Salway et al. BMC Public Health 2011, 11:514 http://www.biomedcentral.com/1471-2458/11/514 Page 6 of 13 Table 1 Migration patterns Population diversity* Policy orientation Migrant/ minority rights and welfare Societal discourses Germany Post WW2 arrival of displaced/forced migrants from eastern Europe, followed by large numbers of guest workers in 1950s- 1970s, followed by asylum seekers and migrants from disintegrating socialist countries in 1990s. A large and long-established population of migrant background (20% of total population). Numerically, people of Turkish citizenship are by far the largest migrant group. Migrants from non-European countries are gaining increased attention in recent years. Canada Between 1950s and 1980s immigration predominantly from Europe (UK, Italy) and the US. From 1980s onwards, increasing numbers of arrivals from Asian countries. In the 1990s, immigration rates were at their highest and three quarters of new arrivals were ‘visible minorities’. Around 20% of the total population was born outside Canada. The ‘Chinese’ are identified as the most populous ‘visible minority’ (25% of whom are Canadian- born). UK Significant post WW2 immigration from ex- colonies in South Asia and the Caribbean as well as from Poland and Ukraine, fluctuating over time with changing immigration rules. Fluctuating numbers of asylum seekers since 1990s. Significant European migration since EU expansion, notably from Poland, but often temporary. Latest estimates show 16% of the population belongs to an ethnic group other than ‘White British’, and 11% were born outside UK. Largest enumerated ethnic groups are ‘Indian’ and ‘Pakistani’. India is most common country of birth outside UK, followed by Poland. Reluctance to embrace an ethnically diverse Immigrant ancestry and multiculturalism are Long recognised itself as an immigrant- identity at policy and societal level [27]. A hallmarks of Canadian identity [30,31]. receiving and multi-ethnic country [34,35]. history of firmly anti-immigration policy Successive governments across the political Self-perception of a strong legal and policy orientation. Citizenship based until 2000 on spectrum have encouraged immigration race relations framework. Critics argue that parental heritage rather than country of and high levels of naturalisation [32,33]. race equality legislation and policy conflict birth. Persistent resistance to dual Points based system for accepting migrants with that relating to immigration control, citizenship [28]. Recent years, significant since 1967. More recent policy citizenship, cohesion, as well as foreign tensions and divergent political agendas interpretations of multiculturalism policy [36,37]. Significant backlash against [29]. emphasise the importance of attachment to multiculturalism in past decade, though Canada and active citizenship, as opposed consistent policy concern with diversity and to maintenance of cultural distinctiveness equality (despite limited evidence of [28]. progress towards a fairer society) [38]. Persistent discriminatory treatment of Generally acknowledged success in migrants categorised as not ethnic German accommodating diversity [28]. Extensive by state institutions as well as within programmes and resources directed housing and employment sectors [39]. Low towards ‘integration’ initiatives [28]. But, rates of naturalization [28]. Poor veneer of tolerance and celebration of socioeconomic indicators among most diversity masks structural barriers to immigrant groups, particularly Turkish [28]. economic and social wellbeing of non- Some significant recent intervention to European migrant groups who have higher recognise and address needs of immigrants levels of unemployment and lower income [40]. than other groups [31]. Public fears of threat to identity and economic welfare. Significant public suspicion of Muslims [43]. Mass media stereotyping and pathologising of migrants, particularly Muslims [44]. Harsh criticism is levelled at government approaches to multiculturalism that are seen to ignore the hierarchies of power and opportunity that perpetuate poor welfare outcomes for racialised groups [45-47]. Significant concerns about cohesion and Canadian identity expressed by some sections of the general public, particularly among Québécois, though broadly positive public opinion towards immigration [48]. Surveys suggest high levels of racial discrimination in society, particularly among some groups [49]; Racism is increasingly recognised as a critical issue by policy makers [50]. Introduction of additional requirements for citizenship in 2000s. Relatively low naturalisation rates. Recently characterised as having a ‘weak’ integration policy [41]. Persistent socioeconomic disadvantage among migrant and minority groups, particularly those categorised as Bangladeshi and Pakistani [42]. Evidence of continued high levels of racial discrimination at institutional and inter- personal levels [28]. Widespread public concern that immigration levels are too high posing threats to identity and economic opportunities [28]. Media contributing to misinformation and negative stereotyping of migrant/minority communities. Islamophobia a particular problem [51-53]. * Given the divergent categorisation and labelling of migrant and minority groups across the three countries we adopt here the country-specific conventions for describing diversity. minority groups - their characteristics, needs and enti- tlements - are constructed and responded to by the state and other actors; strands which may conflict and undermine, or alternatively support and reinforce. It would therefore be important for us to look beyond the health sector to understand how wider state intervention shapes the healthcare experiences and outcomes of migrant/minority people, including how this varies across ‘types’ of migrant/minority as categorised by state institutions. Second, the language of policy discourse is frequently imprecise and open to multiple interpreta- tions, so that how policy is forged in the practice of health organisations and professionals - what Lipsky has termed ‘street level bureaucracy’ [54] - requires careful