The negative health effects of hostile environment policies on migrants: A cross-sectional service evaluation of humanitarian healthcare provision in the UK.
The negative health effects of hostile environment policies on migrants: A cross-sectional service evaluation of humanitarian healthcare provision in the UK.
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DOI：
10.12688/wellcomeopenres.15358.1
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Aldridge, Robert W
中科院分区：
文献类型：
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作者：
Weller, Sophie J;Crosby, Liam J;Aldridge, Robert W
背景：英国最近的“敌对环境”移民政策，包括强制收费和在NHS Digital和内政部之间共享机密数据，制造了一种恐惧的氛围，并通过增加获得NHS医疗保健的障碍，使本已高度边缘化的弱势群体面临重大的健康风险。方法：这是一项对英国世界医生组织(DOTW)寻求医疗保健的患者进行的横断面观察性研究。DOTW是一个人道主义组织，为那些被排除在NHS医疗保健之外的人提供护理。我们的目标是描述使用DOTW服务的个人的人口特征，并确定最有可能面临与NHS护理相关的“敌对环境”障碍的群体，特别是被剥夺医疗保健或害怕被捕的人群。结果：2016年共观察到1474名成年人。几乎所有人都是非欧盟/欧洲经济区国民(97.8%；1441/1474)，生活在贫困中(68.6%；1011/1474)。DOTW看到了大量的无证移民(57.1%；841/1474)和寻求庇护者(18.2%；268/1474)。10.2%(151/1474)的成年人曾被拒绝NHS医疗保健，7.7%(114/1474)的成年人害怕获得NHS服务。寻求庇护者身份与被拒绝NHS医疗保健和无证件的最高风险(调整后的优势比：2.48；95%可信区间：1.48-4.14)相关，与害怕被捕的最高风险相关(调整后的优势比：3.03；95%的可信区间：1.70-5.40)。结论：我们的发现显示了被迫在NHS以外寻求护理的个人的多重和交叉的脆弱性，突显了政府紧急撤回其“敌对环境”政策并解决其对健康的负面影响的公共卫生紧迫性。
Background: Recent UK 'hostile environment' immigration policies, including obligatory charging and sharing of confidential data between NHS Digital and the Home Office, have created an atmosphere of fear and exposed already highly marginalised and vulnerable groups to significant health risks by increasing barriers to accessing NHS care. Methods: This is a cross-sectional observational study of patients accessing healthcare at Doctors of the World (DOTW) in the UK. DOTW is a humanitarian organisation, providing care to those excluded from NHS healthcare. We aimed to describe population characteristics of individuals using DOTW services and identify groups at greatest risk of facing 'hostile environment'-related barriers to NHS care, specifically being denied healthcare or fear of arrest. Results: A total of 1474 adults were seen in 2016. Nearly all were non-EU/EEA nationals (97.8%; 1441/1474), living in poverty (68.6%; 1011/1474). DOTW saw a large number of undocumented migrants (57.1%; 841/1474) and asylum seekers (18.2%; 268/1474). 10.2% (151/1474) of adults seen had been denied NHS healthcare and 7.7% (114/1474) were afraid to access NHS services. Asylum seeker status was associated with the highest risk (adjusted odds ratio (OR): 2.48; 95% confidence interval (CI): 1.48-4.14) of being denied NHS healthcare and being undocumented was associated with the highest risk of fearing arrest (adjusted OR: 3.03; 95% CI: 1.70-5.40). Conclusions: Our findings make visible the multiple and intersecting vulnerabilities of individuals forced to seek care outside of the NHS, underlining the public health imperative for the government to urgently withdraw its 'hostile environment' policies and address their negative health impacts.