The current financial pressures on the public sector and the drive to achieve savings in the NHS are the focus of much debate and speculation at the moment. Of particular concern, though less prominently voiced, in a time of squeezed budgets, is the potential impact of these pressures on some of the more marginalized and vulnerable groups. Often, these are people who have less opportunity to engage in the debates about what services should be retained, scaled back or withdrawn.
I’m a consultant in public health medicine, and my work focuses on population health. Working in London with its large migrant population, I am very conscious of the challenges posed by a lack of access to healthcare for undocumented migrants and other vulnerable population groups.
There are three specific areas of concern that link back to public health initiatives that come to mind, all drawn from my work experience.
The first is the possibility that undocumented migrants lacking access to healthcare will be driven to use emergency services more and more. This is at a time when across the country, initiatives are being developed and implemented to reduce inappropriate attendance at accident and emergency units, because of the high costs that these visits attract.
The second is the possibility that poor access to healthcare will lead to worse outcomes among these groups, thereby widening health inequalities. There is some evidence from Project London, the Doctors of the World project that works to improve access to healthcare for marginalized communities in London, that pregnant women from these groups are deterred from early attendance for antenatal care. Given that late booking is a known risk factor for poor maternal and infant outcomes, poor access to healthcare for certain groups may exacerbate inequalities in maternal and child health.
Finally, drawing from recent experience with planning for pandemic flu and investigating disease outbreaks, I am concerned that poor access to healthcare for any segments of the population may make it more difficult to effectively prevent and control communicable disease outbreaks, potentially, putting the entire population at risk. As the 2012 Olympics draw nearer, planning effectively for emergencies will be made more difficult if there are significant segments of the population without access to healthcare.
In an era in which the government encourages us all to think of the Big Society, healthcare professionals need to advocate and act on behalf of some of the most marginalized and vulnerable groups in our society today; acting as a voice for groups who are unlikely to speak up or be heard in the maelstrom of financial saving plans.
This is why I welcome a recent conference organised by Doctors of the World to examine ways of ensuring access to healthcare for undocumented migrants. The conference also saw the launch of the HUMA declaration, which advocates for the right to healthcare for undocumented migrants and which doctors and health workers across the UK are invited to sign. Already Dr Clare Gerada has signed on behalf of the Royal College of General Practitioners as have Professor Sir Andy Haines of the London School of Hygiene and Tropical Medicine and HIV expert, Professor Brian Gazzard.
The 10th of December was Human Rights day – a good time to sign the declaration.
Ike Anya is a Nigerian public health doctor working in London and co-founder of the Nigerian Public Health Network.