"So far as the economy of the metropolitan country is concerned, migrant workers are immortal: immortal because continually interchangeable. They are not born: they are not brought up and they do not age: they do not get tired: they do not die."

This epigram comes from John Berger and Jean Mohr's book, 'A Seventh Man'. The book is a compelling blend of social analysis, photographs and poetry, which delves into the consequences and paradoxes of the world's unceasing demand for migrant labour.

For Berger and Mohr, the debilitated and dying migrant, although an inevitable presence in contemporary life, is a murky figure within capitalism’s unconscious.

Migration and Health

'Why do people move? What makes them uproot and leave everything they’ve known for a great unknown beyond the horizon? Why climb this Mount Everest of formalities that makes you feel like a beggar? Why enter this jungle of foreignness where everything is new, strange and difficult?

The answer is the same the world over: people move in the hope of a better life.'

(Life of Pi,  Yann Martel)

Inadequate empirical data on migration variables such as immigration status and country of birth have made it difficult to investigate the relationships between migration histories, socio-demographic status and health outcomes for different migrants. However, in a review of the literature on migrant health, Jayaweera (2011) has concluded ‘There is evidence that many migrants are relatively healthy upon arrival, but that good health can deteriorate over time in the receiving society.’

Health of Migrants in the UK - What do we know? (Migration Observatory Briefing)

Hiranthi Jayaweera  

Key points

• Evidence on physical and mental health suggests there are poorer outcomes overall for migrants. However, these vary according to migration histories and experience in the receiving society.
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• Changes in some health behaviours over time in the UK may not be as marked or linear as some accounts suggest.
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• Both socio-economic circumstances of migrants and immigration regulations affecting some migrant categories impact negatively on access to and use of health care.
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• It is currently difficult to gain a comprehensive account of the health of migrants because much existing evidence on health includes ethnic group but not migration variables such as country of birth, length of residence in the UK, or immigration status.

Slow death

The suggestion of a long term wearing out of the health of some socially disadvantaged migrants, reminds me of emerging discussions of the tempo of systemic violation in what Lauren Berlant  (2007) thinks of as ‘slow death’ and the eco-critic Rob Nixon calls (2011) ‘slow violence’.

What concerns both writers is the distributed and deferred nature of ill-health; a systemic grinding down, ‘the long dyings’ of certain bodies (Nixon, 2011, p.2). For Berlant, using the example of obesity, slow death entails ‘the physical wearing out of a population and the deterioration of people in that population that is very nearly a defining condition of their experience and historical existence’ (2007: 754).

This is an injustice that for Nixon - writing about environmental destruction and hazards - ‘occurs gradually and out of sight. A violence of delayed destruction that is dispersed across time and space, an attritional violence that is typically not viewed as violence at all’ (p.2).

I have found this recognition, of an unconscious bodily time to inequality, valuable in thinking about how poverty, war, economic and sexual exploitation, industrial and environmental catastrophes, and a range of other slow motion injuries, can play out across the bodies and the life course of migrants.

Unlike the drama and heightened sensuality of acute events of dying, incremental attrition is a part of the fabric of daily life. It is barely noticeable. Something that we might recognise in hindsight with the same astonishment that the speed-up of timelapse photography offers as we watch a flower unfurl, bloom and then wither before our eyes. Lauren Berlant,

    …slow death, or the structurally motivated attrition of persons
    notably because of their membership in certain populations, is
    neither  a state of exception nor the opposite, mere banality, but
    a domain of revelation where an upsetting scene of living that
    has been muffled in ordinary consciousness is revealed to be
    interwoven with ordinary life, like ants revealed scurrying under
    a thoughtlessly lifted rock. (2007, p.761)

The Healthy Migrant Effect

International migrants tend to be younger and healthier than either those they leave behind or those in the country of destination who are of a similar ethnicity. This health advantage, has been conceptualised as the ‘Healthy Migrant Effect’. The argument is that good health for migrants tends to be eroded within a decade of settlement. A decline that for some ethnic groups is associated with poverty, poor housing conditions, hazardous working environments, stress and anxiety, restricted access to health care and the adoption of new ‘unhealthy’ habits - high fat diets, smoking and substance abuse. Yet, as Hiranthi Jayaweera explains in her podcast, although the Healthy Migrant Effect is an interesting theory, the empirical evidence to support it is lacking.

From a ‘slow death’ perspective, illness, disability and pain can be understood as a part of the long-term effects of the global demand for healthy, aspirational migrant workers, entwined with increasingly restrictive health and welfare entitlements (see Médecins du monde 2012). There are also exceptions to this story of the health disadvantages and pathologies of migration for vulnerable bodies. A cohort study, of Irish immigrants to England, found that high rates of psychological distress among those who had migrated between the 1920s and 1960s, were related to pre-migration conditions, including sexual and physical abuse in industrial or reformatory schools and in the home. The authors of the study argue that because of the better quality of health services in England at the time, migration may have enhanced the health, particularly the mental health, of these vulnerable individuals (Delaney et al. 2011). Such findings point to the importance of recognising how differential experiences of violence and trauma, and varying economies of care, can nuance health and well being, not only between but also within generational cohorts.

The discussions of ‘slow’ out-of-sight bodily violation together with work on how traumatic affects can be transmitted without speech or consciousness, suggest novel ways of thinking about pain and suffering in the lives of socially marginalized migrants..

What characterises my work on transnational dying and social pain is the idea that pain can be simultaneously organic and disease-related and social. That is, connected to social inequality. As Jasbir Puar's work on debility also makes clear, the relationships between social injustices and illness are not easily recognised.  ‘Fear of the social – that is, any notion of illness as a form of social unrest or dis-ease' Puar's argument runs 'becomes muted through the production of fear of one’s own body’ (2009: 168).