Migrant Health in the UK and West Midlands

2. Migrant Health in the UK and West Midlands Workshop on Knowledge and Intelligence Sources Birmingham, 26th November 2013

3. What this presentation looks at: • The relationship between migration and health in the UK: what are the contributory factors in relation to migrants’ health and health needs that have been identified in research and practice • Some evidence on health of migrants and access to healthcare in the West Midlands

4. Context • Migration affects health and health affects migration • Health as an integration indicator • Impact of recent changes in the size and diversity of non-UK born population • Countries of origin • Reasons for migration • Legal immigration status and entitlement • Geographical patterns of settlement

5. Moving beyond ethnic inequalities in health • Research and administrative evidence currently mainly reported for minority ethnic groups • Incomplete coverage of ethnicity in routine health datasets • Government targets to reduce social inequalities in health refer to ethnic differences in outcomes and in cross-cutting social determinants of health – e.g. housing, smoking • Focus on ‘migration variables’ – e.g. country of birth, length of residence in the UK – important for policy and practice

6. What do we know about migrants’ health in the UK? Physical and mental health • Some focus on categories such as asylum seekers and refugees • Some focus on specific areas such as mental health and infectious diseases • Less documentation of health status of economic and family migrants and students • Self-reported health of migrant mothers • Health consequences of inadequate safety practices in some workplaces

7. Tuberculosis case reports and rates by ethnic group and place of birth, England, Wales and Northern Ireland, 2012 (Source: Centre for infectious disease, surveillance and control, Public Health England)

8. What do we know about migrants’ health? Health behaviour • Areas of concern include smoking patterns, alcohol consumption, diet, exercise, breast feeding • Is ‘acculturation’ a useful explanatory model? • Evidence challenging linear models in understanding patterns of health of migrants over time

9. What do we know about migrants’ health? Non-communicable diseases • Ethnic and country of birth differences in increasing risk and prevalence of heart disease, stroke, diabetes, and cancer in the UK – e.g. CHD (‘South Asians’); diabetes (African-Caribbean and South Asian groups) • The theory of the ‘healthy migrant effect’ and impact of ‘risky health behaviours’ – the latter extending to the second generation • Possible challenges to this: • who is adopting whose health behaviour • structural constraints in achieving healthy life styles • disease patterns in countries of origin and pre-migration health

10. What do we know about migrants’ health? Access to and use of health care

11. What do we know about migrants’ health? Access to and use of health care • inadequate information • insufficient language support • poor access to transport • cultural insensitivity of providers Some of these barriers cut across length of residence in the UK

12. Entitlement to free health care • Stratification of rights to health care • Impact of restrictions in immigration regulations for undocumented migrant categories • Impact on health outcomes of vulnerable migrants – e.g. pregnant women and recent mothers

13. Evidence from the West Midlands • Some health issues for migrants • access to health care and GP registration including impact of language and cultural barriers • early access to maternity services including the potential impact which migration may be having on infant mortality and low birth weight • mental health • impact of poor quality housing and destitution • infectious disease - the impact of Tuberculosis, HIV and other infectious diseases

14. Findings from interviews and roundtable discussions with statutory and voluntary sector providers 1 • In Birmingham especially health provision for migrants more generous than in many other areas in England • Take up of immunisations and screening generally high especially among established South Asian and Black populations. Perhaps related to easy access to co-ethnic/co-religious GPs • Specialised health services developed for some migrant categories (e.g. mental health) sometimes under-utilised; perhaps service provision not meeting specific needs e.g. transient populations, newer languages • Confusion around legal status and entitlements among both service providers and migrants; and about different eligibility criteria for health and for social care

15. Findings from interviews and roundtable discussions 2 • Important issues for health identified include unemployment, housing, low wages, FGM which has implications for childbirth • Policy making and service provision target driven – e.g. life expectancy, infant mortality, obesity. Less focus on community specific goals. Not much information on how much migrants contribute to the big targets • There are projects around specific themes – e.g. housing, NRPF, infant mortality – and partnership across sectors, but less of a coherent plan or framework • National policies not always understood or considered positive. “ Birmingham is accidentally tolerant – because we get on with it”

16. Evidence from the West Midlands: example 1 • Infectious diseases • Birmingham has one of the highest incidences of TB among European cities and the rate has risen in the past decade • Most cases concentrated in a small number of wards with high proportions born outside the UK and linked with countries with high rates of TB – e.g. India, Pakistan, some African countries • A significant proportion of cases acquired in Birmingham but not enough evidence on how transmitted and barriers to healthcare

17. Evidence from the West Midlands: example 2 • Maternal health and infant mortality • Some local areas have relatively high proportions of live births to mothers born outside the UK – e.g. in 2012 Birmingham (38.5%), Coventry (36%), Sandwell (30%) • In 2010 the largest proportion of ethnic minority mothers were Pakistani • Infant death rates highest in local areas with high migrant proportions – e.g. Birmingham • Impact of language barriers on information and access • Barriers in access to housing, transport, and a healthy diet because of poverty

18. Suggestions for policy and practice • Improve collection of data on migration variables in routine health data systems • Get more robust and widespread information about health needs and barriers to access among diverse migrant categories • Specifically try to reach more vulnerable groups with problems in accessing mainstream health services • Adopt a community development-based approach focusing on individual and community empowerment and partnership working across agencies

19. Further information on the West Midlands • Useful resources section in Appendix 5 of WMSMP conference report March 2013: Understanding migration, reducing health inequalities – meeting the health needs of the new population • West Midlands Perinatal Institute for local level data on births and infant deaths

20. Publications on migrant health Public Health England – Migrant health guide http://www.hpa.org.uk/MigrantHealthGuide/ Jayaweera, H. (2011) Health of migrants in the UK: What do we know? Migration Observatory at the University of Oxford, Centre on Migration, Policy and Society. http://www.migrationobservatory.ox.ac.uk/briefings/health-migrants-uk-what-do-we-know Jayaweera, H. & Quigley, M. (2010), ‘Health status, health behaviour and healthcare use among migrants in the UK: evidence from mothers in the Millennium Cohort Study’ in Social Science & Medicine 71 (5): 1002-1010. http://www.ncbi.nlm.nih.gov/pubmed/20624665

21. Centre on Migration, Policy and Society University of Oxford 58 Banbury Road Oxford OX2 6QS