To Pécs, in Hungary, last week for the 3rd Conference on Migrant and Ethnic Minority Health in Europe. I had been invited to give a keynote lecture by my old friend István Szilárd, the conference organiser. István and I first met in 1992 when we were working together to develop a new system of public health training in Hungary. It was therefore especially gratifying to see so many high calibre presentations at the conference by Hungarian public health researchers.

The conference was excellent, both in terms of the practical organisation and the quality of the presentations. I was very impressed by the remarkable growth in research on this topic, from a very low baseline, in the past few years. This research remains concentrated in a few centres, in particular Amsterdam, Copenhagen, and Edinburgh, but there is also a growing number of very good young researchers in other centres. Some of the highlights were a superb plenary by Aldo Morrone, who has done an enormous amount to help the boat people arriving on the Italian island of Lampedusa (you can see a presentation of his work on YouTube), Raj Bhopal’s presentation on the many initiatives to address the needs of minority ethnic populations in Scotland, and a series of individual presentations on topics such as expectations of Poles obtaining health care in Scotland, outcomes of diabetes in Belgium, and patterns of hospital care for minority populations in The Netherlands.

My interest in the topic began some years ago with a book that Judith Healy and I edited on delivering health services to diverse populations, including migrants and indigenous populations. We are now in the process of editing a new book on health and health care for migrants in Europe, due out in 2011.

I have to confess that, a few days before the conference, I had no idea what I was going to say. I was speaking to an audience that, collectively, knew an enormous amount about migrant health, but who also had extremely diverse interests, covering different health disorders and different migrant populations. The word cloud that I created to set the scene illustrates the huge diversity of topics at the conference. What on earth could I say that would be relevant to all of them?

I eventually decided not to talk about health at all but to focus on migration. But who are the migrants? Are they the tens of thousands of elderly northern Europeans retiring to the Mediterranean? Are they the footballers from across Africa being paid millions of pounds/euros to play for premier league clubs in Europe? Or are they the global elite who live in hotel rooms and on planes, exemplified by George Clooney’s character in the recent film Up in the air? (a character that I empathise with!) In fact, much of the conference focuses on other groups, at the other end of the wealth spectrum. They include those risking their lives to get to Europe, often in extremely dangerous conditions, and those who have made it to Europe but are subsisting in low-paid jobs, often being exploited by unscrupulous employers and facing multiple obstacles to basic services.

Those we are talking about, therefore, are only a sub-group of the globally mobile population, defined primarily by their inability to cross borders legally. So why do they try? There are the obvious answers, fleeing persecution and searching for a better life. But if we are to understand migration properly, we need to look at the underlying reasons. These relate to the fundamental inequalities of power and resources in a world that permits free movement of goods, capital, and services but not of people. This creates a situation in which those with power and resources (the ones who can glide through borders) can benefit from cheap, and increasingly, skilled labour in poor countries (for example, in telephone call centres or software companies) and cheap unskilled, and often illegal, labour in rich countries (such as the fruit pickers in California). This is the fundamental issue in understanding migration.