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unscathed by the wrath of HIV/AIDS 4 . As of
2003 there were 42 million people living with
the HIV virus and 29 million of these were in
the African continent. The nature of the disease
in Africa has been most devastating affecting the
most skilled and most educated leaving gaping holes
in the skilled labour force, and agricultural and
health sectors have not been spared 5 . The continuing
discovery of highly active antiretroviral therapy
(HAART) medication in managing HIV/
AIDS has brought revived hope in the highly affected
countries in Sub-Saharan Africa. Where as
in the past decade the exodus for brain drain has
been mostly economic the new wave is in search
of economic remittances and access to HIV/AIDS
treatment 6 . Furthermore this new exodus has on
average a lower education attainment than the average
person in the recipient source country. The
high cost, social stigma and discrimination associated
with HIV/AIDS especially in Asia and
Africa makes it more “attractive” to migrate to
the Northern countries, Sweden no exception, for
this treatment. The cost of delivering HAART in
poor countries is compounded by the loss of skilled
health professionals moving (for economic gains)
into the health sectors of developed countries to
provide care for the aging populations 7 .
The migrant’s health
The link between employment and health
Unemployment statistics show that the employment
situation of migrants in Sweden has worsened
during the past decades and that this is largely
due to structural reasons 8 . A recent study further
shows that migrants in particular non-European
migrants have considerably higher unemployment
rates and lower wage incomes than native Swedes
and the main reasons cited for this are 1) structural,
2) network effects (due to separated ethnically homogenous
networks) and 3) statistical stereotypical
thinking 9 . Many studies also show that there is a
clear link between unemployment, poor economic
resources, low education level also known as socio-economic
status (SES) and health 10 . Migrants
from outside Western Europe and belonging to
socially disadvantaged groups, also with the higher
unemployment rates, tend to exhibit more poor
health than their counterparts 11 . Why is this important
and should we as health practitioners be concerned
about this. The answer is obviously yes. Food
and health are closely inter-related. An individual
that is excluded from society psychologically does
not feel well 12 , and will more often than not react by
either consuming too little (anorexia) or too much
food (overweight) 13 , and in some cases, will seek
more health care and consume more anti-depressive
drugs 14 as a coping or struggling mechanism.
78
The migrants’ food – a question of
identity
With people migrating constantly in search of a
better quality of life, it is inevitable that food habits
also migrate, together with the foods required
to sustain food habits and identity. Food from
”home” is one of the things that you most miss
and look forward to when living abroad 15 . “Tell me
what you eat and I will tell you what you are” as the
saying goes. So what do you see when you see an
“Afro-Swede” eating pancakes and pea soup? Food
and culture are two very inseparable factors when
it comes to migrant acculturation.
The migration of food to countries in the north
has come about as a result of colonialism, migration
or tourism. Food brings about a strong identity
to one’s own culture that makes one similar
or vastly different from another. Migrants in any
situation attempt to maintain their culture, however
culture is not static. There are mechanisms to
adapt and change that which must absolutely be
changed for example food habits. Acculturation
refers to the process by which groups and individuals
adapt to the norms and values of an alien
culture 16 . Although the process is assumed to be a
two-way process this is usually dominated by one
culture, the host culture.
Customarily, the migrant is a mobile person
looking for hospitality. The word hospitality refers
to a metaphor for encountering the stranger with
warmth. Paradoxically embedded in the spirit of
hospitality is the aspect of hostility. This is made
apparent when asylum seekers or certain migrant
groups are seen as “utilising” the system or as parasites
especially when they receive subsidies. This
perception not only makes the stranger “uneasy”
but it may also force the stranger to be bipalatal,
eating local food in public and “own cuisine” behind
closed doors at home. This bipalatalism also
affects beliefs, attitudes and particularly the social
use of foods 26 . The older an individual is when they
migrate the more resistant they may be to change
(see Pudaric et al.,) and the less integrated they
may be (see Albin et al.,). While it is assumed that
the younger people may rapidly adopt the new culture
and food habits general studies on health and
well-being show that there is an over-representation
of school drop-outs as well as over-representation
of academic well-achievers 17 . Second-generation
immigrants in Sweden tend to have their own
distinct health and disease pattern that we know
very little about 18 . We know even less about how
this is linked to their diet and lifestyle an interrelationship
is worthy of elucidating.
Acculturation is not without problems, especially
when it comes to food habits. Studies in
North America have shown how “eating the white