| dc.description.abstract | The past decade has witnessed a rise in anti-immigrant sentiment and populism, culminating in Brexit and the election of US President Donald Trump. Accompanying the xenophobic rhetoric of the UK media, a string of government policies have impeded access to healthcare for those not born in the UK.1 These include: the introduction of the National Health Service (NHS) surcharge for non-European Economic Area migrants who wish to stay in the UK for 6 months or longer; the introduction of upfront charging, due to be extended to primary care in the near future; and reports of identity checks at the door. In January this year, a formalized process that allows NHS Digital to pass individual demographic data, including a person's last known address, to the Home Office Immigration Enforcement Team was published.2 When patients hand over personal details in a healthcare setting there is an assumption that the confidentiality of these data will be protected. From its roots in the Hippocratic Oath to the current General Medical Council (GMC) guidance, confidentiality has long been a cornerstone of good medical practice. Allowing the Home Office access to this private space, even if it is only to obtain someone's name, violates the trust that is fundamental to effective health service provision. Access to healthcare is a human right.3,4 Furthermore, barriers to accessing care increase individual morbidity and mortality and threaten public health. However, the government, alongside the post 9/11 securitization of borders, argues that because of the strain undocumented migrants place on public services, it is in the public's best interests to identify and potentially deport these people.5 Using tuberculosis (TB) as an example, I will outline how these measures, rather than being in the public's best interest, put their health at risk. What is more, the economic justification is weak. Setting out the arguments There is clear evidence that the threat of deportation deters people from seeking help when they are unwell.6,7 Even when data are kept confidential, and there is no data exchange between health services and immigration authorities, the simple process of having to provide identification documents is enough to deter people from accessing healthcare.8 For TB, the longer the delay in diagnosis, the more unwell the patient becomes;9 the more likely they are to die;10 and the greater the risk of transmission in the community.11 This can be extended to other infectious diseases.12 Whilst NHS TB treatment is free for all, regardless of immigration status, routes to diagnosis are circuitous and awareness of health rights amongst migrants is poor.7 Furthermore, both upfront charges and identity checks can act as a barrier to people who are eligible for free care but do not have the required documentary evidence—such as the UK-born homeless population. Epidemiological data gathered through health systems are vital to our understanding of the causes and distribution of disease in societies.13 Some infectious diseases, such as TB, must be notified to public health authorities under law so that prompt actions can be taken to limit the spread of infection and safeguard public health. If healthcare workers become concerned about the potential harm that data sharing might do to their patients, the integrity of these valuable data sets will be compromised. One of the key strategies for tackling TB in the UK involves a screening programme for latent TB infection. Eligible patients (non-UK-born individuals who have moved to the UK recently from countries with an incidence of TB > 40/100 000) are identified in primary care. If the population to be screened is deterred from registering with a GP then attempts to eliminate TB via reducing the reservoir of latent infection will most likely fail and the government's £10 million pound investment will have been wasted. This concern extends to other vital public health strategies such as immunization14 and cancer screening.15 Whilst undocumented migrants are chargeable for services in secondary care, they are eligible for ‘immediately necessary’ care in primary care or accident and emergency departments. Using an economic model to analyse costs, a report from the European Union Agency for Fundamental Rights suggests that providing ‘regular preventive care, as opposed to providing only emergency care, is cost-saving for healthcare systems’.16 Conclusion The evidence presented here demonstrates how policies that generate barriers to healthcare access threaten not just the health of the individual but that of society as a whole. However, I urge us to move beyond the evidence and, as Paul Farmer has written, ‘return to the concept of social justice, which once inspired public health’.4 The political fight over control of our borders must be kept out of the health arena. Only by working together and taking a stand against policies which allow health for some but not all will we achieve this. | en_US |
