Contents

1.0 Introduction ……………………………………………………………………. 2

2.0 ethnic inequalities on asylum seekers access to healthcare services …………… 2-3

3.0 Evidence on the health of migrants …………………………………..………… 3-4

4.0 Evidences of inequality to healthcare services for asylum seekers …………….. 4

4.1 Lack of entitlement to free healthcare ………………………………………….. 5

5.0 Policies in addressing inequality to healthcare among asylum seekers ………… 6

5.1 Project London …………………………………………………………………...6

5.2 Regional Strategic Migration Partnerships (RSMPs) …………………………… 6

5.3 NHS linking record policy ………………………….…………………………… 6

6.0 Suggestions for improving policy and practice ………………………………….. 7

7.0 Conclusion ……………………………………………………………………….. 8

8.0 Reference list ………………………………………………………………………9-11

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1.0 Introduction

Asylum seekers' health condition and access to healthcare are important measures of their
"inclusion" into accepting cultures, along with shelter, work, and education. Involvement in civic
life and other aspects of inclusion depend heavily on one's overall health (Bhatia and Wallace, P,
2007). It is true that conventional health research and practice do not place enough attention on
how the experiences and conditions of undocumented migrants and asylum seekers impact the
quality of care or access to health care (McDonald and Billings, 2007). This report sums up some
of the most pressing concerns affecting the health of asylum seekers in the UK today by drawing
together the best available data. For undocumented migrants and asylum seekers, it provides
ways in which health equity, well-being, and healthcare access issues might be addressed via
knowledge, legislation, and practice.

2.0 Ethnic inequalities on asylum seekers access to healthcare services

Only a few studies have looked at the health of asylum seekers and migrants, notably those who
arrived recently in the United Kingdom. These studies tend to concentrate on ethnic minorities, a
group that is growing in size and importance within the country's overall population. Even more
disturbing is the fact that most of the research and statistical facts on health status and access to
treatment are based on ethnicity. Those who were not born in the UK had their citizenship,
ethnicity, and immigrant status omitted from the equation (Fitzpatrick et al., 2005; Sproston and
Mindell, 2006; Commission for Healthcare Audit and Inspection, 2008; Healthcare Commission,
2008; Marmot et al., 2010).

In areas where collecting data on ethnicity is required by law, such as in hospitalisations,

ethnicity was covered by hospital episode reports at a countrywide level of roughly 86% in
2007–2008 (The Health and Social Care Information Centre, 2009). General practitioners have
lately received financial incentives to gather ethnic group data from their patients in the primary
care setting (Warburton, 2008). For example, fertility and mortality registries do not include
ethnicity information, but a new connection between birth records and hospital birth notices has
made it feasible to analyze birthrates by both the child's ethnicity and the mother's citizenship
status (Gray et al., 2009).

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Cross-cutting underlying factors such as child poverty, schooling, earnings, work opportunities,
living conditions, and area deprivation are considered in the government's PSA target to improve
health care (primarily measured by the reduction of inequalities in infant mortality by social class
and in life expectancy by area) (DH, 2008). In the absence of mortality statistics, ethnic group
variations in health determinants and outcomes have been recorded (DH, 2008).

Health disparities in England post-2010's Marmot Review consider the complicated structuring
of health linked with ethnic groupings in light of ongoing evidence that there is a socioeconomic
slope (Marmot et al., 2010). Recent criticism of the report's failure to adequately address the
effect of ethnic diversity and race discrimination on quality of care has highlighted the report's
potential to influence health policy and practice in a manner that benefits minority ethnic
people's equity in health (Salway et al., 2010).

For example, the Marmot Review focused more on minority ethnic groups and less on asylum
seekers since the necessary "migration factors" were not present in the study. Law and policy
suggestions may be influenced by this. Detailed data collection and analysis is needed to
determine whether and why refugee crisis factors, engaging with ethnicity and socio-
demographic variables, may result in migrants' having different needs and encountering different
barriers compared to minority ethnic groups and their mothers' countries of birth (Gray et al.,
2009).

3.0 Evidence on the health of migrants

Asylum seekers and refugees, for example, have been singled out for special attention when it
comes to the health of recent migrants. Concerns include the cognitive, physical, and emotional
impact on people's health of the situations in their home nations, particularly in nations where
there has been violence; the mental anguish of movement of people and settlement, including the
exclusion, destitution, and uncertainty of citizenship status in the receiving country; and the
increased vulnerability to communicable diseases like tuberculosis, contingent on the home
countries' transit and living standards during a journey (IPPR, 2005; Health Protection Agency,
2006; Johnson, 2006; Piachaud et al., 2009). Asylum seekers' health is connected to indications
that the health condition of certain asylum seekers worsens over time in receiving nations, such

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as the United Kingdom. Acculturation—the acceptance of the conventions, attitudes, and
behaviors prevalent in the receiving culture—has been used to explain changes in asylum
seekers' health behaviors that have detrimental effects on long-term access to health care.
Acculturation has been used to explain these variations. Smoking by asylum seekers, including
during pregnancy; lower breastfeeding rates; and regimens with a higher fat content are all
examples of cultural differences that can result in poor access to healthcare services for asylum
seekers (Zaman and Mangtani, 2007; Gilbert and Khokhar, 2008; Hawkins et al., 2008).

Asylum seekers' inaccessibility to healthcare services may not be explained by acculturation

models, which focus on changes in moral standards, social standards, and perceptions (Abraldo-
Lanza et al., 2006), but rather by structural inequalities to good health and access to and
utilisation of healthcare in the UK, mainly based on local evidence. Under nutrition, poor health
and safety habits in some organizations that employ refugees, and lack of access to reliable
transportation are just a few examples of the many obstacles migrants face. Others include
insufficient information on how to obtain health services such as immunizations and health
checks, and lower utilization of these services when compared to UK-born individuals; and
finally, the failure to inform foreigners about their legal rights and responsibilities (Webb et al.,
2004; Spencer et al., 2007; Cassidy, 2008).

As a result, new migrants as well as those who have been in the UK for some time face similar
obstacles (Jayaweera et al., 2005). There is reason to believe that social influences are as
instrumental in understanding access to health care for refugees as they are for minority ethnic
groups. However, the way in which migration affects the social curve in health has not gained
the attention that ethnic inequalities have received (Cassidy, 2008).

4.0 Evidences of inequality to healthcare services for asylum seekers

The following are some of the reasons why asylum seekers in the United Kingdom face
discrimination when it comes to obtaining healthcare services.

4.1 Lack of entitlement to free healthcare: As the myriad of asylum seekers in the United
Kingdom continues to grow, it has become absolutely vital to thoroughly identify and address
both the discriminatory practices and the effects of limitations imposed by asylum seeker status

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in relation to access to health care, as well as the effect of these limitations on access to health
care, in order to improve health outcomes for all. Among vulnerable migrants, such as failed
asylum seekers, people detained in immigration correctional facilities, human trafficking victims,
and visa overstayers, this is illustrated in evidence on pregnant women who are especially reliant
on health services during this period of their lives, but who are categorized as not ordinarily
resident and may be denied access to antenatal services by healthcare providers because they are
not permanent residents (McLeish, 2002; Bragg, 2008).

According to the Confidential Enquiry into Maternal Deaths (2003–2005), the mothers of black
African children, the majority of whom were actual refugees (including asylum seekers and those
with undefined visa status), were found to be more than five times more likely to die than
mothers from white backgrounds. Some of the variables related to deaths were delayed
appointments for prenatal care or no access to antenatal care, as well as a lack of access to
translation services (Lewis, 2007). Medact (2007) and Médecins du Monde (2007) both describe
how organizations in voluntary agencies advocate for the entitlements of vulnerable migrants
and/or run projects to increase the availability of health care for those who are unaware of their
rights or who are rebuffed access to health care by healthcare providers. "Health tourism" (i.e.,
holidaymakers arriving in the UK solely for the purpose of receiving free NHS care) is a topic of
ongoing argument, as is misunderstanding among medical providers about authority billing laws
for those who are not considered "permanent residents." Additionally, changes in regulations
may have negative repercussions on the eligibility for public assistance of a growing percentage
of migrant communities, as is the case with asylum seekers (Cassidy, 2008; Migrant Rights
Network, 2009).

The latter includes the most recent proposal by the UK Border Agency and the Department of
Health to deny entrance to, or the ability to stay in, the United Kingdom to migrants susceptible
to immigration control who owe money to the National Health Service (NHS), among other
things (UKBA, 2010). More studies, as well as a more targeted approach by policymaking, are
required to better identify and address the probable relationship between poor health outcomes
among vulnerable migrants, such as asylum seekers, and obstacles to healthcare access, such as a
lack of eligibility for services. 

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5.0 Policies in addressing inequality to healthcare services among asylum seekers

In the United Kingdom, strategies have been established to address the issues of inequality and
inadequate access to healthcare services among asylum seekers. The initiatives listed below are:

5.1 Project London

It is the goal of this initiative to organize a free clinic in East London for disadvantaged
individuals, many of whom are asylum seekers, who have difficulties obtaining health treatment.
Approximately 1000 service users were visited at the clinic in the years 2006–2007. As a result
of procedural staff's lack of competence and understanding of government requirements, many
people have been denied general practitioner registration and primary care (even individuals who
were plainly entitled to treatment). A crucial service is provided by the initiative, which helps to
ensure that users are enrolled with a doctor and get the treatment they deserve (DCLG, 2009).

5.2 Regional Strategic Migration Partnerships (RSMPs)

Region-based Strategic Migration Partnerships, such as the West Midlands Strategic Migration
Partnership, were established to serve as the primary regional policy platform in the United
Kingdom on topics such as asylum seeker distribution, lodging and assistance, and the
rehabilitation of refugees. In 2007, its scope was broadened to cover current immigrant
communities that had not previously been included. They collaborate closely with national and
local governments, legislated service providers, and consensual, public, and migrant
organizations in nearby regions to coordinate and provide counsel, assistance, and services to
asylum seekers, as well as to ensure that resettlement concerns are a key component of local
plans and strategies (DCLG, 2009). In most areas, they are organized into task forces that focus
on certain issues such as health, accommodation, and jobs.

5.3 NHS linking record policy

In England and Wales, a significant step has been taken toward the integration of ethnic factors
and asylum seeker determinants in health data by integrating birth outcome data, which is
collected at the site of birth, with birth registration records, which are linked via newborns'
unique NHS numbers. Using this data, it is now feasible to examine health outcomes for

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newborns, such as maternal age at delivery and prematurity, as well as death rates, in relation to
socio-demographic factors of their parents, such as their native countries, as well as the ethnicity
of their children.

5.4 Asylum accommodation dispersal policy

Immigration and Asylum Act 1999 Article 95 permits asylum seekers who are awaiting the
outcome of their application (or review) to ask for help for housing, provided they meet a
"penury test" (proving they are, or soon will be, homeless and do not have money to buy
essentials). A 'distribution' strategy was put in place to ensure that no one county council area
was overwhelmed with the responsibility to serve asylum seekers and ensure that they had access
to healthcare (House of Commons Library, 2016).

5.5 The Immigration and Asylum policy

Asylum seekers may ask for financial assistance under article 95 of the Legal immigration
Act while processing their claims. Support might be for housing or food, depending on their
situation and if they meet poverty test. Asylum seekers get £37.75 per week per family member
to help pay for healthcare. Women who are pregnant or have small children may qualify for £3
each week. Children under one receive an extra £5 each week. Families may apply for a £300
prenatal payment (£250 for that rejected asylum) up to six weeks before the baby is due (UK
Visas and Immigration, 2016).

6.0 Suggestions for improving policy and practice

People's health outcomes and use of services in their local area should be collected using a
centralized monitoring system that includes "asylum seekers" parameters (such as nation of
origin, immigrant status in the UK, or dialect use) as well as ethnicity and socio-demographic
variables (recognising that migration data collection can be sensitive).

Learn about the healthcare demands and obstacles faced by various migratory populations, such
as asylum seekers and refugees. Migrants' own welfare networks, statutory and volunteer
organizations, and those representing diverse migrant groups in local regions might all help. In
addition, primary research that gives information on age, gender, socioeconomic position,

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ethnicity, religion, language, and country of birth is critical. This might be accomplished via the
creation of Regional Strategic Migration Partnerships (RSMPs), but an assessment of the
consequences is required first (DCLG, 2009). There should be a special focus on those
populations who are less likely to register for primary care because of a lack of knowledge or a
lack of legal certainty. Religious institutions, such as churches, mosques, and temples, may be
useful in mapping people without legal immigration status and those who rely on religious
organizations for assistance in accessing services.

As part of a community-based strategy, include the following crucial elements: improved access
to health care as an outcome in itself; a focus on user and community empowerment; a focus on
collaborative working across disciplines; an acknowledgement of the latencies involved in
dealing with obstacles to successful access; and a shift away from an emphasis on the
measurement of health outcomes as a short-term observable and progress marker.

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7.0 Conclusion

The growing numbers, variety, and requirements of asylum seekers in the United Kingdom have
not been adequately addressed in educational studies, public health policy, or primary health
delivery to date. Humans must move beyond the foundation of ethnic differences and disparities
in healthcare services and recognize a host of variables that may describe the concerns and
perspectives of migrant populations, including those who are most susceptible, such as refugees
and asylum seekers, and those who are limited in their eligibility for free healthcare in the United
Kingdom. Achieving this aim, as outlined in the Marmot Review (Marmot and colleagues,
2010), is critical to the overall objective of establishing a fairer and more equitable society. 

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8.0 Reference list

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Bhatia, R. and Wallace, P., (2007). Experiences of refugees and asylum seekers in general
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Cassidy, J. (2008) ‘NHS care for overseas patients: free for all?’, BMJ, 337, p. a1111.

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Gilbert, P. and Khokhar, S. (2008) ‘Changing dietary habits of ethnic groups in Europe and
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