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, use the ‘Checklist for assessing migrant patients’ below to address their health 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, their entitlements to healthcare, and how to access healthcare.
All possible efforts should be made to ensure effective communication with migrant patients. This includes offering professional language interpreting and translation services, rather than using family or friends to interpret.
Consider applying the principles outlined below in ‘Trauma-informed practice’ when working with migrants affected by trauma.
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 no one size fits all way to assess the health needs of new migrant patients. The typical 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:
- 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, which 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 the vulnerable migrants page)
- 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
- any experiences of discrimination upon arrival into the UK, and its impacts on their health
See the country specific pages for risks of infectious diseases and other possible health issues affecting migrants from different countries.
Assessing patients from overseas animation
The entitlements to NHS services for migrants in England animation contains a section on assessing new patients from overseas (section begins at 08:05).
Checklist for assessing migrant patients
It’s important to consider the person’s previous life experience and circumstances of migration in order to understand their likely health needs.
Questioning in this area requires sensitivity. As for any new patient, it can take time for them to trust their healthcare practitioners and to disclose difficult issues.
Information for new migrant patients
Take time to explain to the patient:
- how the NHS works, migrants’ entitlements to healthcare, and how to access healthcare. Many migrants come from countries with very different health care systems
- the circumstances in which non-medical personal information can be shared between the NHS and Home Office
- that questions about their migration history will be used to inform your understanding of their health and medical history, and help you to assess their health risks
In addition to the typical new patient health check, some questions to consider when speaking to new migrant patients are listed below.
- What is their country of birth, and have they lived in other countries besides the UK and their country of birth?
- 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 a result of involuntary or unforeseen circumstances like persecution, conflict or environmental disaster?
- Are they planning to travel to visit friends and relatives in their country of origin? If so, how frequently?
- What is their ethnicity? Does their ethnicity put them at increased risk of any health problems that may require additional tests, such as cardiovascular risk or diabetes? See the ‘Ethnicity and chronic conditions’ section below.
- What is their main or preferred spoken and written language or languages?
Ensure that the patient’s ethnicity and migration related data (for example, country of birth, main language, interpreter needs) are documented in their electronic health record.
- How much social support do they have?
- Do they feel they are able to participate in their local community?
- Do they have access to stable accommodation?
- Are finances and employment a current concern for them?
- Do their current social circumstances affect their physical or mental health?
- Have they experienced discrimination after arrival into the UK, and how has it affected their health and wellbeing?
- Do their children have access to education (school, nursery)?
Consider potential safeguarding concerns (regarding the patient, their children or other family members) that may arise.
Specific health concerns
- Have they received immunisations in line with the UK schedule?
- How is their dental health?
- How is their vision and hearing?
- Are there any specific nutritional or metabolic considerations for this person? Use the country specific pages to guide your questions.
- 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 background.
- Are there any women’s health concerns that should be addressed?
- Is this person at increased risk of any infectious diseases as a result of their origin or their journey to the UK? Use the country-specific pages to guide your questions and refer to the ‘Increased risk of infection’ section below.
- Are there any neurodevelopmental concerns that have not yet been addressed? There is some evidence that migrants may receive late diagnosis and therefore miss beneficial early interventions. Identify any undiagnosed neurodevelopmental disorders, or any risks which may have not yet been addressed, and make appropriate referrals.
- Do they have any concerns about their child or children’s health?
- Do they have a diagnosed learning disability (LD), special educational needs and disabilities (SEND), physical or mobility challenges, or any other ‘hidden’ disabilities that affect their daily activities and participation? Were they diagnosed in their country of origin or birth, or in the UK?
- Do they consider themselves to have a disability that has not been diagnosed? This may be the case due to lack of access to disability support in their country of origin.
- How do they feel their disability impacts their daily activities and participation?
- What disability-related supports or interventions did they receive prior to their move to the UK?
- Do they need specialist equipment, mobility aids, communication aids or special adjustments around the house?
- Do they have any specific occupational adjustment needs (for example, at school, in the workplace)?
- How is their disability perceived in their home country, and by their friends and relatives? Beliefs about health, illness and disability can vary considerably between and within cultures. Stigma can impact a person’s perceptions of their own disabilities and may influence how they and/or their family disclose, discuss and interpret matters relating to their disability.
See the ‘Migrants with disabilities’ section below for further information.
Increased risk of infection
Many migrants to the UK arrive from a country with a high burden of infectious diseases.
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. This puts them at increased risk of infectious diseases whilst living in the UK.
Healthcare professionals should consider infectious diseases 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 communicable disease pages offer guidance on testing and further management.
Ethnicity and chronic conditions
Be aware of the increased risks of chronic diseases in certain ethnic/migrant groups.
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 also significantly associated with tuberculous infection and tuberculosis disease
Questions about family history and ethnicity should be handled with sensitivity. In some cultures, causes of illness and death may not be explicitly shared.
Migrants with disabilities
People with learning disabilities and other types of disabilities have overall poorer health outcomes and are at risk of dying earlier than they should. There is limited evidence of the prevalence and specific needs of migrants with disabilities. The identification of migrants with learning disabilities, special educational needs and disabilities and other ‘hidden’ disabilities is an ongoing challenge. Reasons include:
- diagnosis and support for individuals with disabilities varies between countries, and health professionals in the UK may be the first to identify migrants who have specialist health and care needs
- a multidisciplinary approach to assessment and integrated management may be challenged by migrants’ entitlements to support from specialist community health teams
- immigration status issues, short-term or unstable accommodation, language barriers and cultural differences may further complicate migrants’ access to mainstream disability services
- vulnerable migrants who have disabilities face further social exclusion and discrimination. Stigma (cultural or otherwise) around certain illnesses and disabilities may also make it difficult for individuals and their families to disclose or discuss this topic
Healthcare professionals can support migrants with disabilities by:
- identifying their specific support needs. A checklist of additional disability-related questions can be found in the ‘Checklist for assessing migrant patients’ section above
- conducting regular health checks. Support migrants with learning disabilities to be added to their GP practice’s learning disability register. People with learning disabilities over the age of 14 can access annual free health checks. Provide this information to migrant patients in the language and format of their choice (for example, paper-based for those who cannot access to digital resource; voice recording or video for those with low literacy)
- making relevant referrals to paediatric services for children with disabilities and developmental needs.
- making reasonable adjustments in the delivery of your healthcare services. Your assessment of a migrant’s health and disability needs can also help them to advocate for access to reasonable adjustments in other aspects of their life, like in education and employment
- helping patients with disabilities to access other support to improve their health and wellbeing, including improving their participation in physical activity. Healthcare professionals can access the OHID/Sport England Moving Healthcare Professionals Programme to develop their skills in having conversations with patients about physical activity and supporting them to access local services
- identifying and supporting patients to access the advocacy services available in their local area
Migrants, particularly vulnerable migrants, may be exposed to trauma prior to, during and following their migration journeys.
Trauma-informed practice is an approach to care provision that considers the impact of trauma exposure on an individual’s biological, psychological and social development. Delivering services in a trauma-informed way means understanding that individuals are likely to have a history of traumatic experiences. These experiences may impact on their ability to feel safe and develop trusting relationships with services and healthcare professionals.
Trauma-informed practice is not intended to treat trauma-related issues. It seeks to reduce the barriers to service access for individuals affected by trauma. While more evidence is needed to gain an in-depth understanding of the effects of trauma-informed practice for migrant populations, there is evidence that services provided to vulnerable migrants without a trauma-informed approach can result in harm.
There are 6 principles of trauma-informed practice:
- cultural consideration
For more information on trauma-informed practice, access the trauma-informed practice toolkit produced by Public Health Scotland.
The migrant health guide contains a collection of other resources on migrants and the NHS, vulnerable migrants, communicable diseases and non-communicable health concerns.
The British Medical Association has produced an asylum seeker and refugee health toolkit for medical practitioners to help them understand asylum seekers’ and refugees’ health needs and how to overcome common barriers to healthcare.
e-GP online e-learning resource for NHS general practitioners and doctors undertaking speciality 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 Birmingham by PS Gill, J Kai, RS Bhopal and S Wild.