Enhancing patient safety and access to care to populations at risk of exclusion: the example of the Portuguese-speaking migrant community in South London (original) (raw)
Related papers
Illness and healthcare experiences of recent low-income international migrants in a UK city
Multiple factors account for inequality in health outcomes and in access to healthcare in the UK, including ethnicity. This thesis explores length of residency in a country after migration through the subjective experiences of a group of recent low-income international migrants who have used local health services to seek care for a range of illnesses and conditions. The project was formulated in collaboration with Brighton and Hove City Council and the then NHS Brighton and Hove (now Brighton and Hove Clinical Commissioning Group) to recruit participants and collect narratives from this hard to reach social group. The theoretical background of this research draws on ‘lived’ experience in the context of illness. Analysis of qualitative interviews used narrative typologies derived from the work of Frank (1991), revealing both the commonalities across and the specificities of illness experiences, and highlighting a multi-factorial web of bio-psychosocial and economic factors at play. The interviews overwhelmingly fitted with a chronic, ‘chaos’ typology, in which diagnoses were commonly contested. The particularities of recent migrant status impacted upon participants’ illness experiences and healthcare use with migrants making comparisons with health systems in their countries of origin and managing healthcare through social networks. The findings from the data analysis around patient experience showed that the overall experience was negative, characterised by themes of problems in communication and access. Some outcomes were explained in terms of direct and indirect discrimination. Direct discrimination and stigma were perceived by many participants with attitudes and practices of staff, and the theme of ethnicity, immigration status and faith being stated. From this study it is possible to hypothesise that some healthcare practices and policy may give rise to the perceptions of discrimination.
Health Policies Towards Immigrant Populations and Ethnic Minorities in the United Kingdom
Migration Santé, nº 110/111, 1er et 2ème trimestre , 2002
Britain host a plurality of ethnic minorities within its population, mostly as a result of the migratory processes that took place after World War II. The presence of these groups posed a series of challenges to British health authorities, both in terms of their access to the health care services, and in the specific needs that had to be addressed. Here I will argue that the incorporation of immigrant populations and ethnic minorities at the fringes of the British welfare state was determined by the political environments that prevailed at the time of their arrival and settling in the UK, as well as by the institutional arrangements that characterised the British welfare system.
2006
Background: Changing immigration trends pose new challenges for the UK's open access health service and there is considerable speculation that migrants from resource-poor countries place a disproportionate burden on services. Data are needed to inform provision of services to migrant groups and to ensure their access to appropriate health care. We compared sociodemographic characteristics and impact of migrant groups and UK-born patients presenting to a hospital A&E/Walk-In Centre and prior use of community-based General Practitioner (GP) services.
Social Science & Medicine - Mental Health, 2022
This article contributes new insights into how refugees, asylum seekers and undocumented migrants experience access to healthcare in the UK from both the perspective of caseworker volunteers and the assessment of policy regulations that influence such experiences. Drawing on material taken from qualitative interviews conducted with Doctors of the World caseworkers and Freedom of Information documents from NHS trusts, we reveal the various complexities faced by refugees, asylum seekers and undocumented migrants when trying to access vital health care. These issues include, charging regulations, the refusal to register patients at GP practices without proof of ID, language barriers and complications navigating the healthcare system. We found that such deterrents lead to risky help and health seeking, lack of or inadequate healthcare, and worse health outcomes among these populations. DOTW caseworkers perceived policies such as charging regulations, to be unjust as they plunge patients into significant debt, which is reported to the Home Office and can lead to the detainment or deportation of patients and their families. Study participants called on the UK government to recognise health as a fundamental human right, to develop inclusive social policy and to create an empathetic health system that allows refugees, asylum seekers and undocumented migrants equitable access to health and social services. To achieve health for all, they argued the need for clearer guidelines regarding access to healthcare and charging regulations, with some suggesting the importance of revising current Department of Health and Social Care policies and Home Office measures. Our article concludes that there is a need to tackle the underlying causes of ill health, including discriminatory policies, racism, and exclusion; addressing the social and economic determinants of health; and providing meaningful and culturally sensitive healthcare and social support.
Feminist Legal Studies
Our commentary aims to show that the COVID-19 pandemic has amplified existing barriers to healthcare in England for ethnic minority and migrant women. We expose how the pandemic has affected the allocation of healthcare resources leading to the prioritisation of COVID-19 patients and suspending the equal access to healthcare services approach. We argue that we must look beyond this disruption in provision by examining existing barriers to access that have been amplified by the pandemic in order to understand the poorer health outcomes for women in ethnic minority and migrant communities. The reflection focuses on racialised medical perceptions, gendered cultural norms including information barriers and stigma, and specific legal barriers.
Ethnicity & Health, 2014
Objectives. This study aimed to investigate the associations between migration status and health-related outcomes and to examine whether and how the effect of migration status changes when it is disaggregated by length of residence, first language, reason for migration and combined with ethnicity. Design. A total of 1698 adults were interviewed from 1076 randomly selected households in two South London boroughs. We described the socio-demographic and socioeconomic differences between migrants and non-migrants and compared the prevalence of health-related outcomes by migration status, length of residence, first language, reason for migration and migration status within ethnic groups. Unadjusted models and models adjusted for socio-demographic and socioeconomic indicators are presented. Results. Migrants were disadvantaged in terms of socioeconomic status but few differences were found between migrant and non-migrants regarding health or health service use indicators; migration status was associated with decreased hazardous alcohol use, functional limitations due to poor mental health and not being registered with a general practitioner. Important differences emerged when migration status was disaggregated by length of residence in the UK, first language, reason for migration and intersected with ethnicity. The association between migration status and functional limitations due to poor mental health was only seen in White migrants, migrants whose first language was not English and migrants who had moved to the UK for work or a better life or for asylum or political reasons. There was no association between migration status and self-rated health overall, but Black African migrants had decreased odds for reporting poor health compared to their non-migrant counterparts [odds ratio = 0.15 (0.05-0.48), p < 0.01]. Conclusions. Disaggregating migration status by length of residence, first language and reason for migration as well as intersecting it with ethnicity leads to better understanding of the effect migration status has on health and health service use.
Migration, ethnicity and the ‘social determinants of health’ agenda
Migration, ethnicity and the ‘social determinants of health’ agenda. Psychosocial Intervention / Intervención Psicosocial 21(3), 331-341. , 2012
One of the most promising recent developments in health policy has been the emergence of a global ‘health equity’ movement concerned with the social determinants of health. In European research and policy-making, however, there is an strong tendency to reduce ‘social determinants’ to ‘socioeconomic determinants’ and to ignore the role of ethnicity, migration and other factors in the creation of inequities. This threatens to hold up the development of work on ethnicity and migration and thus to perpetuate inequities linked to these factors. The present article sets out to illustrate this tendency and to investigate the reasons which may underlie it. The justifications often put forward for neglecting ethnicity and migration are shown to be erroneous. An integrated approach, simultaneously taking account of socioeconomic status, migration and ethnicity as well as other determinants of inequity, is essential if work on the social determinants of health is to make progress. Equity is indivisible; researchers investigating different aspects of social stratification should not treat each other as rivals, but as indispensable allies. An integrated, intersectional, multivariate and multilevel approach will improve our understanding of health inequities and make available more resources for tackling them.
eClinicalMedicine
Background The SARS-CoV-2 pandemic has brought racial and ethnic inequity into sharp focus, as Black, Asian, and Minority Ethnic people were reported to have greater clinical vulnerability. During the pandemic, priority was given to ongoing, reconfigured maternity and children's healthcare. This study aimed to understand the intersection between race and ethnicity, and healthcare provision amongst maternity and children's healthcare professionals, during the SARS-CoV-2 pandemic. Methods A qualitative study consisting of semi-structured interviews (N = 53) was undertaken with maternity (n = 29; August-November 2020) and children's (n = 24; June-July 2021) healthcare professionals from an NHS Trust in ethnically-diverse South London, UK. Data pertinent to ethnicity and race were subject to Grounded Theory Analysis, whereby data was subjected to iterative coding and interpretive analysis. Using this methodology, data are compared between transcripts to generate lower and higher order codes, before super-categories are formed, which are finally worked into themes. The interrelationship between these themes is interpreted as a final theory. Findings Grounded Theory Analysis led to the theory: An 'Imperfect Mosaic', comprising four themes: (1) 'A System Set in Plaster'; (2) 'The Marginalised Majority'; (3) 'Self-Discharging Responsibility for Change-Making'; and (4) 'Slow Progress, Not No Progress'. The NHS was observed to be brittle, lacking plasticity to deliver change at pace. Overt racism based on skin colour has been replaced by micro-aggressions between in-groups and out-groups, defined not just by ethnicity, but by other social determinants. Contemporaneously, responsibility for health, wellbeing, and psychological safety in the workplace is discharged to, and accepted by, the individual. Interpretation Our findings suggest three practicable solutions: (1) Representation of marginalised groups at all NHS levels; (2) Engagement in cultural humility which extends to other social factors; and (3) Collective action at system and individual levels, including prioritising equity over simplistic notions of equality.