There is more mobility now than at any other time in world history. Latest estimates suggest that one in 33 people worldwide is an international migrant, a 37% rise in two decades.
In 2010, almost 214 million people, 3% of the global population, were living in a country other than the one in which they were born.
This has implications not only for the health of migrants but also for the health systems of destination countries. Since migration is always politically charged and laced with many misconceptions, Elements thought it was time to ask: when it comes to migration, what is fact, and what is myth?
Perception versus reality
The percentage of the UK population comprising migrants is 11% (source Eurostat), which is a fairly standard proportion for a European country. The Gulf states have the highest percentage of migrant populations. Qatar is out in the lead with an astounding 87%.
United Arab Emirates 70%
And here are the three largest groups of foreign citizens in the UK:
Source: Vasileva, A. (2009), cited in Migration and Health in the European Union, p23.
The last Labour Government encouraged migration over the period 1997 to 2010. In 1997 immigration to the UK was 327,000, and emigration was 279,000 with a net migration of 48,000 people. This increased in 2010 to immigration figures of 591,000 with an emigration of 339,000 and a net migration of 252,000 people.
In the year to June 2011, the largest group of migrants were students, at 40%, followed by people with working visas, 31%, and by those people who visit families and friends in the UK (Office of National Statistics data).
Populist feeling against migrants is reflected in current Government immigration policy, which aims to reduce total net migration to less than 100,000 per year. Almost two-thirds of British people want fewer migrants, in particular fewer asylum seekers, even though asylum seekers make up only 4% of total migrants to the UK.
The British Government also want fewer migrants who are low skilled. Since the majority of low-skilled migrants are from the EU, their number cannot be controlled. But the Government has introduced changes in immigration rules. These include introducing a cap on non-EU migrants and student numbers, and setting a minimum earning threshold for visiting family members.
Myth: migrants come to the UK to access health care
There is no evidence to suggest that a significant number of people come to the UK to access health care – so-called ‘health tourism’. Nearly all migrants are young and healthy, nearly half are 25-44 years old and 42% are aged 15-24 years.
Myth: The UK is an easy target for asylum seekers
Since the mid-2000s, most European countries have tightened their asylum procedures. The EU has a common set of rules for accepting asylum seekers but it is interpreted in different ways by member states. The figures below show the percentage of asylum claims that are accepted first time. Given that Greece’s rate of recognition is so low compared to other countries, it is clearly not responding to its international obligations to grant permission to stay for those seeking asylum.
Contrary to perception, there are relatively small numbers of asylum seekers in the UK. In 2010, there were 17,916 asylum seekers (compared to a peak of 84,000 in 2002) and in 2011 there were 19,804 asylum seekers. In 2010/2011, Iranians made most asylum applications, while in 2009 it was Zimbabweans.
In public opinion surveys, 60-70% of people think that “there are too many immigrants” and that the majority of them are asylum seekers. The reality is very different. Universities, for example, depend on funding that comes from international students. The numbers of people moving to the UK to study in 2010 was 238,000, the highest ever on record.
Migrants from outside the EU are more at risk of having a communicable disease, particularly TB, HIV and viral hepatitis. The infectious disease rate in the UK is increasing as more immigrants return to their home countries to visit relatives and then arrive back in the UK with disease.
In 2010, the migrant population saw almost 60% of newly diagnosed cases of HIV, 77% of diagnosed cases of malaria and 73% of new cases of TB. These data were presented by Dame Sally Davies, chief medical officer, at the Migrant Heath Conference at Cumberland Lodge on January 26, 2012.
Immigration legislation enables the UK to conduct health screening of nationals from outside the European Economic Area (EEA). But when it comes to TB, screening at UK port entries has been found not to be cost effective or efficient.
For example, in one UK pilot of 44,000 chest X-rays conducted on migrants, only 35 cases of TB were detected. The £2 million-a-year programme is to be discontinued.
Access to primary care
Vulnerable migrants have difficulties registering with a GP. To address this problem, Project London, run by the charity Doctors of the World, has a primary health care clinic in East London. In 2011, 545 out of 1,288 patients seen had failed to register with a GP.
There is confusion in many general practices about what registration documentation is required and who is able to register. In fact, GPs can register patients “at their discretion” and need to know only that the person is living in the catchment area. Although no other evidence is required, some surgeries request bills and passports as evidence of address. There appears to be considerable confusion on the ground as to the “rules”. Perhaps discriminatory behaviour is taking place.
Inconsistencies in Government policy
Public policy creates conditions for a growing demand for migrant workers at a time when the Government is looking to reduce numbers. We have an aging population and a social care sector that depends on cheap migrant labour.
The NHS has historically encouraged and depended on overseas doctors and nurses. Stats reported in the BMJ show that 31% of doctors and 13% nurses working in the NHS are foreign born.
Lack of data
The immigration debate has suffered from a lack of transparency. There are limited quantitative data collected or available on migrant health, which makes identifying need and planning services difficult. Lack of data limits the ability to make policy.
Data on migration status are not routinely collected and the current government is reluctant to collect any more.
For example, only 0.3% of the 8.9 million patients in the general practice database (2000-2011) had country of birth recorded as giving an address to your GP is not compulsory.
By contrast, ethnicity data are collected in primary care and now 75% of patients registered since 2006 have ethnicity recorded. But how useful are ethnicity data?
Would it be more useful to collect more relevant data that might include country of birth, reason for migration and a means of identifying a person’s socio-economic status? For example, your health status is likely to be better if you are a professional from India rather than an asylum seeker fleeing Afghanistan.
Although the figures and charts above can help to dispel some myths about immigration to the UK, there remains a sizeable gulf in the dataset, and no clear direction from the Government on what information we should collect and why.
Illustrations created by Harriet Bailey.
Photo by marcusjroberts.