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The Negative Health Effects of Hostile Environment Policies on Migrants: A Cross-Sectional Service Evaluation of Humanitarian Healthcare Provision in the UK
29 Pages Posted: 20 Jun 2019
More...Abstract
Background: Recent UK 'hostile environment' immigration policies, including obligatory charging and sharing of confidential data between NHS and 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 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.
Findings: 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 OR: 2·48; C.I:1·48-4·14) of being denied NHS healthcare and undocumentation was associated with highest risk of fearing arrest (adjusted OR: 3·03; C.I:1·70-5·40).
Interpretation: 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.
Funding Statement: Funding provided by Wellcome Trust, European Union; European Programme for Integration and Migration, European Commission: DG Health and Food Safety / Consumers, Health, Agriculture and Food Executive Agency.
Declaration of Interests: RWA received consultancy fees from Doctors of the World, outside the submitted work to complete the 2017 Médecins du Monde Observatory Report. LJ and AM are both employed by Doctors of the World. SJW, LJC, ERT and RB have no conflicts of interest to declare.
Ethics Approval Statement: Prior to undertaking this analysis, this project was reviewed by the joint chairs of UCL’s Research Ethics Committee who deemed it exempt from requiring ethics clearance on the basis that it constituted a service evaluation aiming to improve understanding of demand for and access to DOTW services. DOTW provided anonymised data for this analysis.
Keywords: refugees; migrants; undocumented; emigrants; immigrants; asylum; UK; England; health; barrier; access; hostile environment; fear
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