Tuberculosis: looking beyond ‘migrant’ as a category to understand experience
The 24th March each year marks World TB Day – the date in 1882 on which Dr Robert
Koch presented his famous paper that demonstrated that tuberculosis (TB) was not
an inherited disease as some thought (Gerrish, Naisby & Ismail, 2012) but rather
caused by a bacterium – Mycobacterium tuberculosis.
Globally, it is estimated that one in four people are infected with TB (Houben & Dodd,
2016). According to the World Health Organisation, TB kills more people than any
other infectious disease worldwide, despite being completely treatable. In 2016
alone, 10.4 million people fell ill with TB disease and over 1.3 million people died
(World Health Organisation, 2017). Whilst the number of cases of TB in the UK is
relatively low, particular populations bear a disproportionate burden of disease
(Public Health England, 2017a).
- Tuberculosis (TB) remains a significant public health issue globally. In the
UK, the burden of disease is unequally distributed with immigrant
populations and those from black and minority ethnic (BME) groups
- Although compared with developing countries, rates of TB in England are
low, they are higher than in many other European countries and the USA.
In response to England’s relatively high incidence of TB and with an aim to
achieving the WHO target of reducing TB incidence by 50% by 2025, a
national strategy was launched in 2015. This included the introduction of
primary-care led systematic screening of recent immigrants from high TB
incidence countries for latent TB infection.
Whilst England’s national TB strategy attempts to improve access to TB
services, a wider ‘hostile environment’ includes mechanisms that restrict
access to healthcare and housing for migrant populations, which heightens
the exposure rate of TB to those already most at-risk of TB.
- Although TB, along with many other infectious conditions, is exempt from
NHS charging, research shows that the perceived threat of charging, and
specifically, the requirement to provide identification to access healthcare
as well as the fear of deportation deter people from seeking help when
they are unwell.
- National surveillance data need to recognise the complexity of the migrant
experience in order to generate a better understanding of ways in which
health care can be improved amongst this population.
- Healthcare providers and civil society must work together both to
challenge and circumnavigate the current adverse conditions that
migrants face accessing healthcare.
Author(s): Dr Jessica Potter and Dr Adrienne Milner
Publisher: Race Equality Foundation
Publication date: July 2018