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The Health of Immigrants and
Refugees in Canada
Morton Beiser, MD, FRCP, CM

Canada admits between more than 200,000 immigrants every year. National policy emphasizes rigorous selection to ensure that Canada admits healthy immigrants. However, remarkably little policy is directed to ensuring that they stay healthy. This neglect is wrong-headed: keeping new settlers healthy is just, humane, and consistent with national self-interest.

By identifying personal vulnerabilities, salient resettlement stressors that act alone or interact with predisposition in order to create health risk, and the personal and social resources that reduce risk and promote well-being, health research can enlighten policy and practice. However, the paradigms that have dominated immigrant health research over the past 100 years – the “sick” and “healthy immigrant,” respectively – have been inadequate. Part of the problem is that socio-political controversy has influenced the questions asked about immigrant health, and the manner of their investigation. Beginning with a review of studies that point out the shortcomings of the sick immigrant and healthy immigrant paradigms, this article argues that an interaction model that takes into account both predisposition and socio-environmental factors, provides the best explanatory framework for extant findings, and the best guide for future research. Finally, the article argues that forging stronger links between research, policy and the delivery of services will not only help make resettlement a more humane process, it will help ensure that Canada benefits from the human capital that its newest settlers bring with them. MeSH terms: Canada; immigrants; settlement and resettlement; migration policy

La traduction du résumé se trouve à la fin de l’article. Professor of Psychiatry, University of Toronto; Senior Scientist, Joint Centre of Excellence for Research on Immigration and Settlement (CERIS); National Scientific Coordinator, Reducing Health Disparities Initiative, Canadian Institutes of Health Research (CIHR).

Correspondence and reprint requests: Dr. Morton Beiser, Joint Centre of Excellence for Research on Immigration and Settlement (CERIS), 246 Bloor Street West, 7th Floor, Toronto, ON, M5S 1V4, Tel: 416-946-5351, Fax: 416-921-7080, E-mail: [email protected] Acknowledgements and Sources of Support: The Reducing Health Disparities Cross-cutting Initiative, Canadian Institutes of Health Research, commissioned an initial draft of this article for an International Think-Tank held in Ottawa, Sept. 21-23, 2003. The author wishes to acknowledge the support of the CIHR for the preparation of this report, and the Think-Tank participants, whose helpful comments led to what is hoped to be a much-improved revision. S30 REVUE CANADIENNE DE SANTÉ PUBLIQUE

dentifying a category of people as vulnerable implies that they suffer a disproportionate burden of illness, lower than average life expectancy or compromised quality of life. As a group, immigrants fulfil none of these criteria. Immigrants are, on average, in better

health than native-born Canadians, and
have lower mortality rates. However,
shortcomings in immigration and resettlement policy jeopardize immigrants’ health advantage.
Canada selects immigrants on the basis
of attributes such as education, job skills
and youth, all of which are grouped under
the rubric of human capital. Screening
helps ensure that they are healthy as well.1
After immigrants enter the country,
responsibility for assuring they stay healthy
devolves to the provinces. However, aside
from defining a mandatory waiting period
before becoming eligible for health-care
coverage, and arranging surveillance for
immigrants with a history of tuberculosis,
provincial health policies have little to say
about immigrants. Refugees, a sub-category
of immigrants, have, by definition, suffered unusual stresses and assaults on their health prior to coming to Canada. In some
ways, refugees are like other immigrants.
For example, like immigrants in general,
refugees have lower death rates than
native-born Canadians. However, refugees
are in less robust health than their immigrant counterparts, and they have a particular vulnerability to infectious and parasitic diseases.2 Expending a great deal of effort to select
people to become part of Canada, and
then more or less ignoring them is shortsighted. Resettlement experiences exert enormous influence on the eventual health
of immigrants and refugees, and on the
likelihood that their human capital will
fulfil its promise.3 A century or more of
research concerning the health of immigrants and refugees has produced potentially useful findings that are, however, diverse, scattered and sometimes contradictory. This article advances an integrative framework to help make sense of an unwieldy literature. It proposes that the

two paradigms that dominated 20th century research and practice – the sick and the healthy immigrant, respectively – were, at
least in part, products of the socio-political
context of the times, and that they fail to
do justice to a complex issue. It further




proposes that the current gap between
research, policy and practice must be
bridged to help ensure that the people who
come to this country in apparent good
health stay that way.
Background: Canada and immigration
Eighteen percent of the people living in
Canada were born somewhere else.2 In the
expectation that immigration will help
rejuvenate an aging society, provide both
skilled labour where it is needed and
unskilled labour for jobs Canadians do not
want, and help to ensure present and
future competitiveness in the global economy, Canada admits between 220,000 and 240,000 new settlers each year.2 For reasons having nothing to do with economic benefit, or with compensating for the greying of a nation, about 10% of Canada’s annual immigration quota consists of

refugees, people deemed to be in need of
refuge and protection. Canada is one of
roughly 150 countries to have signed a UN
Convention, signalling a commitment to
protect the persecuted and stateless.
Canada is also part of a much smaller
group of these Convention signatories –
about 20 – who offer not just temporary
protection, but the option of permanent
National discourse tends to focus on
whether immigration fulfils the promise of
net economic benefit and on the effects of
immigration on social cohesion. The
neglect of immigrant health is not only
irresponsible, it is wrong-headed. Health is
integral to immigrant human capital. If
their health is compromised, immigrants
cannot achieve their full economic and
social potential. Moreover, immigration
demands changes in social institutions,
none more so than in health and health
care; an effective response to this challenge
requires information and the development
of appropriate expertise.
As they have ever since Confederation,
immigrants and refugees resettle in
Canada, adjusting and changing their languages, habits, dress, foods and values in the process. They also reshape the language, habits, dress codes, foods and values of Canada.
Change brings challenges to new settlers
and the resettlement country alike.
However, nothing in the 100-year history
of Canada prepared either the country or

the immigrants and refugees it received for
the diversification in migration flows that
began in the 1970s. Before 1970, most
immigrants (70% or more) came from
Europe, with the United States a distant
second (about 15%); Asia was the source
region for 10% or fewer of all immigrants,
and Africa, the Middle East and the
Caribbean accounted for the remaining
5%.1 Post-1970 figures document a startling reversal. By 2002, Europe and the UK accounted for only 17% of immigrant
flows, the US for only 2%. South and
Central America (9%), Africa and the
Middle East (20%), and Asia and the
Pacific (52%) have replaced so-called traditional sources of immigration.4 Although Canadian societal institutions
– the economy, education, and health –
have been slow to respond, the country’s
changing makeup can no longer be
ignored. To adapt to change, the caregiving sector requires information about the health of immigrants and refugees, and
about how this evolves over time; an
understanding of health determinants,
some of which may be similar to those in
the majority culture population, others of
which may be unique; an analysis of the
match between health needs on the one
hand, the use of health and related services
on the other, and an appreciation of how
socio-political context can affect research
about and care for new settlers.
Models of immigrant and refugee
Three somewhat conflicting paradigms
have influenced the conduct of immigrant
health research: nation states have always
been cautious about admitting strangers
who might be a menace to the health of
the indigenous population, or a threat to
its economic well-being. Consistent with
these time-worn concerns, the sick immigrant paradigm proposes that it is the least healthy and well-adjusted people who
choose to emigrate from their home countries of origin. Taking Canada’s rigorous selection policies as its point of departure,
the healthy immigrant paradigm portrays
immigrants as the cream of the world’s
crop. According to this framework, if
immigrants become ill as they resettle, it is
likely due to convergence and/or resettlement stress. Convergence is a process through which, because immigrants are

exposed to the health risks encountered by
resident Canadians, their good health
declines to the more mediocre Canadian
average. The resettlement stress model proposes that declining health may be due to stresses inherent in the resettlement
process. The interaction framework proposes that health is the outcome of interacting processes including predisposition – which may be genetic, or based on premigration exposures and experience – as well as post-migration stressors and individual and social resources.

The Sick Immigrant Paradigm
Until at least the middle of the 20th century, the idea that immigrants were sick and that the public needed to be protected from
them dominated North American thinking.
There was good reason for this, since it was
immigrants from Europe who brought
measles, smallpox, cholera and syphilis to
the continent in the 16 th and 17 th
centuries.1 Protecting the public’s health
and economic well-being continues to
guide federal policy. For example, Canada’s
Immigration and Refugee Protection Act
refers to migrant health in only one place,
s. 38.1, which mandates rejecting an applicant if he/she is (a) likely to be a danger to public health, or (b) to pose a danger to
public safety, or (c) if he/she might reasonably be expected to cause excessive demand on health or social services. The last restriction does not apply to refugees or persons admitted to rejoin family. Regulations

stemming from the Act call for continuing
provincial surveillance of immigrants or
refugees who have been granted permanent
residence status, but who have evidence of
inactive tuberculosis or who have been successfully treated for syphilis. Refusing entry to people who might
jeopardize public safety and/or empty the
public purse seems reasonable. Politics can,
however, all too easily use concern for the
health of the public as a convenient smokescreen. Late 19 th century Canada was ambivalent about immigrants who did not
come from the “right” places, meaning
Britain, northern Europe and the United
States. The country needed cheap Asian
and southern European labour to help
build the railroads, cut down forests and
work in mines, and it needed eastern
European know-how to make central
Canada’s fields produce grain. But it was


not at all sure that Canada wanted these
people to stay.5-9 Selection and settlement
policies militating against non-white immigrants remained in effect until 1967, when they were replaced by a colour-blind system based on points assigned according to an applicant’s human capital.

Rather than always supplying ballast for
reasoned argument, science has been a
sometimes naïve, sometimes complicit
bedfellow of politics.
Until well after World War II, the sick
immigrant paradigm fuelled anti-immigrant
discourse. Psychiatry provides the most
obvious example. G.F. Bodington, a powerful British Columbia mental hospital superintendent, inveighed against foreign
governments for shipping off to Canada
“weak-minded young persons…[to]…
swell the ranks of the already too numerous lunatics….” 5 Toronto-based C.K. Clarke, a leader of pre-World War II
Canadian psychiatry, wrote articles with
titles such as “Keeping this young country
sane,” in which he cautioned that the
influx of the genetically weak threatened to
impair the quality of Canadian stock.10 A
popular explanation for migrants’ putative
mental fragility was that they were individuals who chose to leave home because they were the least well-integrated, and perhaps
the least competent people in their respective societies.11,12 Statistics showing that mental hospitalization rates among immigrants were higher than among the native-born lent credence to the mentally sick immigrant paradigm.13-15 However, hospital statistics confuse the amount of mental disorder a group suffers with the resources they can

call upon to deal with problems. When
mental illness strikes a member of a small,
isolated or fragmented community, he or
she may experience different treatment
than someone suffering the same type of
disorder who belongs to a community that
can call on traditional healers, supportive
family, or health-care professionals who
understand the language and share the
ethnocultural background of the patient.
Hospitalization – usually the last resort in
an episode of illness – may take place
quickly in the first scenario, but take much
longer, or even be avoided, in the second.
A groundbreaking study by H.B.M.
Murphy16 illustrates this point. Murphy
showed that mental hospitalization rates

for immigrant groups in Canada increased
as the size of the like-ethnic community
decreased. Consistent with these findings,
Bland and his colleagues17 demonstrated
that migrants as a whole were no more
likely than members of the general public
to be hospitalized for schizophrenia.
Immigrants who were also members of
ethnic minorities were, however, overrepresented on hospital rolls. Undeterred by methodologically flawed
studies, leading psychiatrists such as
Bodington and Clarke argued in favour of
psychiatric surveillance to make it tougher
to get into Canada. Interestingly, although
health officers during the early years of the
20th century could turn down a prospective
immigrant if they found any evidence of
insanity, neurosis or feeble-mindedness,
psychiatric disorder accounted for less than
1% of all rejected applications.5
Psychiatry played a more significant role
in a second method of crowd control –
expulsion. Between 1900 and 1940,
approximately 10,000 people were expelled
from Canada every year, 10% of them –
nearly 1,000 annually – for psychiatric reasons. Statistics from the one province, British Columbia, that recorded deportations by country of origin, suggest ethnic bias. Between 1921 and 1936, 6-7% of

Canadian immigrants who had been born
in the UK and admitted to a mental hospital were deported: comparative figures for Finns were 35%, for Hungarians 40%, and
for Slovaks 65%.5
Nowadays, all immigrants, with the
exception of refugee claimants, undergo
comprehensive medical screening before
entry. Perhaps partly as a result of these
practices, newly resettling immigrants are,
on average, healthier than resident
Canadians.2,18-23 Nevertheless, the idea that
immigrants bring with them diseases such
as syphilis, malaria and tuberculosis (TB)
continues to be evoked as an argument
against immigration.24
Screening and mandatory pre-entry
treatment obviate the spread of syphilis by
immigrants, and the mosquito vector necessary to infect humans with malaria is not found in Canada. However, TB is a more
serious issue.
The major source countries for contemporary immigration are burdened with high rates of TB. For example, in the
Philippines and China – currently the two

major sources of Canadian immigration –
the rates are 316 per 100,000 and 88 per
100,000 respectively. In Afghanistan, a
major refugee-sending country, TB cases
number 321 per 100,000.25
Tuberculosis rates fell in Canada
throughout most of the 20 th century,
reaching an all-time low of 6.9 cases per
100,000 per year in 1987. However, rather
than continuing to fall, the prevalence of
the disease has since stabilized, and continues to hover within a range of 6.9 to 7.4 cases per 100,000 per year. Immigration
helps account for TB’s tenacity. Although
the foreign born make up approximately
18% of Canada’s population, they account
for almost 60% of all cases of TB.26 Most
cases of active infection occur within five
to seven years after initial resettlement.27-33
Immigrant-receiving countries in Europe,
Australia and the US have reported consistent findings: immigrants and refugees have a 4- to 10-fold greater risk of developing TB than non-Aboriginal native-born people.27,31,34-38
Do immigrants and refugees bring TB
with them, as the sick immigrant paradigm
The rigorous health screening immigrants undergo as part of their entry requirements argues against this interpretation. Both Canada and the US require that immigrant applicants have a negative sputum culture and a normal chest X-ray. The system is not foolproof, however. People

admitted under non-resident visa categories – a category that includes inland refugee claimants – do not receive preentry screening. Fraud is another possible explanation. Although plausible, and the

subject of many anecdotes, the use of
fraudulent X-rays is difficult to establish,
its possible impact on the high rates of TB
among new settlers probably impossible to
For hundreds of years, countries have
used quarantine to protect themselves
against importing infectious illnesses.
Although it does not quarantine prospective immigrants suspected of having TB, Canada disqualifies applicants who have
X-ray abnormalities compatible with active
TB until they have been successfully treated and found to be free from active disease.1
Modern-day quarantine has sometimes
jeopardized health. During the winter of


1993-94, Dutch researchers studied the
health of refugees who, while waiting to be
officially processed, were housed in an offshore cruise ship. By the time health inspections took place, TB had spread not
only among the refugees themselves, but
also among the staff. The mini-epidemic
was not the result of high initial rates of
disease. Although there were a few carriers
among the group placed under quarantine,
disease spread resulted from inadequate living conditions and poor ventilation.39 In his book, Silent Travellers: Germs,
Genes, and the Immigrant Menace, Kraut40
describes late 19th century and early 20th
century screening of immigrants on Ellis
Island in New York. Charged with identifying carriers of dangerous or loathsome diseases, insanity and idiocy, medical officers examined thousands of would-be immigrants with a long list of conditions

that could exclude entry. Despite rigorous
screening, most immigrants proved to be
healthy, and were admitted. Within a few
years, however, the new settlers were suffering high rates of illness, including TB. In Kraut’s view, immigrants had not
brought TB with them, but, instead, contracted it after being admitted to the US where they faced overcrowded living conditions and poor diets, and were subjected to exploitative and physically hazardous

work situations, all of which increased the
likelihood of exposure and decreased their
resistance to disease.
Explanations like Kraut’s, which shifted
the onus of disease from the individual and
placed it in the lap of society, were consistent with the socio-political climate of the 1950s, 60s and 70s. The new optimism
about human nature characteristic of these
times prompted a new social construction
of immigrants: perhaps they were not all
sick or misfits, but strong, adventurous
and healthy people. The “healthy immigrant,”41-43 a popular construct consistent with post-1960s values, offers both good
news and bad news. It proposes that immigrants are healthy when they arrive, but that they are fated to lose this advantage.

The Healthy Immigrant Paradigm
According to analyses of Canada’s
National Population Health Survey
(NPHS) data,19,22,23 short-stay immigrants
(people present in Canada 10 years or less)
have fewer chronic illnesses and less disMARCH – APRIL 2005

ability than either native-born Canadians
or long-term immigrants. After 10 years,
immigrant and native-born health patterns
are similar. Using a different data set, the
Canada Community Health Survey,
Perez 42 describes a similar pattern.
Immigrants present in Canada for less ...

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heritag hershfield heterogen hi high high-risk higher highest highlight hildesheim hind hinton histor histori hitman hiv hm hogman hollifield holm holocaust home homepag homogen honest hoover hope hopewel hospit host hou hous households.82 hover howev hp humain human humanité humel hummer hundr hungarian huraux huraux-rendu hv hyman hyperinsulinemia hypothes hypothesi idea ident identif identifi idioci idiom ignor ii il ill illness.184 illness18 illustr im immedi immens immigr immigrant-receiv immigrantsend immigration-receiv immigration.24 immigration.4 immun impact impair implement impli implic import impos imposs impoverish improv inact inadequ inadequaci inadéquat inand incid includ inconsist incorpor increas inde independ index india indian indic indigen individu indochines indra induc industri inequ inevit infant infante-rivard infect infecti infections.116 infer influenc influx inform inher initi inland inner inquiri insan insensit inspect inst instead institut insuffici insulin int intak integr intel intellectu intens interact interest intern internet interplay interpret intervent interview intoler intrauterin intuit intérêt invari inveigh investig invok iranian irish irregular irrespons island isol isolé issu it.174-177 itali italian iti j j.s ja jam jama jansen japan japanes japanese-styl jb jc jd je jenkin jeopard jeopardi jer jh jj jk jl jm job johansen john johnson joint jolli jone journal jp jr js jt junk justic jw k kajand kaminski kampman karvonen kas kaspar kate katzmarzyk kazanjian kb ke kean keep kegan kerbel kessler kg khmer kim king kingston kinney kinnon kinzi kitson kleinman klett kliewer klingeren km know know-how knowl knowledg known kok kok-jer kolodi kolonel korean kr krakow kramer kraut kraut40 krieswirth kuo kurihara l la label labour lack ladder lai laid lambregt lambregts-van lancet langhoff langhoff-roo languag lanka laotian lap laport larg large-bowel larger laroch last late later latino latter lau law le lead leader least least-accultur leav led lee leff left legaci legitim leichsenr lend length length-of-stay lent les lesquel less lessen leung leur levav level lewinsohn li lian libman lien life light like like-ethn likelihood lillebaek limit lin line line82 linear linguist link list literaci literatur lithuanian littl littlefield live lié ln loathsom local lock loenhout loenhout-rooyack london long long-recogn long-stay long-term longer longitudin longterm look lose loss lost low low-birthweight low-popul lowbirthweight lower lower.82 lowest lowincid ls lsia lt luke lunat lung m m5s ma maclean madan made magdorf mai mail [email protected] maintain maintenir major make maker makeup malad malaria male mammogram manchest mandarin mandat mandatori manfreda mani manitoba manner manson manuel mar march margin marit market marmot marot maskarinec mass massiv master masuda match matern matter maximum may mc mccarti mcclelland mccray mcdermott mcgill mcgill-queen mckeigu mckenna mcsharri md meador meal mean measl measur meat mechan med medic medicin mediocr medium medium-term meerloo meet meilleur mellitus member memori memory.113 men men.62 menac ment mental mental-health menzi mesh mesur metaphor method methodolog mexican mf mg mi middl midway might migrant migrat milit militari miller million mind minded mine mini mini-epidem minim minist ministri minor mis misfit misinform misinterpret mitig mk ml mode model modern modern-day modèl molecular mollica moltchanova monozygot monterrosa month montreal moonan moor morbid moreov moroccan mortal mortality.70-73 morton mosquito mother mothers.69 motion movement mp ms mt much much-improv multi multi-ethn multicent multicentr multicultur multipl multivari munro munroe-blum murphi murphy16 murray must muster mv mw myth n nafzig nagelkerk nair name nargundkar nat nation national nationwid nativ native-born nativeborn natl natur naturell naïv near necessari ned need needed.2 needless negat neglect neider neither neonat nerv net netherland neurasthenia neuros neurosi never nevertheless new newbold newcom newcomers.3 newest newli news ng nj noh nomura non non-aborigin non-bias non-depress non-effect non-immigr non-insulin non-insulin-depend non-migr non-resid non-western non-whit nonadherence.88 nonclust none nonimmigr noninsulin nonmigr norm normal north northern nostalgia notabl note noth notif notion nouveau nouveau-né nouveaux nov nova nowaday nphs nr ns nt number numer nur nurtur nw ny négligenc nés o oberg obes obeyeseker obscur observ obviat obvious occup occur occurr oct odd offer offic offici offord offrirait offshor offspr offspring63 often oil old older omnigraph one onorato onset ontario onus oost open oper opportun oppress optim option order organ ori orient origin origin.89 orn orphan orr orthopsychiatri ossorio ostby other ottawa ottawa-carleton ou out-migr out.119 outcom outmigr overcrowd overlook overrepres oversea overshoot overtak overview overweight owan oxford p pacif pai pain painless pakistan pakistani pan panminerva pap par paradigm paradigm.13-15 paradox parasit parent pari part parti particip particular partner passiv past patern pathogen pathogen-contain patholog pathologi patient pattern payn pb pc pd peac pedersen pediatr pent pent-up peopl people.27 per perceiv percent percentag perez perform perhap perinat period perman permit perpetu perpétuent persecut persist person personnell perspect pertain peu pfister pfister-ammend pg ph phan phase phenomena phenomenolog phenomenon phero philippin pho physic physician pierpoint pike pj pk pl place plan plausibl play plenti plf plus pm pogoda point polici policy-mak polish polit politiqu pollut pool poor popul popular population-bas population.18 population.62 populations.89 porter portrait portray pose posit possibilité possibl post post-1960s post-arriv post-migr post-traumat post-world postmigr postmigratori posttraumat posé potenti potter pour pourrait poverti powel power powerless practic practition pratiqu pre pre-entri pre-migr pre-world predecessor predict predictor predispos predisposit preentri pregnanc pregnant prematur premigr premigratori premis prenat prepar present press pressur prestat preuv prev preval prevent previous primari primarili principaux principl prior prioriti privat pro probabl problem problèm process processus produc product profession professor profici proficiency.87 profil profile.61 profit profound program project promis promise.3 promot prompt prone proport propos proposit prospect protect prove provid provinc provinci provis prédisposit psychiatr psychiatri psychiatrist psychic psychoan psychoanalyt psychol psycholog psychoneuros psychopatholog pt ptsd public publiqu puerto pugh purport purs putat pw q qin qu qualifi qualiti quand quarantin que quebec queen question qui quick quiescenc quit quota r ra race racial radic railroad rais rajpathak ramachandran rang rank rare rate rath rather ratio ravel raviglion ray rc re reach reaction reactiv reader real reapprais reason reassess recaptur receiv recent recept recherch reciproc recogn recognit reconcil reconsid record recoveri recovery.144 rectal reduc reeb refer refug refuge refugee-send refugees115 refus regard regardless region regul reintegr reject rejoin rejuven relat relationship relativist reli reluct remain remark remarquabl remors rendr rendu renforç rep repercuss replac report repress reprint republ request requir research research102 research112 research114 research149 research48 researchers2 resembl resettl resettlement.27-33 reshap resid residu resili resist resort resourc respect respectiv respir respond respons ressourc rest restent restrict result retard retent return rev reveal revers review revis revu rf rg rican rich richmond rieder right rigor rigoureus rihal riley rio rise risk risk-induc risk-pron risqu rivard rj rm rn rnm robert robust rockvill roe role roll roo roosmalen rooyack rose roski rough routin routledg rowman roy rubric rule rumbaut rummen run rural réduisent réinstal résumé révélés s30 s31 s32 s33 s339 s34 s35 s36 s37 s39 s41 s42 s43 s44 s76 sa sack sad safeti salienc salient salvendi salvioli sampl san sandri sane santé saphir saurel saurel-cubizoll say scale scand scarciti scatter scenario schizophrenia school schuitemak schwartz sci scienc scientif scientist scott scottish screen se second section sector secular secur seek seeley seem seen segi segment select self self-interest self-select senay send seneg senior sens sensitivs40 sep separ sept sequela serait serer seri serial serious servic set settl settlement settler seven sever sex sex-adjust sex.42 shackl share shed sheet shelley sheth shift ship shock short short-stay shortand shortcom shortsight show shown shukla si sick sign signal signatori signifi signific silent silov simich similar simpl simplist simultan sinc site situat six six-fold size sj sjoberg skill skilled44 skovgard sl slatteri slight slovak slow slowli sm small smaller smallpox smith smoke smokescreen sn snehalatha so-cal soc social societ societi societies.11 society.130-132 socio socio-econom socio-environment socio-polit sociocultur sociodemograph socioeconom sociolog sociopolitiqu sole solut somali somalia somat somatis someon sometim somewhat somewher son sont sophist soulign sound sourc sourcebook south south-east southeast southern specialist specif spectrum spinaci sponsor sponsorship sporad spread springer springer-verlag sputum sri stabil stachan staff stage standard starr startl state stateless statist statistics/reference status stay stay.114 stay.5-9 steel steel158 stem stengel step stereotyp stern stewart stimul stir stock.10 stope stopes-ro stori stranger strategi street strength strengths.3 stress stress-buff stressor strike strong stronger structur studi studies109 studies112 study77 study86 study90 styblo style sub sub-categori subcategori subcontin subject suboptim subsampl subsequ substanc substandard substitut success sudr suffer suffici sugar suggest suicid sujet superintend superior suppl suppli supplément support sur sure surg surpris surveil survey surviv suscept suspect sw sweden sweet swell swirl syme symposium symptom syphili system sélection sûre take taken talbot tank target tarrant task tb tb.26 td team teen teenag tel tell temper tempor temporari tempt ten tenac tenant tend tendenc tender tenet term test texa tf th theoretician theori thereafter117 think think-tank third thompson thorni though thousand threat threaten three three-year thrifti throughout tiet tijdschr time time-consum time-specif time-worn tippl titl tm tn tokyo tolan took tool topic tor toronto toronto-bas tortur torture.153 total totowa tougher tout toward toxin tradit traduct traduis tragedi train trajectori tran transcultur translat transmiss transmission.120 transmit trauma traumat traumata travel treat treatment treatment.43 trend trigger trop trouv true trust tseng tuberc tubercl tuberculosi tuomilehto turk turkish turn turner twice twin two tyhurst type typic typolog uk un uncov undeni underemploy undergo underli underlin underrepres understand undet undu une unemploy unemployment84 unesco unexpect unfortun unhealthi union uniqu unit univers unravel unrealis unskil unsworth unusu unwieldi updat upon uproot urban urgenc urgent us us-born us-resid usborn use usual util v valid valu value-fre van vang vari variabl variant variat vector veen vega veget ventilation.39 verlag veroff versus veteran victim victoria vient vietnam vietnames vietnamese-languag view viik viik-kajand vinh violat violenc visa visibl visit vissandje vivo vocabulari vol volum vountri vulner vulnérabilité w wa wait waldmann wale walsh want war ward warheit warner washington way weak weak-mind wear week weeks100 weezenbeek wei weight weijer weiss well well-adjust well-b well-integr well-known well-train well.1 west westermey western western-born wg wh whatev whether white whittemor whole whose wickrama wide widespread wiley wilkin william window winter wish within within-group women woodburi woon word work work.84 worker world worldwid worldwide51 worn wors worse.22 would would-b wp wr wrap wrong wrong-head wrote ws x x-ray xxvi y yap year year.2 year.55 york young younger youngta youth yusuf z zaffaroni zealand zeric ziegler zimmet zuber zwingmann zyzanski à étude être