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The purpose of this assignment is to discuss health issues in relation to socio-economic and political variables. The role of health care providers and the effectiveness of policy in meeting the health needs of the population will also be reviewed. The author has chosen to focus on how asylum seekers in the UK are affected by disease. The reason for this choice is that over the last decade issues regarding asylum seekers has received persistent and widespread media coverage. Asylum seekers are rarely talked about except in terms of being a problem or drain on limited resources including health. It has also been a subject of many political debates and issues have been raised on how this has an effect on both the economy and healthcare system.
According to the home office there were 23430 asylum applications in 2007. The office of national statistics also state that in the third quarter of 2008 (July -September) there were 6620 applications and this is 12% higher than last year. They also state that it is the fifth successive quarter with a year on year increase. This shows that the issue about asylum in the UK will carry and the health of this group needs to be considered.
Health is a broad and often contested concept with a huge range of meanings. It is used in many different contexts to refer to different aspects of life, Naidoo and Wills (2000). The WHO defined it as the extent to which an individual can realise aspirations and satisfy needs while also coping with the environment, WHO (1984) cited in Naidoo and Wills (2000). This definition is widely accepted because it takes into consideration the social, physical and personal aspects that affect individuals. This is supported by Dahlgren and Whitehead (1991), who identified the main determinants of health and describe them as layers of influence on an individual potential for health. These include age, gender, sex, lifestyle, socio-economic, cultural environmental and social or community networks, Bartley et al (1998) pp61.
Asylum seekers in the UK come from a wide variety of countries and from different ethnic backgrounds. According to Watters (1999), this diversity presents a major challenge for health care workers to be able to provide a culturally appropriate service to this group. This is further complicated by the inequalities in health that exist in the UK. The Acheson report of 1998 stated that inequalities in health are of long standing and their determinants are deeply ingrained in our social structure. Inequalities are measured according by occupation, income, education and social circumstances. On the other hand, inequities are defined as differences which are unnecessary and avoidable and judged to be unjust and unfair, (Whitehead 1990) cited in Abel-Smith (1994). This shows whats clearly inequitable are restrictions of choice of lifestyle, exposure to unhealthy living and working conditions and inadequate access to essential health and public services, Abel-Smith (1994).
There are many issues that affect the health of asylum seekers in the UK. When they come into the UK they are held in detention centres. These detention centres are run by private companies who buy in professional health and social care services. According to Watters (1999), the knowledge and training of these workers may be minimal and this can be detrimental to the health of asylum seekers. These people usually come to this country fleeing persecution from their own countries so they may already have physical injuries and for some of them mental illness due to torture. The British medical association state that the health of this vulnerable group can actually deteriorate once they come to this country rather than improve, BMA (2008). Research has also shown that being held in detention can be seen as a prison and cause some to relive their experiences of torture. This can compound the psychological damage that they have suffered and can increase anxiety, depression and stress. BMA (2008) also say threats to the health of asylum seekers are mostly posed by diseases linked to poverty and overcrowding. This includes infectious diseases like HIV, TB and hepatitis.
According to Rowntree (1995) cited in Naidoo and Wills (2000), the modern UK is characterised by profound inequalities in income and wealth. Graham (2000), states that poverty is associated with poor health even in rich societies. While an application for asylum is processed, they are not allowed to work and this group will have to depend on income support from the government. The home office states that this is 70% of state benefits. This support is given in the form of vouchers. These vouchers are only acceptable in certain supermarkets in exchange for food and clothing and change can not be given so every penny has to be spent. Charity groups argue that this takes away their freedom of choice in buying certain foods like halal and aids poor nutrition. According to Connelly and Shweiger (2000), this lives asylum seekers to face an uncertain time trapped in poverty and absolute dependence. Freedman (2008) argues that the definition of poverty is flawed. He states that poverty is defined on income but does not take into account wether people have savings, meaning that not all people below the poverty line are strictly poor. This echoes Watters (1999) view that a high proportion of asylum seekers in the UK are well educated. So this may mean that they may have savings in their own country despite fleeing persecution.
The home office states that asylum seekers with failed applications will have no income support and those who do not return to their home country can be detained or forcibly removed. In 2007, 16800 became failed asylum seekers. Of these, 12705 were removed which leaves thousands still in the country without any income support. According to Benjamin (2008), the think-tank found that at least 26000 failed asylum seekers in the UK are surviving on Red Cross food parcels. They argue that this policy of stopping income support is forcing asylum seekers to face destitution and drift into prostitution.
Graham (2000) states that health inequalities faced in childhood will carry on into adulthood. Asylum seekers with children can enrol them in local schools. The majority of these do not qualify for the government free meals at school. This means that with the minimal income support received, these children are left hungry. According to Green (2008), this failure of policies around free meals to reinforce and reflect the government's child poverty priorities is undermining the impact of extensive initiatives designed to reduce educational inequalities.
According to the department of health all asylum seekers have free access to NHS health while their application is in progress and when they have been granted asylum. Smith (2000) argues that while treatment is given for free in the NHS for some asylum seekers, it will be difficult for many of them to access the service without interpreters. Research has also shown that some of them actually need advice about the services available to them. The DOH also say asylum seekers can have free testing of infectious diseases like HIV and the first counselling lesson for free. This is criticised by the BMA in the case of failed asylum. They argue that this leaves the individuals with no support and who in many cases can not afford to pay for drugs and as a result will enhance the spread of the infection.
It is now widely known that one of the reasons why inequalities in health exist and the gap is widening is due to government priorities and policies. The world Health Organisation sums this up by saying "the toxic combination of bad policies, economic and politics is in large measure responsible for the fact that the majority of people in the world do not enjoy the good health that is biologically possible" WHO.
According to Ham and Mclver (2000), the main responsibility for making decisions about which services are given priority and wether or not some types of treatment should be funded rests at local level even though NHS executives publish annual guidances. For the case of asylum seekers the home office states that asylum policy instructions are the government policy. According to Glasby (2007), the health and social care service in most developed countries is beset by problems of fragmentation and insufficient interagency collaboration. Evidence has shown that the gap in inequalities in health is actually widening and the British government has responded to this by making the reduction of inequalities in health a duty of public agencies at all levels and in all sectors, Graham (2000). In view of this difference much work has been done to evaluate previous initiatives to tackle health inequalities and now there is a call for agencies to work together. According to the Health Development agency, partnership working identifies gaps, whats being done and what can be done to tackle health inequities. This will just leave the planners to decide which resources are distributed fairly in relation to the exact needs of different groups.
In conclusion, the author has identified the health needs of asylum seekers linking these to theories and concepts of health. It has been shown how policy, politics and differences in organisations can affect the delivery of these health needs. If this is implemented by all concerned agencies may we will see the health of asylum seekers in UK improve.