This article analyses ‘internal’ (professional) and ‘external’ (social) factors which lead to the implementation of measures to improve health care delivery for migrants and ethnic minorities. Developments in this field in Europe have been slower than in the traditional immigration countries. The Netherlands and the UK, however, are two countries in which measures have been supported by government policy (although in The Netherlands this support was short-lived). The article analyses the similarities and differences between these countries in terms of migrant and minority population, social climate and government policy. It argues that as well as ‘bottom-up’ initiatives undertaken by health care workers and service users, decisive government intervention is an essential condition of structural improvements to health care for migrants and minority groups.Increasing migration to and within Europe has confronted health care systems with the challenge of developing accessible, appropriate and effective services for migrants and ethnic minorities. Existing service provisions have been developed for majority native populations and often fail to meet the needs of other groups (Watters, 2002). In this article I will try to analyse the factors which may stimulate or impede the development of multicultural health care. The article will draw on data from several countries, but will focus particularly on the two with which I have been most closely concerned - Britain and The Netherlands - to gain more insight into these factors. © 2006, Emerald Group Publishing Limited

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