Abstract
ABSTRACT Many migrant groups, particularly those that are politically and economically marginalised, such as asylum seekers and refugees (ASRs), face inequities in access to health care as well as poorer physical and mental health outcomes. The role of post-arrival experiences in contributing to these inequities is increasingly being explored, and it is suggested that being a migrant is itself a determinant of health outcomes. Drawing on the theoretical concept of structural vulnerability, this paper explores ASRs’ experiences of health, wellbeing, and health practices in the context of their lived realities in Scotland. 24 semi-structured interviews were conducted with ASRs from Sub-Saharan Africa between January and December 2015. Data were explored using thematic analysis. Experience of the UK asylum system, both alone and in conjunction with other sources of vulnerability including racism, poverty, and language barriers had a negative and ongoing impact on the physical and mental health of ASRs. These impacts continued, even once refugee status was obtained. Efforts to engage ASRs in preventive health programmes and practices must take into account the ways in which the asylum system acts as a determinant of health, affecting both what it means to be healthy and what capacity individuals have to engage with their health. Political choices in how the asylum process is enacted have far-reaching implications for individual and population health.
Highlights
Many migrant groups, those that are politically and economically marginalised, such as asylum seekers and refugees (ASRs), face inequities in access to health care and poorer physical and mental health outcomes compared to the majority population (Gill- Gonzalez et al, 2015; Medecins du Monde & University College London, 2017; O’Donnell et al, 2016)
KEYWORDS Social determinants; asylum seekers; refugees; vulnerability. Those that are politically and economically marginalised, such as asylum seekers and refugees (ASRs), face inequities in access to health care and poorer physical and mental health outcomes compared to the majority population (Gill- Gonzalez et al, 2015; Medecins du Monde & University College London, 2017; O’Donnell et al, 2016)
While the focus of much research on migrant health has been on infectious diseases and mental health, increasing attention is being paid to why marginalised migrant groups face disproportionate risk of developing noncommunicable diseases (NCDs) and what could be done to address this (Agyemang et al, 2012)
Summary
Those that are politically and economically marginalised, such as asylum seekers and refugees (ASRs), face inequities in access to health care and poorer physical and mental health outcomes compared to the majority population (Gill- Gonzalez et al, 2015; Medecins du Monde & University College London, 2017; O’Donnell et al, 2016). Various factors have been considered as potential contributors to these health disparities. These include biological determinants, behavioural factors related to cultural norms, pre-migration experi ences, and the social and structural factors that shape migrants’ lives once they have moved to a new country (Abubakar et al, 2018; Agyemang, 2019). Are certain migrant groups exposed to many of the structural determinants of poor health (Chaufan et al, 2011), but migration-related factors can intersect with these determinants to intensify chronic disease risk (Castañeda et al, 2015).
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