, or individualistic, are likely to have problems adjusting to the new culture, especially if the individuals are socio-centric in their own belief system. A consequent lack of an adequate social support system, a disparity between expectations and achievements and a low self-esteem may result from this dissonance in culture between the individual and the surrounding population. An increase in ethnic density may help decrease the distress of the individual in this situation, especially by providing a social support system. For example, a person who migrates to the United States, a predominately egocentric society, from Vietnam, a predominately socio-centric society, may feel isolated and alienated, especially if the individual is socio-centric in outlook. Feelings of isolation and alienation may be decreased, and social support improved, if other people from Vietnam, with socio-centric views, surround this person in the area of resettlement; however, the socio-centric individual may remain on the periphery of his/her new homeland's society since linguistic and social fluency of the dominant culture may not be attained. Cultural bereavement may also be minimized if the immigrant is able to maintain ties to the culture of origin, either through increased ethnic density, improved social support or maintenance of religious beliefs and practice. On the other hand, individuals who migrate from a predominately socio-centric culture into a society that is predominately egocentric in nature may experience little in the way of problems, and a relatively easy transition to the new culture, if the person who has migrated is mostly egocentric, or individualistic, in his/her outlook. In this case, an increase in ethnic density may be disadvantageous and exacerbate or cause cultural conflict and mental distress.

CONCLUSIONS

The proportion of ethnic minorities in the UK has been increasing at least in part due to the migration of individuals from all over the world. Migration is a complex process, involving a heterogeneity of causes, experiences, cultural adjustment and stages, that influence the mental health of migrants. The stresses of the migration process itself combined with a lack of social support, a discrepancy between achievement and expectations, economic hardships, racial discrimination and harassment, and a lack of access to proper housing, medical care, and religious practice can lead to poor self-esteem, an inability to adjust, and poor physical and mental health. Social and cultural factors have been implicated in the aetiology of mental illness in immigrants and refugees, and further study is needed to better understand the role of culture as pathogenic or patho-protective ( 7).

Cultural bereavement, a paramount aspect of the migrant's experience, is influenced by, and mediated through, the interplay of the migration process, cultural identity and cultural congruity, along with biological and psychological factors. To appropriately guide diagnosis and treatment interventions, mental health practitioners must appreciate and recognize the socio-cultural factors that influence the manifestation of grief in people who have migrated. Cultural identity and congruity will affect the ability of the affected person to understand and work through the grieving process, and disturbances of identity and congruity are likely to lead to a pathologic, or complicated, bereavement.

Rates of depression, phobias and schizophrenia are elevated in some migrant groups. The understanding of race, ethnicity, social isolation and a lack of social support, racism, unemployment and poverty, poor housing and a lack of access to appropriate medical care is important in explaining the increased rates of mental illness in ethnic minority groups. Additionally, cultural congruity and ethnic density, cultural identity, and biological and psychological factors are likely important influences in the development of mental illness in migrants. With further study, a better understanding of the complex interplay of these potential vulnerability factors may eventually lead to preventative measures and lessen the burden of mental illness in this growing population.

References

8. Bhugra D. Ayonrinde O. Depression in migrants and ethnic minorities. Advances in Psychiatric Treatment. 2004;10:13-17. [ Google Scholar]

9. Bhugra D. Jones P. Migration and mental illness. Advances in Psychiatric Treatment. 2001;7:216-223. [ Google Scholar]

18. Bhugra D. Bhui K. Mallett R, et al. Cultural identity and its measurement: a questionnaire for Asians. Int Rev Psychiatry. 1999;11:244-249. [ Google Scholar]

19. Boydell J. Van Os J. McKenzie J, et al. Incidence of schizophrenia in ethnic minorities in London: ecological study into interaction with the environment. Br Med J. 2001;323:1336-1337. [[ PMC free article] [ PubMed] Google Scholar]

Articles from World Psychiatry are provided here courtesy of The World Psychiatric Association

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Migration, cultural bereavement and cultural identity

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Migration has contributed to the richness in diversity of cultures, ethnicities and races in developed countries. Individuals who migrate experience multiple stresses that can impact their mental well being, including the loss of cultural norms, religious ...