Table 2.

Health influences related to phase of mobility (modified from Gushulak and MacPherson41)

Phase	Examples	Outcomes/risks
Existing pre-departure influences	Endemic diseases	Departure/arrival with health indicators of origin:
	Level of development	Differing incidence and prevalence of illness
	Access to care	Differences in awareness of and use of health-care services:
	Availability of care	Preventive
	Differences in linguistic and cultural background as compared with destination	Promotional
		Diagnostic
	Possible forced or nonvoluntary departure from emergency situations	Therapeutic
Influences during travel	Trauma (physical and mental)	Greater prevalence of illness resulting from torture, trauma, abuse, and climatic exposure
	Deprivation
	Violence	Refugees
	Climatic exposure	Refugee claimants or asylum seekers
	Injury	Unauthorized migrants, including trafficked/smuggled migrants
Post-arrival influences	Administrative/legal restrictions on access to services or care	Awareness of and access to health services by migrants may be limited by immigration status, poverty, language, culture, and discrimination
	Poverty
	Language and cultural isolation	Working conditions may be associated with health risks,
	Occupational risks	exploitation, and abuse:
	Duration of stay at destination	Migrant agricultural laborers
		Commercial sex workers
		Illegal workers
		Trafficked migrants
Health influences associated with return travel	Changed health environment at origin (health systems improvements or declines)	Introduction of disease, acquired abroad, into home country Populations making return journeys to the place of origin (particularly children born at new destination) may be at increased risk of disease or illness:
	Children of foreign-born parents may have no exposure to risks present at origin	Visiting friends and relative travelers
		Locally born children of foreign-born parents
		Risks may return to new home after visit or may be introduced during travel