ALAN HIGGINS

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ALAN HIGGINS

• DIRECTOR OF PUBLIC HEALTH, OLDHAM LEAD DPH,
• HEALTH MIGRATION

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Regional Strategic Migration Partnership
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• Brenda Fullard Lead at N.W. SHA
• Alison Ricketts Regional Coordinator for Health
  Migration
• Geography Merseyside Cheshire, Lancashire
  Cumbria and Greater Manchester.

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Health Interest Group Aims

• Promote access to appropriate health and social
  care services for migrants.
• Assess the impact of migration on health,
  well-being and service delivery.
• Reduce inequalities between migrant groups and
  wider population.
• Contribute to the development coherent migration
  strategies.

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Timetable

• By May 2008 produce a report summarising
• - impact of migration on health in North West
• - implications for provision of healthcare
  and other services/environments relevant to
  health.
• Set the agenda for the work of the Health
  Interest Group.

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Findings to date

• Within NW, people moving from urban areas to
  rural and coastal areas.
• Movement is to areas where quality of life
  expected to be better.
• Leading to increased spacial polarity low income
  groups living in the urban areas.

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Findings to date

• Inflow of migrant workers from the EU in May
  2004.
• Concentrated in urban centres.
• Growing cultural diversity.
• Implications for service provision.
• Challenge to tackle the negative perceptions.

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Findings to date

• Minority groups experience exclusion and
  disadvantage.
• Lower rates of earnings.
• Tackling inequality of opportunity is a key
  economic and social challenge.
• Education is key.
• Flexibility of public services.

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Summary

• Health of Migrants, and Use of Services
• For certain infections, the major burden of
  disease falls upon particular groups of people
  who were not born in the UK
• Migrants may have a disproportionate burden of
  other infectious diseases, including those that
  are commonly thought of as travel related
• This does not mean that migrants overall have a
  very high prevalence of infectious diseases
• Impact on UK population
• There is little evidence that the wider UK
  population is at risk of significant levels of
  transmission of disease from affected migrants,
  especially during normal social contact.

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Summary 2

• Infection prior to, during and after migration
• Prevalence of disease in country of origin is
  major factor
• Ongoing health risks
• Socio-economic conditions in UK
• Ongoing travel to country of origin

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Findings to dateAsylum Seekers and Refugees

• Powerlessness, uncertainty of future.
• Grief.
• Physical and mental health issues from harsh
  treatment, torture, domestic violence, rape,
  sexual abuse.
• The Asylum System.
• Language, culture, faith issues.

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Findings to dateMigrant Workers

• Isolation.
• Unequal treatment.
• Working long and unsocial hours.
• Racism.
• Limited awareness of how services work.

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Access to health care

• 2004 - withdraw free secondary care (except
  if immediately or life threatening) to failed
  asylum seekers.
• 2007 - consideration of access to free
  primary health care services.

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Primary Care

• GPs, Pharmacists, Dentists etc.
• Majority of health needs are met in primary care.
• Assessment and access to hospital care.
• Treatment.
• Early detection.
• Prevention immunisation, screening.
• Continuity of care.
• Gatekeeping role.

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So if some people cannot access primary care..

• Later presentation - more complex care.
• - more costly
• - poor outcomes.
• More treatment in hospital more costly.
• Lack of treatment ethical issue.
• No access to immunisations - risk for
  individual.
• - risk for public.
• More pressure on accident and emergency services.
• No continuity of care difficult to develop
  trust.

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Current situation - confusing

• Lack of clarity difficult for primary care staff.
• Primary care staff asked to decide eligibility.
• People not accessing care even when entitled.
• People entitled to care are refused.

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Conclusion

• Restricting access to primary care will have
  serious implications for any section of
  population.
• Particularly so for migrants and asylum seekers.
• Treatment should be provided when it will prevent
  serious harm without undue cost.