Inequality in African Immigrants' Health Care in the United Kingdom - Coursework Example

Health inequalities on African Immigrants in the United Kingdom Introduction United Kingdom is one of the few countries in Europe, which collects health data based on ethnic groups. It is common knowledge that black immigrants in the United Kingdom receive the worst healthcare. One of the main factors that contribute to the black African immigrants receiving poor healthcare is socioeconomic factor. Many researchers have undertaken the task of investigating health inequality in the United Kingdom, but their efforts have been hampered by inadequate data (Nazroo & Williams, 2005). Recently, the government has been making efforts to develop policies, which are aimed to tackle healthcare inequalities. There is little information regarding black African immigrants’ access to health services and information. The purpose of this study is to determine the experiences of black African immigrants in accessing health services in the United Kingdom. This paper will also review evidence of health inequality, policies and the causes of health inequality amongst black African immigrants in the United Kingdom (Evandrou, 2000). There are many ethnic groups in the United Kingdom. Ethnicity has many important effects on health and distribution of health services (Rudat, 1994). Understanding different ethnic backgrounds of a given country is crucial in improving healthcare in that country. A lot of research has been conducted on the role of ethnicity on healthcare and many journals and books have written on that topic. Despite all the efforts that have gone in studying this issue, there is still a lot of ignorance, misunderstanding and prejudice about the aspects of ethnicity and its role on healthcare among minority groups (Kelly et al., 2005). Black African immigrants in the United Kingdom have the worst healthcare as compared to the rest of the population. Patterns vary between health issues and diseases. Evidence shows that one of the factors that contribute to poor healthcare among Black African immigrants is poor socioeconomic status. The government has tried to enforce some policies meant to tackle healthcare inequalities but, ethnicity has not been the main focus of the said policies. The extent of socioeconomic inequality in United Kingdom remains a debatable issue. Lack of good socioeconomic data has made tackling the healthcare issue in United Kingdom a tough problem to deal with (Erens & Primatesta, 1999). Racism is also considered a factor that has magnified healthcare inequality in the UK. Racism is not a new problem in United Kingdom considering that the UK is considered as a multiracial society. However, in the past, most immigrants in the United Kingdom were from Europe. As the British Empire expanded and the conclusion of the Second World War, labor shortage made many black Africans started to immigrate to Britain. Since then, the Black African immigrants have settled in many parts of the United Kingdom. Research has shown that the mortality rate is very high among black African immigrants as compared to their white counterparts in the United Kingdom (Bhopal, 2009). Cancer and coronary heart disease were found to be the main killer diseases. Other diseases include accidents, mental illnesses and stroke. In all of these diseases, black African immigrants were found to be the worst affected (Townsend & Davidson, 1988). That indicated that there was rampant healthcare inequality between black African immigrants and the people born in the United Kingdom. Background The government has made reduction of health inequality as one of its core objectives. The Department of Health has highlighted the need for a better framework and better leadership in healthcare organizations. The Department of Health has outlined standards which require basic principles of equality and human rights to be met in all aspects of social and health care provision. The government policy encompasses all the determinants of health. Some of these determinants include education, lifestyle, income, environment, employment, crime and housing. The government has also sought the support of other departments like Department of Transport, Housing and Department of Work and pensions to help in enforcing this policy (Acheson, 2007). The government’s determination to enforce this policy is because of the fact that Britain is a multiracial society. There has been a lot of immigration to Britain since the 18th century. Each and every group of these immigrants has left their mark on the Britons’ way of life. Majority of these immigrant groups were white therefore, there were no discernible signs of racial diversity in the United Kingdom (Gilroy, 2003). In the mid 18th century, scores of black African immigrants started arriving in London and other United Kingdom sea ports. Most of the black African immigrants went to Britain as a result of invasion, commerce while others were taken there through slave trade. Labor shortage after World War 2 also led to a lot of people to immigrate to Britain to work. However, most of these immigrants ended up living in very bad conditions. This was partly due to the fact that most of the black African immigrants were not skilled laborers. That meant that they could only get informal jobs with poor pay. Their low economic status has made them to live in the poorest parts of the cities they occupy. They also had no access to proper medical care due to lack of adequate money to cater for such services. Health inequality Evidence shows that most black African immigrants are relatively healthy when they arrive in the United Kingdom. However, their state of health can deteriorate over time once they have settled in their new homes. There are various degrees in which this phenomenon can happen. For instance, there are black African immigrants who move to the United Kingdom to seek asylum. Most of these asylum seekers tend to suffer from mental or physical illnesses caused by the impact of wars from their countries of origin. These immigrants tend to show signs of trauma as they settle in the new country (Davey, 2000). Most of them tend to be socially isolated, poor and are always tormented by their insecure immigration status. Studies conducted in England indicate that these immigrants have higher chances of anxiety and depression compared to the rest of the population or other immigrants. The study showed that 70% of women who had experienced sexual or physical abuse as they were trafficked to the United Kingdom exhibited mental and physical health symptoms such as anxiety, depression, abdominal pain, headaches and dizziness (Townsend & Davidson, 1988). According to the register of infectious disease in the United Kingdom, newly arrived immigrants stood a higher chance of contacting TB than people born in the United Kingdom. This is attributed to poor living conditions in the new country and low income. Another factor that contributes to high infection rates among black African immigrants is poor nutrition. TB is a disease that has always been associated with deprivation and poverty. Majority of these immigrants do not have adequate money to buy drugs and they also do not have medical insurance. Therefore, accessing proper medical services remains a mirage. This has been one of the reasons why Black African immigrants’ mortality rate remains high. Nowadays there is substantial data that describes differences in healthcare across different ethnic groups. In the 19th century, the high mortality rate of Irish immigrants in England was attributed to their poor socioeconomic status (Harding & Rosato, 1998). Over the years, the effect of socioeconomic status on health inequality still remains the same. However, the only difference is that the black immigrants from Africa are the latest victims. Some researchers have argued that genetic and cultural elements of ethnicity play a greater role than socioeconomic status in health inequality. The crude explanations that are brought forward are showing a worrying trend since most of these explanations are based on cultural stereotypes and genetic differences. Ethnicity The United Kingdom is currently more diversified than ever. One out of ten people one is a black African. Most of these black Africans have immigrated to the United Kingdom in the last 50 years. Healthcare care services have now more than ever tried to ensure that culture diversity does not affect the way health services are offered. Most black African immigrants’ population is geographically concentrated. About 45% of black African immigrants live in the London area. They make more than 20% of the total London population. In some residential areas in London, they make up more than 50% of the total number of immigrants. A survey done at a London school showed that there were more than three hundred languages being spoken. Majority of those languages were of African origin (Clark, 2007). Black African immigrants’ children have a higher population growth compared to white children. That implies that in the future, black African immigrants’ children will form the bulk of the working class in the United Kingdom. The disadvantages in health services access experienced by black African immigrants is attributed to deprivation rather than race. For instance, a study conducted between 2001 and 2002 showed that unemployment among black African immigrants was at around 20%. That was four times that of British or Irish. It was also twice that of Indian immigrants. That implied that almost half of the black African immigrants were not financially stable which would make it tough for them to access proper health services (Randhawa, 2003). The study also showed that 70% of black African immigrants lived in poverty compared to 22% of Indian immigrants and 20% of whites. The study also showed that black African immigrants had the largest families in the United Kingdom. On average, a typical family had 4.5 children. This was in contrast with whites who had below 2 and Indian at 3.2 children. Therefore, with poor financial status and a big family to support, black African immigrants’ resources are much stretched. The study also showed that in a black African immigrant’s house, most family members were young and dependent on the family while whites’ households had older people who do not really need to be supported by their families. Causes of Health Inequalities The factors that affect health and healthcare inequalities are cross-cutting and complex. Some of those factors are beyond the direct control of social or health care. These factors start right from birth. A child born in poverty is more likely to die in infancy, have impaired growth and suffer from chronic diseases later in life. These health problems also tend to cross generations. That implies that health problems suffered by parents are likely to affect the children and the grandchildren. This has led to emergence of an inherited cycle of health inequality in the United Kingdom (Wilder & Keigue, 1997). There are some differences in healthcare inequalities that are unavoidable. These differences are genetic and biological differences. Other differences include the significant difference in opportunities between black African immigrants and their white counterparts. There is also the issue of access to services, materials resources and the personal lifestyle (Nazroo, 2003). All of these differences have directly or indirectly contributed to healthcare inequality in the United Kingdom. Healthcare inequality is not limited to specific areas or certain ages of these immigrants. Chahal et al (1999) have shown that healthcare inequality in the United Kingdom among black African immigrants ranges from socioeconomic status, geographical area, gender and age. The determinants of healthcare inequality are unevenly distributed which makes pooling of data rather unreliable. Death certificates do not reflect ethnicity of a deceased person therefore, when collecting data; the country of birth is used to determine the ethnicity of the deceased person. This method of collected data has proven to be unreliable because a white person may be born in an African country and then later on immigrate to the United Kingdom (McCarty. et al., 2011). Black African Immigrants Health As mentioned earlier, differences in health equity among different ethnic groups in terms of mortality and morbidity have been carefully documented a number of times in the United Kingdom. The patterns followed by these inequalities are complex but persistent. The most notable illnesses that affect black African immigrants in the United Kingdom are diabetes, obesity, hypertension and mental illnesses (Ochieng, 2010). Many researchers have conducted studies to help them understand why there is such a big difference in health issues between white people and black African immigrants. The aim of these research activities is to understand the factors that underlie the greater risk of poor health and diseases among black African immigrants. Despite the genetic and biological arguments brought forward by some researchers, it is clear that economic and social inequalities have a big role in the poor health of black African immigrants. These immigrants run a high risk of having poor health due to poor economic position and exposure to discrimination and racial harassment (Fenton, 1999). Epidemiology It is hard to take a group of diseases and declare that they affect a given ethnic group. However, there are some diseases that researchers have identified to be very common among black African immigrants. Some of these diseases are usually associated with poverty while others are associated with genetic and biological factors (Kauffman et al., 1998). Generally, black African immigrants are more likely to report bad health compared to Indian immigrants or the whites. Studies have also shown that black immigrant women are more likely to report bad health as compared to male black African immigrants. These and many other factors contribute to the high mortality rates among black African immigrants. Diabetes Diabetes diagnosed by doctors is at least four times more among black African immigrants than the whites and at least two times more than Indian immigrants. This is mostly attributed to genetics and lack of proper health services in the country of origin. Research conducted by Nazroo indicated that most black African immigrants are usually ignorant about diabetes and they only learn about it once they have gone to a doctor. This can be attributed to poor medical record keeping in their country of origin therefore; most of these immigrants do not know whether any other person in the family had suffered from the same illness. Smoking Black African immigrant men are reported to suffer from smoking related illnesses as compared to black African immigrant women. Tobacco chewing is prevalent among black African immigrants especially from West Africa. A small percentage of black African immigrant women also suffered from tobacco related illnesses according to a study done by Nazroo. Mental illnesses Most black African immigrants escaped to the United Kingdom due to wars in their countries of origin. Such countries include Somalia. These immigrants usually show signs of mental illnesses due to the mental or physical injuries that they may have suffered in their countries of origin. Nazroo’s study showed that women are likely to suffer from mental or physical illness as compared to men. This is due to the fact that women may have been sexually assaulted or injured when immigrating to the United Kingdom (Bowling, 2004). The effect of wars in their countries of origin also plays a big role in one’s mental health. Men also suffer from mental illnesses such as anxiety and depression due to the horrors they experienced during the war and the suffering during the escape process. Women usually suffer from depression, anxiety, stomach pains, sexually transmitted diseases and gynecological complications. Children also suffer mental illnesses due to these wars and the prospect of adapting to a new community that they were not used to before (Patel, 1999). The idea of joining school where everybody is communicating in English which is usually not their first language can also make them to be anxious. Black African immigrants also suffer from the constant uneasiness of their insecure legal immigration status. The effect of these mental illnesses has led to high suicide rates, drug and alcohol abuse and criminal activities among the black African immigrants (Burnett et al., 2002). Parental Concern Many black African immigrant parents are not as concerned as their white counterparts. Many black African immigrant parents are usually concerned with looking for work in order to sustain their families (Ochieng, 2011). Therefore, there is a high chance that a parent might miss signs showing a kid is ill. A study conducted in 2007 showed that parental concern among black African immigrants is consistently poor as compared to the Indian immigrants and the white British people. The study also indicated that most black African immigrant usually neglect reporting to a doctor whenever they were ill (Mindell, 2006). Most of them take it for granted and hope that the illness will go away. This poor relationship between black African immigrants and healthcare provider has also contributed to healthcare inequality. Age It is common knowledge among health professionals that one runs the risk of falling ill more often at extreme ages (Burnett, 2001). Therefore, old people and children are the most likely to fall ill more often. In the United Kingdom, children compose a fifth of the whole population while old people compose 16% of the entire population. However, black African immigrants’ children constitute about 50% of the total population of all immigrants’ children. On the other hand, black African immigrants’ population of old people is very low. Children Children and young people are well known for engaging in risky behaviors and putting themselves in dangerous situations. Engaging in risky behaviors is a strong indicator of deprivation (Nazroo, 1997). About 25% of black African immigrant children between the ages of 10 – 15 have a habit of smoking. Study has shown that black African immigrant kids between the ages of 16 – 19 are more likely to engage in excessive drinking and smoking as compared to their elder folks. The same goes for young people aged between 20 – 24 years. The habit of engaging in these vices at a young age contributes heavily on many illnesses leading to an increase in healthcare inequality since most of these kids cannot afford treatment in proper hospitals (Butcher, 1994). About 15% of boys between the ages of 11 – 15 engage in drug use according to a study done in 2000. Drug use in young people between the ages of 20 – 24 stood at 24%. These risky behaviors have led black African immigrants’ kids and young men to start engaging in sex at an early age. This has led to increased cases of sexually transmitted diseases infection as well as HIV/AIDS infection (Zimmerman, C. et al., 2004). Engaging in loose unprotected sex at an early age has also led to an increase in teenage pregnancy. These teenage mothers usually have a hard time caring for their kids and getting proper healthcare for them and their kids (Hawkins et al., 2008). Old People Old black African immigrants are likely to suffer from coronary heart diseases, hypertension, diabetes, obesity and disability as their age advances. Some of the serious diseases that old people suffer from include cancer and dementia (Patel, 1999). Among black African immigrants, about 65% of old people suffer from chronic diseases or some form of disability. In a study done in 1999, old about 40% of old black African immigrants who were over 65 years died of accidents and fatal injuries (Nazroo, 2006). Middle aged women black African immigrants also suffer from breast cancer. Most of these old people have no one to take care of them. Therefore, majority of them have difficulties accessing healthcare services. Secondly, most of these old people do not work therefore, their income is limited and most of them cannot afford the services of a personal physician (Salway et al., 2010). Recommendations Solving health determinants does not automatically solve the determinants of health inequalities. Initiatives in health promotion and employing the use of technology in service delivery can improve the status of healthcare inequalities among the black African immigrants (Lightstone, 2001). Some of the policies that the government is pushing are also going to play a great role in eliminating healthcare inequality. Such policies include improving immigrants’ living standards and imposing tougher rules on smoking. The Department of Health also rolled out an ambitious program in 2004 that was to tackle the problem of healthcare inequality. The program is named “Making Health Choices”. The purpose of this project is to ensure that everybody in the society can access healthcare services. The program also acts as a means of collected data so that the officials can make informed decisions in the future based on facts (Tucker, 2006). Conclusion In the United Kingdom there is persistent problem with the data available that can be used in exploring ethnic inequalities in the health sector. The data available is not detailed enough especially in the field of ethnicity. The data available does not reflect heterogeneity across different ethnic groups in the United Kingdom. Socioeconomic data is never collected and whenever it is collected, the data is very crude and inadequate to make any sensible interference. The data that is usually collected usually reflect the current position rather than risks across life course. The data also does not include other factors of health inequality and social issues such as racial harassment, discrimination and geographical dependent inequalities. Despite all those shortcomings on availability of data, the amount of research and studies done have indicated that healthcare inequality is directly related to differences in socioeconomic status. Evidence from these studies also shows that experiences of discrimination, racial harassment and living perceptions in a discriminatory society contribute to ethnic inequality in health. One of the major questions is how these social inequality factors relate to biological and psychological markers of stress and eventually translating to diseases. From an epidemiological point of view, it might be fruitful to explore how social inequality translates to hypertension among black African immigrants (Corcoran, 2007). Despite the increase in prosperity and improved healthcare services in the recent years, there is still a lot of inequality in United Kingdom’s healthcare sector. Some recent studies actually show that health inequality is actually widening; teenage conception rate increased by 3.7%, between 1998 and 2008. That implies that despite the efforts that the government has tried to implement, more needs to be done to reduce health inequality. References Acheson, D. 2007. Independent Inquiry into Inequalities in Health. London, England: The Stationery Office. Bhopal, R. 2009. Ethnicity, Race, and Health in Multicultural Societies: Foundations for Better Epidemiology. Public Health, and Health Care. Oxford: Oxford University Press. Bowling, A. 2004. Socioeconomic differentials in mortality among older people. 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The Health of Trafficked Women: A Survey of Women Entering Postrafficking Services in Europe. American Journal of Public Health 98 (2008), pp. 55- 59. Read More