Commentary: kisses or money for Penelope?

authors offer two explanations—financial (material) and emotional (psychosocial) factors, respectively. It will be probably a bit of both. On the one hand, not receiving financial assistance from those who emigrated has obvious consequences on income and material circumstances of those who stayed at home. Material deprivation is one of the main factors driving emigration. It has been estimated that the amount of money sent home by Latin American migrant workers to their families exceeds the combined total of all direct foreign investment and foreign aid. 4 In Albania, it has been estimated that money send from abroad accounted for 14% of GDP and approximately one-third of total household income in 2005. 5,6 These are staggering amounts, and it is likely that money from abroad provides the receiving families with a considerable advantage. Despite the difficulties with measuring income (including transfers) and its effects, it is likely that material deprivation caused by the lack of transfers, in this case remittances, has an effect on the health in the population studied. On the other hand, as Burazeri and colleagues discuss, 1 not receiving money from abroad is also a marker of low family cohesion and low social support. There is evidence that major life events requiring emotional adjustment are associated with increased risk of cardiovascular events. 7 Emigration of close relatives and the associated loss of social support can have consequences similar to bereavement 8 or poor social networks. 9 The view that the effects of emigration are not exclusively driven by material factors is supported by the fact that, in this study, adjustment for total household income did not make much difference to the estimated association between acute coronary syndrome and emigration. It is also not clear how exactly would material factors affect cardiovascular risk; classical risk factors are unlikely candidates. The question as to whether emigration affects health of those who remained at home is an important one, both for research and for public health. If the results are replicated by further studies and in different populations, emigration of close family members may be another interesting social exposure, sharing both material and psychosocial features. Since, in contrast to many other social determinants, this is a reversible exposure, and one which varies over time, it may provide new opportunities to investigate the contribution of different aspects of social environment to health. effects of emigration to those who remain at home. Stampfer …