Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Experiencing ‘pathologized presence and normalized absence’; understanding health related experiences and access to health care among Iraqi and Somali asylum seekers, refugees and persons without legal status

Authors: Mei Lan Fang, Judith Sixsmith, Rebecca Lawthom, Ilana Mountian, Afifa Shahrin

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Asylum seekers, refugees and persons without legal status have been reported to experience a range of difficulties when accessing public services and supports in the UK. While research has identified health care barriers to equitable access such as language difficulties, it has not considered the broader social contexts of marginalization experienced through the dynamics of ‘othering’. The current study explores health and health care experiences of Somali and Iraqi asylum seekers, refugees and persons without legal status, highlighting ‘minoritization’ processes and the ‘pathologization’ of difference as analytical lenses to understand the multiple layers of oppression that contribute to health inequities.

Methods

For the study, qualitative methods were used to document the lived experiences of asylum seekers, refugees and persons without legal status. Thirty-five in-depth interviews and five focus groups were used to explore personal accounts, reveal shared understandings and enable social, cognitive and emotional understandings of on-going health problems and challenges when seeking treatment and care. A participatory framework was undertaken which inspired collaborative workings with local organizations that worked directly with asylum seekers, refugees and persons without legal status.

Results

The analysis revealed four key themes: 1) pre-departure histories and post-arrival challenges; 2) legal status; 3) health knowledges and procedural barriers as well as 4) language and cultural competence. Confidentiality, trust, wait times and short doctor-patient consultations were emphasized as being insufficient for culturally specific communications and often translating into inadequate treatment and care. Barriers to accessing health care was associated with social disadvantage and restrictions of the broader welfare system suggesting that a re-evaluation of the asylum seeking process is required to improve the situation.

Discussions

Macro- and micro-level intersections of accustomed societal beliefs, practices and norms, broad-levellegislation and policy decisions, and health care and social services delivery methods have affected the health and health care experiences of forced migrants that reside in the UK. Research highlights how ‘minoritization processes,’ influencing the intersections between social identities, can hinder access to and delivery of health and social services to vulnerable groups. Similar findings were reported here; and the most influential mechanism directly impacting health and access to health and social services was legal status.

Conclusions

Equitable health care provision requires systemic change that incorporate understandings of marginalization, ‘othering’ processes and the intersections between the past histories and everyday realities of asylum seekers, refugees and persons without legal status.
Footnotes
1
Cultural safety is a concept that emerged from the field of nursing in New Zealand and firmly asserts a distancing from victim blaming through the dispelling of cultural stereotypes [33].
 
2
Section 4 support is part of UK’s Immigration and Asylum Act since 1999. For failed asylum seekers, Section 4 support may provide accommodation to those who have a temporary barrier to leaving the UK and who would otherwise be destitute [32].
 
3
Health literacy, more broadly, refers to accessing, understanding and using information to make health decisions and encompasses terms and actions such as health knowledge, health motivation and health activation [42].
 
Literature
1.
Crawley H. Chance or choice? Understanding why asylum seekers come to the UK. London: The Refugee Council; 2010.
2.
Carta MG, Bernal M, Hardoy MC, Haro-Abad JM. Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1). Clin Pract Epidemiol Ment Health. 2005;1:13.CrossRefPubMedPubMedCentral
3.
Shannon PJ, Wieling E, McCleary JS, Becher E. Exploring the mental health effects of political trauma with newly arrived refugees. Qual Health Res. 2015;25(4):443–57.CrossRefPubMed
4.
Cook TL, Shannon PJ, Vinson GA, Letts JP, Dwee E. War trauma and torture experiences reported during public health screening of newly resettled Karen refugees: a qualitative study. BMC Int Health Hum Rights. 2015;15:8.CrossRefPubMedPubMedCentral
5.
6.
Ghebrehewet S, Regan M, Benons L, Knowles J. Provision of services to asylum seekers. Are there lessons from the experience with Kosovan refugees? J Epidemiol Community Health. 2002;56:223–6.CrossRefPubMedPubMedCentral
7.
Mountian I. Asylum seekers, refugees and drug use - final report. Rochdale: Early Break; 2005.
8.
Sixsmith J, Lawthom R, Mountian I, Whittle N, Fang ML. Understanding health and access to health care: the case of Somali and Iraqi asylum seekers and refugees. Manchester: Research Institute for Health and Social Change (RIHSC); 2012.
9.
Phoenix A. Theories of gender and black families. In: Weinger G, Arnot M, editors. Gender under scrutiny: new inquiries in education. London: Open University Press; 1987.
10.
Grove NJ, Zwi AB. Our health and theirs: forced migration, othering, and public health. Soc Sci Med. 2006;62(8):1931–42.CrossRefPubMed
11.
Weis L. Identity formation and the process of ‘othering’: unravelling sexual threads. Educ Found. 1995;9:17–33.
12.
Chantler K. Border crossings: nationhood, gender, culture and violence. Int J Crit Psychol. 2007;20:138–66.
13.
Burman E, Chantler K. Domestic violence and minoritisation: legal and policy barriers facing minoritized women leaving violent relationships. Int J Law Psychiatry. 2005;28(1):59–74.CrossRefPubMed
14.
Brekke JP, Brochmann G. Stuck in transit: secondary migration of asylum seekers in Europe, national differences, and the Dublin regulation. J Refug Stud. 2015;28(2):145–62.CrossRef
15.
Allsopp J, Chase E, Mitchell M. The tactics of time and status: young people’s experiences of building futures while subject to immigration control in Britain. J Refug Stud. 2015;28(2):163–82.CrossRef
16.
Council R. The development of a refugee settlement policy in the UK. London: Refugee Council; 1997.
17.
Tomlinson F, Egan S. From marginalization to (dis)empowerment: organizing training and employment services for refugees. Human Relations. 2002;55(8):1019–43.CrossRef
18.
Witherall C, Noddings N. Stories lives tell: narrative and dialogue in education. New York: Teachers’ College Press; 1991.
19.
Stefanovic D, Neophytos L, Parsons S. Home is where the heart is? Forced migration and voluntary return in Turkey’s Kurdish regions. J Refug Stud. 2015;28(2):276–96.CrossRef
20.
Patel N, Mahtani A. The politics of working with refugee survivors of torture. The Psychologist. 2007;20(3):164–6.
21.
Muggah R. The invisible displaced: a unified conceptualization of population displacement in Brazil. J Refug Stud. 2015;28(2):222–37.CrossRef
22.
McColl H, Johnson S. Characteristics and needs of asylum seekers and refugees in contact with London community mental health teams - a descriptive investigation. Soc Psychiatry Psychiatr Epidemiol. 2006;41(10):789–95.CrossRefPubMed
23.
Littlewood R, Lipsedge M. Aliens and alienists - ethinic minorities and psychiatry. London: Routledge; 2001.
24.
Zetter R, Pearl M. The minority within the minority: refugee community-based organisations in the UK and the impact of restrictionism on asylum-seekers. J Ethn Migr Stud. 2000;26(4):675–97.CrossRef
25.
Kirkwood S, McKinlay A, McVittie C. ‘He’s a cracking Wee Geezer from Pakistan’: lay accounts of refugee integration failure and success in Scotland. J Refug Stud. 2015;28(1):1–20.CrossRef
26.
Braun V, Clarke V. “Using thematic analysis in psychology”. Qual Res Psychol. 2006;3(2):77–101.CrossRef
27.
Chantler K. An analysis of present drug service delivery to Black Communities in Greater Manchester. Manchester: Greater Manchester Drug Action Partnership and Black Drug Workers Forum - North West Publication; 1998.
28.
Johnson JL, Bottorff JL, Browne AJ, Grewal S, Hilton BA, Clarke H. Othering and being othered in the context of health care services. Health Commun. 2004;16(2):255–71.CrossRefPubMed
29.
Phillips DA, Drevdahl DJ. “Race” and the difficulties of language. ANS Adv Nurs Sci. 2003;26(1):17–29.CrossRefPubMed
30.
Kang E, Rapkin BD, Springer C, Kim JH. The “Demon Plague” and access to care among Asian undocumented immigrants living with HIV disease in New York City. J Immigr Health. 2003;5(2):49–58.CrossRefPubMed
31.
Fang ML, Goldner EM. Transitioning into the Canadian workplace: challenges of immigrants and its effect on mental health. Canadian Journal of Humanities and Social Sciences. 2011;2(1):93–102.
32.
Kitchin R. ‘Out of place’, ‘knowing one’s place’: Space, power and the exclusion of disabled people. Disabil Soc. 1998;13(3):343–56.CrossRef
33.
Pottie K, Ng E, Spitzer D, Mohammed A, Glazier R. Language proficiency, gender and self-reported health. Can J Public Health. 2008;99(6):505–10.PubMed
34.
Hargreaves S, Holmes A, Friedland JS. Charging failed asylum seekers for health care in the UK. Lancet. 2005;365(9461):732–3.CrossRefPubMed
35.
36.
Smith MM. Asylum seekers in Australia. Med J Aust. 2001;175(11–12):587–9.PubMed
37.
Mountian I. Some questions around the Otherness of Asylum Seekers in the UK. London: Psychotherapy and Liberation Conference; 2008.
38.
Feldman R. Primary health care for refugees and asylum seekers: a review of the literature and a framework for services. Public Health. 2006;120(9):809–16.CrossRefPubMed
39.
Dwyer P, Brown D. Meeting basic needs? Forced migrants and welfare. Soc Policy Soc. 2005;4(4):369–80.CrossRef
40.
Webster A, Robertson M. Can community psychology meet the needs of refugees? The Psychologist. 2007;20(3):156–8.
41.
Cameron M, Andersson N, McDowell I, Ledogar RJ. Culturally safe epidemiology: oxymoron or scientific imperative. Pimatisiwin. 2010;8(2):89–116.PubMedPubMedCentral
42.
Peerson A, Saunders M. Health literacy revisited: what do we mean and why does it matter? Health Promot Int. 2009;24(3):285–96.CrossRefPubMed
Metadata
Title
Experiencing ‘pathologized presence and normalized absence’; understanding health related experiences and access to health care among Iraqi and Somali asylum seekers, refugees and persons without legal status
Authors
Mei Lan Fang
Judith Sixsmith
Rebecca Lawthom
Ilana Mountian
Afifa Shahrin
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2279-z

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Is the association between physical activity and healthcare utilization affected by self-rated health and socio-economic factors?

Research article

Couple based family planning education: changes in male involvement and contraceptive use among married couples in Jimma Zone, Ethiopia

Research article

Proposing a framework for Health Impact Assessment in Iran

Research article

Design, implementation and evaluation of a training programme for school teachers in the use of malaria rapid diagnostic tests as part of a basic first aid kit in southern Malawi

Research article

Do unfavourable working conditions explain mental health inequalities between ethnic groups?: cross-sectional data of the HELIUS study

Research article

Associations of psychological capital, demographic and occupational factors with cigarette smoking among Chinese underground coal miners