Define migrant
Any person who is moving or has moved across an international border or within a State away from his/her habitual place of residence, regardless of:
1) the person’s legal status
2) whether the movement is voluntary or involuntary
3) What the causes for the movement are
4) What the length of stay is
What is a refugee?
Refugees are persons who are outside their country of origin for reasons of feared persecution, conflict, generalised violence, or other circumstances that have seriously disturbed public order and, as a result, require international protection.
What is an asylum seeker?
An individual who is seeking international protection. In countries with individualised procedures, an asylum-seeker is someone whose claim has not yet been finally decided on by the country in which they have submitted it.
Define migrant worker
A person who is to be engaged, is engaged or has been engaged in a remunerated activity in a state of which they are not a citizen.
Define international students
Students who have crossed a national or territorial border for the purpose of education and are now enrolled outside their country of origin.
Define undocumented migrants
Someone who does not have legal papers to support their presence in another country eg. students or tourists with overstayed visa, victims of trafficking, women who entered on a spouse visa.
Why does definition of a migrant matter in the NHS?
- Everyone in England is entitled to free primary care, regardless of immigration status
- Asylum seekers and refugees are entitled to free secondary care, others are charged
- Understanding these terms can help healthcare workers advocate for their patients
Give examples of models that are used in migration in health
- The migration cycle
- The Dalghren and Whitehead model (rainbow model)
What can be some burdens of disease and migration?
Perinatal health – worse outcomes for maternal mortality, maternal mental health, preterm birth and congenital abnormalities. [ 19 systematic reviews]
Child health – generally adapt well but disruption to immunisation schedules, early childhood development and access to schooling.
Adolescent health- puberty = brain maturation leading to increased sensitivity to differences related to migration. Stigma, social exclusion, bullying can contribute to anxiety, depression, self-harm and suicide.
Mental health – prevalence varies widely. In first generation international migrants have higher rate of depression, anxiety and PTSD.
Communicable disease –public health burden remains high in many settings.
Non-communicable diseases – people are moving with established NCDs. Interruption of care – prevents effective management of chronic health conditions. One study found 2.5x incidence of diabetes compared to host population.
Tobacco and alcohol use – depended on prevalence in country of origin + in host country.
Occupational health – rates of fatal and non-fatal injuries are higher in labour migrant populations. Type of employment – construction, fishing, metal-working. Can include: injuries, exposure to weather or pesticides, respiratory conditions, depression + anxiety, infectious diseases.
What should you take into account when assessing new patients from overseas?
- Social circumstances
- Integration
- Risk of infectious disease
- Immunisations
- Dental health
- Nutritional or metabolic disorders
- Vision and hearing
- Ethnicity risk factors
- Lifestyle
- Sexual health
- Travel plans
What does good access to healthcare mean?
Adequate and appropriate supply of health care so that people who need it can access it
What is the difference between equal access and equitable access?
Equal access refers to providing the same level or kind of service to everyone, regardless of need
Equitable access is providing services according to need
What is horizontal inequity?
When people with the same needs do not have access to the same resources.
Unequal treatment of equals.
What is vertical inequity?
When people with greater needs are not provided with greater resources to meet those needs
What is the key indicator of health inequity?
Maternal mortality
Tuberculosis is also a disease of poverty
Why address inequities in health care?
- Justice and fairness
- Growing evidence base that equitable access to medical and health care can contribute towards reductions in health inequities
- Not addressing inequity in access to health care may widen health inequalities
- Duty under Equality Act 2010: public sector duty
What are some barriers to equitable access?
Supply side:
- Lack of funding
- Services at wrong time/place
- Costs attached
- Culturally inappropriate
- Variable quality
- Clinician biases
Demand side:
- Health literacy
- Can’t use services due to geographical or physical barriers
- Community and cultural attitudes and norms
Define rough sleepers
- People sleeping, about to bed down or actually bedded down in the open air
- People in buildings or other places not designed for habitation
What is hidden homelessness?
- This includes people who become homeless but find a temporary solution by staying with family members or friends (sofa surfing), living in squats orother insecure accommodation, cars and night shelters.
- Research by the charity Crisis indicates that about 62% of single homeless people are hidden and may not show up in official figures.
What are some causes of homelessness?
Structural:
- Poverty
- Inequality
- Housing supply and affordability
- No employment/insecure employment
- Access to social security
Individual:
- Poor physical health
- Mental health problems
- Childhood trauma
- Experience of violence, abuse, neglect, harassment, hate crime
- Substance abuse
- Bereavement
- Relationship breakdown
- Time in care or prison
- Refugees
What is the role of health professionals in homelessness?
- Identify the risk of homelessness among people who have poor health, and prevent this
- Minimise the impact of homelessness on health among people who are already homeless
- Enable improved health outcomes for people experiencing homelessness so that their poor health is not a barrier to moving on to a home of their own.
What is the Homeless Reduction Act (2017)
TheHomelessness Reduction Act 2017puts a legal duty on councils to offer more support to a wider range of people who are homeless or threatened with homelessness within 56 days.
Some public authorities in England have a duty to notify Local Housing Authorities of service users they think may be homeless or at risk of homelessness
Known as Duty to Refer
This came into place on 1st October 2018
Which public services are included in the duty to refer?
- youth offender institutions
- secure training centres
- secure colleges
- youth offending teams
- probation services (including - community rehabilitation companies)
- Jobcentre Plus
- social service authorities
- emergency departments
- urgent treatment centres
- hospitals in their function of providing inpatient care.
Define bronchitis
LRTI affecting the bronchi, may be acute or chronic
