Migrants

Migrants are widely described as people who belong to (or have an allegiance) to one state/country, but move into another for the purpose of settlement.

Migrant populations are diverse, and many have social, cultural and health needs. Migration is driven by many reasons (including economic, family reunion, study, humanitarian reasons or human trafficking). As a consequence migrants may have several diverse health and social care needs.

Migrant populations have different health and wellbeing issues depending on lifestyle risk factors, cultural practices, country of origin, genetic and hereditary factors and wider determinants (poor housing, lower economic opportunities, unemployment and living in deprived areas).

This topic links to the following JSNA topics:

Last updated: 2013-03-12 16:16:16
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1. What are the key issues?

Migrants have poor access to (and uptake of) services compared to the general population.

Migrants are often housed in unsatisfactory conditions with inadequate heating.

Emergency accommodation does not always meet some of the cultural needs of migrants.

Migrants often live in more deprived and unsafe neighbourhoods.

Migrants experience racism and discrimination.

Many migrants become isolated, which can lead to poor mental and physical health.

Migrant workers are often subject to exploitation (such as unfair pay and exposure to unsafe working).  

Migrants often work below their qualification level. This may be due to a lack of language skills and lack of recognition of overseas qualifications and work experience.

Mental health problems (including post-traumatic stress disorder) are common in refugees and asylum seekers, but also common in other migrant populations due to isolation, racism or lack of access to services. Low self-esteem and self-worth have been identified locally among migrants.

Sexual health issues including sexually transmitted infections, HIV and unwanted pregnancies as well as accessing culturally appropriate services are problematic for some migrants.

There is a lack of (or incomplete) screening and immunisations (including communicable diseases, cervical smears, breast screening and hearing and eye checks) for migrants.

Migrants have poor access to dental care and some may have a lack of understanding of dental health needs.

Hypertension and diabetes among some of the migrant population (such as South Asians) is higher than the general population. 

Behavioural health problems (including alcohol misuse and smoking) may be a problem for some migrants.

There is a lack of advice and support for the transition period from asylum status to refugee status locally.  Eligibility and accessibility of services (e.g. housing, benefits, education and health) may lead to health problems.

There is a lack of comprehensive data to reflect the current migrant population.

The local Housing Options service is not made aware of the decisions on individual asylum cases in a timely manner.

There are not enough interpreting services due to the ever changing needs of the community. The services that are available are not flexible enough to meet the needs of migrants.

Anecdotal evidence suggests that some migrant populations consume a diet of high saturated fat, high sugar and salt which can contribute to an increased risk of diabetes and heart disease.

There is evidence that migrants fail to register with a new GP when they move elsewhere.

Some asylum seekers receive temporary registration (when entitled to full registration), and therefore they do not have an NHS number and so cannot access the full range of services available.

Migrants present more often to hospitals due to poor access to primary care and communication needs.

Last updated: 12/03/13

2. What commissioning priorities are recommended?

Commissioning priorities yet to be determined.

Last updated: 12/03/13

3. Who is at risk and why?

Age

Migrants are likely to have more children than the general population.

The population of older migrants will rise over the next few years.

Gender

Women from South Asian communities are less physically active compared with their white counterparts.

Obesity is more likely to be reported in Black Caribbean and Pakistani girls and Indian and Pakistani boys.

Socioeconomic status

Migrants often live in deprived areas. Poverty, isolation and discrimination lead to poor health outcomes (especially for mental health).

Ethnicity

Black African: High risk of infectious diseases, mental disorders, pneumonia, HIV, perinatal disorders and diabetes.
Afro-Caribbean: High risk of diabetes, prostate cancer, mental disorders and cerebrovascular disease.
Asian: High risk of tuberculosis, diabetes, chronic heart disease, cerebrovascular disease, perinatal conditions, and respiratory diseases.
Chinese: High risk of cancer, digestive system issues, congenital anomalies and diseases of the eyes and ears.

Tuberculosis rates are highest amongst Black Africans, followed by Pakistani, Indian and Bangladeshi groups.

Uptake of preventative services (such as cervical cancer smears) is lower in South Asian women.

Asian children have lower levels of physical activity but are less likely to report smoking or alcohol consumption behaviours.

The highest levels of accidents recorded are in the Black Caribbean population.

Education

Children who have English as an additional language have lower levels of attainment compared with children who have English as their first language.

Employment

Migrant workers may find it difficult to access services due to long working hours and/or shift patterns.

Lifestyle

Bangladeshi men have higher smoking prevalence (44%) compared to men in the general population (27%).

Destitute refused asylum seekers

Asylum seekers who are declined entry are required to leave the UK once all appeals have been concluded. They then automatically become destitute as all forms of support will be withdrawn including accommodation and subsistence payments. Homelessness ensues with mental health often worsened.

Last updated: 12/03/13

4. What is the level of need in the population?

Nationality: non-British

Redcar & Cleveland has a lower non-British population (1%) compared to the North East (3.2%) in 2010.

Country of birth: non-UK

The proportion of Redcar & Cleveland’s population born outside the UK (2%) is slightly higher than the regional average (5%) in 2010.

Births to non-UK-born mothers

The proportion of births in Redcar & Cleveland to mothers who were born outside the UK (4%) is lower than the North East (10.3%).

New international arrivals

In 2010, the formal estimate from the Office for National Statistics (ONS) was for about 318 new migrants who will stay more than a year (‘long term migrants’) to arrive in Redcar & Cleveland.

The National Insurance Number (NINo) data only records migrants over the age of 16, who are planning to work or claim benefits and would therefore not take account of dependants.

Net migration

Source: ONS

Net migration in Redcar & Cleveland has significantly increased in the last 6 years. In 2010, net migration was 158.

Country of origin (NINO)

The top four countries of origin are Romania, China, India and Poland.

Workers registration scheme

In Redcar & Cleveland, the total number of workers on the Workers Registration Scheme in 2010 (11) was considerably lower than in 2008 (105).

Asylum seekers

In 2011/12 there were 3 asylum seekers accommodated in Redcar & Cleveland. This represents less than 1% of the asylum population of the North East.

Last updated: 12/03/13

5. What services are currently provided?

Content under development

Last updated: 10/10/11

6. What is the projected level of need?

While net migration to Redcar & Cleveland was 158 in 2010, future net migration is projected to decrease and provide a significant overall loss (as immigration decreases and emigration increases). This projection assumes no changes in policy or international conditions.

Last updated: 12/03/13

7. What needs might be unmet?

Content under development

Last updated: 10/10/11

8. What evidence is there for effective intervention?

Social Care Institution for Excellence (2010)

Good practice in social care for asylum seekers and refugees.

www.scie.org.uk

Access to the NHS by migrants and overseas visitors for primary care staff and commissioners.

http://www.pcc.nhs.uk/news/4775

Including Migrant Populations in Joint Strategic Needs Assessments (2011). www.idea.gov.uk

Audit Commission (2007)

Crossing borders: Responding to the local challenges of migrant workers.

http://www.audit-commission.gov.uk/SiteCollectionDocuments/AuditCommissionReports/NationalStudies/CrossingBorders.pdf

NHS Evidence

Provided the best available evidence on health needs and access to health care of migrant and minority ethnic groups, and on the management of the health care service for these groups.

www.evidence.nhs.uk

NICE (2010)

A model for services provision for pregnant women with complex social factors. 

http://guidance.nice.org.uk/CG110

NICE (2011)

Preventing type 2 diabetes: population and community-level interventions in high-risk groups and the general population.

http://www.nice.org.uk/guidance/PH35

Department of Health (2003)

Caring for dispersed asylum seekers: a resource pack. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4010379

Department of Health (2011)

Female genital mutilation: multi-agency practice guidelines. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124551

The Health Protection Agency (2006)

Migrant health a baseline report. http://www.hpa.org.uk/Publications/InfectiousDiseases/TravelHealth/0611MigrantHealth2006/

Last updated: 12/03/13

9. What do people say?

Content under development

Last updated: 10/10/11

10. What additional needs assessment is required?

Content under development

Last updated: 10/10/11