COVID-19 Highlighting Inequalities in Access to Healthcare in England: A Case Study of Ethnic Minority and Migrant Women

Germain, Sabrina; Yong, Adrienne

doi:10.1007/s10691-020-09437-z

Cited by 59 publications

(69 citation statements)

References 10 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…161 Many marginalised and vulnerable groups, such as people working in the sex industry, people who were subjected to domestic abuse, people with problems with addiction, people who are homeless, people who are incarcerated, and unregistered migrants (which are circumstances that often coexist), who are less likely to have easy access to the internet to use remote services than are other people, have struggled to receive support during the pandemic. 162 The problem has been compounded by pre-existing shortfalls in statutory services which left them ill-prepared for an unexpected shock of this magnitude. Many people who are vulnerable or marginalised, particularly people whose immigration status prevents them from accessing public funds, 163 have been left to provide for themselves or relied on the support offered by charities, such as Shelter and Doctors of the World, which are themselves facing substantial financial constraints as a result of the global economic downturn.…”

Section: Addressing the Growing Unmet Need For Health Servicesmentioning

confidence: 99%

LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19

et al. 2021

View full text Add to dashboard Cite

The UK's response to the pandemicThe UK has recorded one of the highest death rates associated with COVID-19 globally, whether measured as deaths that are directly attributable to COVID-19 or by excess mortality. The reasons for this high rate are complex and not yet fully understood, but elements of the UK Government response have been criticised, including delayed implementation of physical distancing measures, poor coordination with local authorities and public health teams, a dysfunctional track and trace system, and an absence of consultation with devolved nations. The role of the National Health Service (NHS) and relevant national executive agencies in relation to testing capacity, availability of personal protective equipment (PPE), the cancellation and postponement of many aspects of routine care, and decisions around discharge from hospital to care homes should also be critically examined. Conversely, aspects of the response by the NHS and relevant national executive agencies deserve recognition. In only a few weeks, capacity for critical care was mas sively expanded, many thousands of staff were reallocated, and services were reorganised to reduce transmission of SARS-CoV-2. The NHS also collaborated with academic institutions to share knowledge about clinical characteristics of the disease and to establish world-leading clinical trials on vaccines and treatments.The response to COVID-19 brings to attention some of the chronic weaknesses and strengths of the UK's health and care systems and real challenges in society to health. Failures in leadership, an absence of trans parency, poor integration between the NHS and social care, chronic underfunding of social care, a fragmented and disempowered public health service, ongoing staffing shortfalls, and challenges in getting data to flow in real time were all important barriers to coordinating a comprehensive and effective response to the pan demic. More positively, the high amount of financial protection that was provided by the NHS and an allocation of resources that explicitly accounted for differing geographical needs have, to some extent, mitigated the already substantial effect of the pandemic on health inequalities. The London School of Economics and Political Science-Lancet Commission on the future of the NHSThis UK-wide London School of Economics and Political Science (LSE)-Lancet Commission on the future of the NHS provides the first analysis of the initial phases of the COVID-19 response as part of a uniquely comprehensive assessment of the fundamental strengths of and chal lenges that are faced by the NHS. The NHS has long been regarded as one of the UK's greatest achievements, providing free care at the point of delivery for over 66 million people from birth to death.Against this backdrop, and considering international evidence, this Commission sets out a long-term vision for the NHS: working together for a publicly funded, integrated, and innovative service that improves health and reduces inequalities for all. This Commission makes seven reco...

show abstract

Section: Addressing the Growing Unmet Need For Health Servicesmentioning

confidence: 99%

LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Testing and treatment for COVID-19 has been made free of charge and exempt from immigration status checks in many countries, with these messages communicated in multiple languages; however, concerns remain that these exemptions do not fully mitigate the extensive barriers that migrants experience in accessing healthcare ( Guadagno, 2020 , Wood and Devakumar, 2020 , Orcutt et al, 2020 ). Concerns within migrant communities that COVID-19 treatment might be chargeable, or that undocumented migrants might be identified by health systems on presentation remain, and could prevent early presentation and testing in migrants who distrust authorities ( Doctors of the World 2020 , Kanlungan Filipino Consortium 2020 , Germain and Yong, 2020 ). In the US, where nearly half of undocumented adult migrants and a quarter of lawfully present adult migrants lack health insurance ( Cholera et al, 2020 ), or have insurance that relies on a specific employer, migrants may avoid seeking care for fear of losing their job and being deported ( Doyle, 2020 ).…”

Section: Resultsmentioning

confidence: 99%

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review

Hayward

Deal

Cheng

et al. 2021

Journal of Migration and Health

242

228

View full text Add to dashboard Cite

“…Testing and treatment for COVID-19 has been made free of charge and exempt from immigration status checks in many countries, with these messages communicated in multiple languages; however, concerns remain that these exemptions do not fully mitigate the extensive barriers that migrants experience in accessing healthcare (8, 96, 97). Concerns within migrant communities that COVID-19 treatment might be chargeable, or that undocumented migrants might be identified by health systems on presentation remain, and could prevent early presentation and testing in migrants who distrust authorities (50, 60, 98). In the US, where nearly half of undocumented adult migrants and a quarter of lawfully present adult migrants lack health insurance (99), or have insurance that relies on a specific employer, migrants may avoid seeking care for fear of losing their job and being deported (100).…”

Section: Resultsmentioning

confidence: 99%

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review

Hayward

Deal

Cheng

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundMigrants, including refugees, asylum seekers, labour migrants, and undocumented migrants, now constitute a considerable proportion of most high-income countries’ populations, including their skilled and unskilled workforces. Migrants may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are being affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations (cases, hospitalisations, deaths), indirect health and social impacts, and to determine key risk factors.MethodsWe did a systematic review following PRISMA guidelines, registered with PROSPERO (CRD42020222135). We searched databases including PubMed, Global Health, Scopus, CINAHL, and pre-print databases (medRxiv) via the WHO Global Research on COVID-19 database to Nov 18, 2020 for peer-reviewed and grey literature pertaining to migrants (defined as foreign born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on our primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts, and risk factors, using narrative synthesis.Results3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps and labour compounds may have been especially affected. In general, migrants have higher levels of many risk factors and vulnerabilities relevant to COVID-19, including increased exposure to SARS-CoV-2 due to high-risk occupations and overcrowded accommodation, and barriers to health care including inadequate information, language barriers, and reduced entitlement to healthcare coverage related to their immigration status.ConclusionsMigrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health responses to the pandemic and should inform policymaking on strategies for reducing transmission of COVID-19 in this population. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.

show abstract

COVID-19 Highlighting Inequalities in Access to Healthcare in England: A Case Study of Ethnic Minority and Migrant Women

Cited by 59 publications

References 10 publications

LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19

LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review

Contact Info

Product

Resources

About