Perceptions of Migrant Families on Child Health Services in the UK

1. MERH, Session 5.2Governing healthy migrant families:migrants’ and health workers’ views and perceptions of child health and wellbeing services in the UK Dr Stuart McClean Research Theme Leader, Health & Wellbeing Centre for Public Health & Wellbeing Research University of the West of England UK Professor Louise Condon University of Swansea UK

2. Background and focus: • Migration as movement between health care systems, and health and policy discourses, as well as ways of thinking about the state, personal responsibility and self-governance. • Involves a changing relationship between the migrant (individual/family) and the state, depending on the health/social systems they are moving from and to. • With a ‘fortress Europe’ approach to migration policy, and receding (or evolving) globalisation, what will be the impact on migrants’ own perceptions of their rights, responsibilities and obligations in the UK? • This paper focuses on how migrant parents and families, originating from different countries of origin (both within and outside of the EU), understand and make sense of the UK health care system, including preventive child health services.

3. Methods • Five focus groups with parents of pre-school children from both EU Accession countries (Romania & Poland), and established migrant communities (Somalia & Pakistan), who had migrated to the UK within last 10 years. One group consisted of Roma parents. • Topic guide: parents’ experiences of keeping children healthy in the UK, including exercise, diet, infant feeding, safety, alcohol and smoking. • Semi-structured interviews with health and community professionals working with migrant families. • Data analysed using a thematic content analysis approach, transcripts coded to identify themes and categories using constant comparison and to identify patterns and search for deviant cases.

4. Findings (1)Migrant perceptions of social and welfare systems: state versus individual Adjusting to the transition meant engaging with different ideas about people’s relationship to the state, and the extent to which families felt more or less supported Care for children was seen by all groups as being woven into the broader aspects of society which impact upon health, such as housing. Statutory regulations such as a child being entitled to a room of their own were unanticipated and seen as almost overly paternalistic There is an awareness of the levels of support for new families, but for some migrant families this is perceived as unwanted monitoring of their parenting that does not fit with some of their normative assumptions about the role of health professionals

5. state versus individual ‘There is such a big focus on family and on children… here I heard that a child needs to have a bedroom on its own. I thought… why!? In Poland no one cares how you live, where you live, how many bedrooms you’ve got, if you sleep in the kitchen, on the floor. No one cares. If you cannot afford a house or if anything happens in your life, you lost a job or someone dies, you cannot afford to rent a flat and live with your child they would probably take your child away from you.’ (Polish FG, P5) ‘Here everybody is interested (laugh) you get the social worker involved, the hospital people and doctor involved; nobody has responsibility back home only the mum.’ (Pakistani FG, P1)

6. Findings (2)Health governance, security and risk The UK was seen as providing greater security, but with some loss of freedom for both children and parents. Both Polish and Somali groups felt that a pervasive concern about ensuing continual safety for the child could create a climate of fear and added worry for parents Somali and Polish parents described how living in the UK heightened their perception of risk for children and families. Pakistani mothers described being overtly taught to care for their children in a safe way and being socialised into UK safety norms by their children’s schools The provision for children in the UK can be seen as a double-edged sword, by which more is demanded from parents who are socialised into a public agenda of striving for higher standards in their parental role

7. health governance, security and risk ‘Here for example they have free education, better education for your life. You can plan your child’s future but here although they have freedom…still something is missing and here it’s not so safe… there is a lot going on so you have to be careful all the time.’ (Somali FG, P4) ‘[Here] you cannot trust your child like to go out and by themselves, because you always think something might happen to them; back home although they may be around but because other adults are looking after them as well…you feel more safe.’ (Somali FG, P5) ‘[In Poland] they don’t have wellness, they don’t have healthy living. Healthy lifestyle, they don’t have the time, they don’t have the money, they are average people (Polish FG, P3)

8. Findings (3)Migrant views/experiences of health care services in transnational context All migrant groups experienced extreme differences between health systems and services in their own counties compared to the UK. A Roma father described these as being as wide as, ‘Differences between the earth and the sky’ Preventive health services were new to most migrant groups. Rather than the patient as a consumer simply accessing services when they had a need for them, in the UK a universal child health promotion programme meant that some health workers sought out families proactively seeking to optimise the wellbeing of their children While appreciating state provision of health services, those who had access to private medicine in their country of origin found the lack of choice within the NHS, and the inability to manipulate the system to work in their favour, difficult to deal with

9. Migrant views/experiences of health care services in transnational context ‘We have a really high rate certainly around here of families going to A&E for minor illnesses really what we perceive to be minor illnesses although obviously they’re perceived differently by the families.’ (Health visitor) ‘The midwife come and see you and the health visitors come and see you, and then they keep on seeing you, and then if the child has any problem they keep coming and guiding us.’ (Somali FG, P2) ‘We had many cases at the beginning when people were suspicious about the fact that they didn’t have to pay…you would have the health visitors coming [to the] home and not accepting bribery. They didn’t know why not, because [of] that fear of, if you don’t receive my money or my gift that means you are not going to treat me properly, because that is ingrained in Romania.’ (Link worker, Romanian)

10. Conclusion: • In the UK, health promotion and preventive health strategies are focused on individuals and families, emphasising citizenship obligations, and increased responsibility for health, which involves some new thinking about the relationship between the state and the individual. We need to conceptualise how we think about migrant health in the context of citizenship rights. • Preventive health care can be seen to promote monitoring and surveillance of migrant parents and their children - migrant parents may be ambivalent. • What we see is that self-governance and personal responsibility towards health and well-being is often seen as a necessity and a normative practice (Foucault – ‘governmentality’) • Many public health interventions may unintentionally work to reinforce the social exclusions and discrimination that many migrant families feel in the UK and other societies (e.g. Roma) – responsibility for health professionals to collaborate

11. Thank you! Any questions? stuart.mcclean@uwe.ac.uk @StuartDMcClean