Assessing new patients from overseas: migrant health guide
Advice and guidance on the health needs of migrant patients for healthcare practitioners.
Offer migrants the same basic new patient check as for all registering patients.
In addition to typical new patient health checks, new migrant patients may have additional health care needs, stemming from:
- their life experiences prior to migration
- circumstances of their migration
- circumstances in which they are living in the UK
Many migrants come from countries with very different health care systems. Take time to explain about how the NHS works and what they can expect of it.
Checklist for new migrant patients
In addition to the typical new patient health check, some questions to consider when speaking to new migrant patients:
- how long have they been in the UK?
- are the circumstances of their move to the UK likely to have affected their physical or mental health: For example, was their migration a positive choice or enforced?
It’s important to understand the person’s previous life experience and circumstances of migration, to consider their likely health needs.
Questioning in this area requires sensitivity. As for any new patient, it can take time for them to trust their health care practitioners and to disclose difficult issues.
It is important that they understand:
- why you ask them about their personal history
- that health services are not linked to immigration procedures
- will their current social circumstances affect their physical or mental health?
- how much social support do they have?
- how are they integrating into UK society?
- is this person at increased risk of any infectious diseases, as a result of their origin, or their journey to the UK: see country specific pages?
- have they received immunisations in line with the UK schedule?
- how is their dental health?
- how is their vision and hearing?
- does their ethnicity put them at increased risk of any health problems that may require additional tests, such as cardiovascular risk or diabetes?
- are there any specific nutritional or metabolic considerations for this person: see country specific pages?
- What does the person understand about the importance of lifestyle factors on health?
- What understanding does the person have of sexual health; does their sexual history make them vulnerable to sexually transmitted infections? Do they have contraceptive needs? Questions in this area require care, and sensitivity, considering the patients’ cultural origin
- will they travel to visit friends and relatives in their country of origin?
Every individual, no matter where they are from, has a unique life story that affects their current and future health.
As with any patient, getting to know and understand a migrant’s health needs takes time. Learning of their needs can become more of a challenge where there are language barriers or cultural differences.
There is probably no one size fits all way to assess the health needs of new migrant patients.
Bear in mind that the standard new patient check may not adequately address the range of health needs that your migrant patients may have.
Consider the following factors that can affect their health needs, You may need to discuss them as you get to know the new patient:
- their life experiences prior to migration (education, employment, family life, socio-economic and political circumstances) and access to health care in their country of origin
- the circumstances of their migration has a large bearing on possible health needs: workers or students have potentially different health needs to a trafficked migrant, or an asylum seeker (see vulnerable migrants)
- their current circumstances in the UK, including economic circumstances and social supports (which significant people in their lives they are now ‘without’, from their home country) and how they are integrating into their new community
See the country specific pages for risks of infection and other possible health issues that can affect migrants.
Increased risk of infection
Many migrants to the UK arrive from a country with a high burden of infection.
Some groups of migrants, such as asylum seekers and refugees, unskilled workers or undocumented migrants, may be economically disadvantaged, live in over-crowded conditions, and live and meet socially with other at-risk groups, putting them at increased risk of infection whilst living in the UK.
Health care practitioners should consider infectious conditions in at-risk migrants. Some diseases may not present clinically for a long time after arrival in the UK.
The country specific pages describe which particular infections a practitioner should consider in caring for migrants.
The disease specific pages offer guidance on testing and further management.
Ethnicity and chronic conditions
Data from the World Health Organization and the Health Survey for England in 2004 show that:
- over 80% of diabetes deaths occur in low and middle income countries
- in the UK diabetes prevalence is higher in Bangladeshi, Pakistani and Indian men and women than in the general population
- more than 75% of the 17.5 million deaths from cardiovascular disease in 2012 occurred in low and middle income countries
- in the UK, among ethnic minority groups, the prevalence of angina and heart attack is highest in Pakistani men and Indian men and women
- almost 80% of smokers live in low and middle income countries
- in the UK 40% of Bangladeshi men reported smoking compared with 24% of men in the general population
Passive or active exposure to tobacco smoke is furthermore significantly associated with tuberculous infection and tuberculosis disease.
Be aware of the increased risks of chronic diseases in certain ethnic/migrant groups.
e-GP online e-learning resource for NHS general practitioners and doctors undertaking specialty training for UK general practice, jointly developed by the Royal College of General Practitioners and e-Learning for Healthcare.
Black and minority ethnic groups: chapter on health care needs assessment from University of Birminghamby PS Gill, J Kai, RS Bhopal and S Wild.