The negative health effects of hostile environment policies on migrants: A cross-sectional service evaluation of humanitarian healthcare provision in the UK

Abstract

Background: Recent UK ‘hostile environment’ immigration policies, including obligatory charging and sharing of confidential data between NHS Digital 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.

Migration health research in the United Kingdom: A scoping review

“…This is surprising given how understanding migrant healthcare access and experience is critical to planning health services and reducing barriers to access. Despite all residents in England regardless of immigration status being entitled to access primary care, a few studies showed that some migrants struggle to register with a General Practice, lack knowledge of their entitlement or even fear arrest when accessing NHS services ( Fang, 2015 ; Kang et al., 2019 ; Weller et al., 2019 ). In terms of secondary care where non-urgent treatment is chargeable for those who cannot prove their entitlement, research has shown that some migrants have been denied urgent care or received delayed treatment ( Potter et al., 2020 ; Doctors of the World 2020 ).…”

“…Examining how structures and systems impact migrants’ health has become increasingly important within the context of England's growing number and breadth of policies aiming to embed immigration control within public services like the NHS ( Griffiths and Yeo, 2021 ). Sharing data between the Home Office and public services (e.g., a patient's hospital bill, a victim's report of a crime, or a worker's report of employer abuse) for immigration enforcement has garnered distrust and fear within some migrant communities ( Weller et al., 2019 ; Delvino, 2020 ). Furthermore, migrants without recourse to public funds cannot receive welfare such as income support, school lunch subsidies or homelessness assistance ( Weller et al., 2020 , Delvino, 2020 ).…”

A systematic review exploring palliative care for families who are forced migrants

“…Negative media discourse around migration, community antagonism, and a hostile environment further creates a sense of unease with the potential for forced migrants to be stereotyped or discriminated against (Manstead, Reicher, Greenland, & Nightingale, 2016; Weller et al., 2019). Forced migrant families particularly value those HCPs who offered them compassion, caring concern, affection, and empathy.…”

Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK

“…The conditions prior to, during and after migration expose individuals to a range of health risks, resulting in differences in health outcomes between migrants and non-migrants in the migrant's country of arrival (2). In the UK, there are well-established multi-generational minority ethnic communities but a history of 'hostile' migration policies (3). The study of migrant health is therefore needed to complement the study of ethnic inequalities to understand how migration intersects with ethnicity, as well as its effects over and above ethnicity to shape risk factors for health, physical and mental health outcomes, and healthcare access (4).…”