Wellcome Open Research
Volume 4, 2019

The negative health effects of hostile environment policies on migrants: A cross-sectional service evaluation of humanitarian healthcare provision in the UK [version 1; peer review: 2 approved, 1 approved with reservations] (Article) (Open Access)

Weller S.J. , Crosby L.J. , Turnbull E.R. , Burns R. , Miller A. , Jones L. , Aldridge R.W.*
  • a Academic Foundation Programme, North Central and East London Foundation School, Health Education England, Stewart House, 32, Russell Square, London, WC1B 5DN, United Kingdom
  • b School of Public Health, St Mary's Hospital, Imperial College London, Praed St, Paddington, London, W2 1NY, United Kingdom
  • c Academic Foundation Programme, North Central and East London Foundation School, Health Education England, Stewart House, 32, Russell Square, London, WC1B 5DN, United Kingdom, Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, United Kingdom
  • d Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, United Kingdom
  • e Doctors of the World UK, 29th Floor, One Canada Square, London, E14 5AA, United Kingdom
  • f Doctors of the World UK, 29th Floor, One Canada Square, London, E14 5AA, United Kingdom
  • g Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, United Kingdom

Abstract

Background: Recent UK ‘hostile environment’ immigration policies, including obligatory charging and sharing of confidential data between NHDigital and the Home Office, have created an atmosphere of fear and exposed already highly marginalised and vulnerable groups to significant health risks by increasing barriers to accessing NHS care. Methods: This is a cross-sectional observational study of patients accessing healthcare at Doctors of the World (DOTW) in the UK. DOTW is a humanitarian organisation, providing care to those excluded from NHS healthcare. We aimed to describe population characteristics of individuals using DOTW services and identify groups at greatest risk of facing ‘hostile environment’-related barriers to NHS care, specifically being denied healthcare or fear of arrest. Results: A total of 1474 adults were seen in 2016. Nearly all were non-EU/EEA nationals (97.8%; 1441/1474), living in poverty (68.6%; 1011/1474). DOTW saw a large number of undocumented migrants (57.1%; 841/1474) and asylum seekers (18.2%; 268/1474). 10.2% (151/1474) of adults seen had been denied NHS healthcare and 7.7% (114/1474) were afraid to access NHS services. Asylum seeker status was associated with the highest risk (adjusted odds ratio (OR): 2.48; 95% confidence interval (CI): 1.48-4.14) of being denied NHS healthcare and being undocumented was associated with the highest risk of fearing arrest (adjusted OR: 3.03; 95% CI: 1.70-5.40). Conclusions: Our findings make visible the multiple and intersecting vulnerabilities of individuals forced to seek care outside of the NHS, underlining the public health imperative for the government to urgently withdraw its ‘hostile environment’ policies and address their negative health impacts. © 2019 Weller SJ et al.

Author Keywords

UK Migrants Asylum Hostile environment Health Refugees Barrier Undocumented

Index Keywords

[No Keywords available]
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85072729003&doi=10.12688%2fwellcomeopenres.15358.1&partnerID=40&md5=820b3ca9d14c80294e5796173e6971cd
DOI: 10.12688/wellcomeopenres.15358.1
ISSN: 2398502X
Original Language: English