Anales de la RANM

13 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 MIGRATION AND HEALTH INEQUITY Aagaard-Hansen J, et al. An RANM. 2025;142(01): 11 - 20 4. HEALTH INEQUIT Y The insight that there is more to ill-health than biology, is not new. In 1848, John Snow showed the causal relationship between polluted water from the Thames distributed by a water pump and an outbreak of cholera in the London quartier served by this pump (14). Shortly after, Rudolf Virchow (1821-1902) conducted his visionary work in the second half of the 1800 hundred, integrating disease in the social context, and he stated that “if medicine were to fulfil her great task, then it must enter the political and social life; therefore, medicine must be viewed as a social science” (15). In more recent times a number of outstanding scholars have further refined the theoretical foundations (16). In its seminal report ‘ Closing the gap in a Genera- tion’ , the CSDH made a strong case for the importance of health inequity based on social determinants of health (3). The commission used an analytical framework for causal pathways for health action including five levels allowing a differentiation of the ways in which the social determinants operate (3,17), which will be used in a simplified manner in this article: • Socio-economic context and position focus on the societal organization and distribution of entitlements at the national level including models of health care funding or institution- alized discrimination against various groups. • Differential exposure describes the likelihood of getting a disease either due to infection or living in unhealthy environments. • Differential vulnerability is here perceived as whether individuals or groups have an increased risk of getting infected due to biomedical reasons such as co-morbidity or malnutrition, rather than the social meaning of the concept. Table 1. Typology of population movements according to the characteristics of onset, cause, direction, and motivation combining and expanding categories from previous work (2). Movement type Examples Onset Cause Direction Motivation Resettlement Relocation because of water development schemes Urbanization Slow Human ⁄ political Unidirec- tional Voluntary Labor migration Permanent migration to other countries Family unifica- tion Diaspora Pastoralism Nomadism Transhumance Circular Labor migration Seasonal work in agricul- ture Trading Selling rural products in towns Pilgrimage Hajj Tourism Charter Long-term back packing Refuge War Rapid Human ⁄ political Both Forced Forced displace- ment Forced resettlement Slow Refuge Earthquake Rapid Natural Refuge Drought Slow