On 20 June 2017 – the United Nations World Refugee Day – Abbas et al (2018) convened a workshop during the 4th International Conference on Prevention and Infection Control in Geneva. The authors note that article 23 of the 1951 Refugee Convention and article 25 of the Universal Declaration of Human Rights guarantee the right of refugees to access physical and mental health services at the same level as other residents.
An important strand that contributes to the current state of global flux is the movement of populations that have either been forcibly displaced or have left their home countries for economic and/or related reasons. The range of conditions that can burden such vulnerable populations not only include psychiatric illnesses like post-traumatic stress disorder and depression, but as Abbas et al (2018) report: ‘The prevalence of certain chronic parasitic diseases in asymptomatic migrants reflects, in general, the epidemiologic burden at the country of origin and may be high, up to 5.8%, 48.5%, and 56.1%, for schistosomiasis, Chagas disease, and strongyloidiasis respectively’ and the prevalence of chronic viral diseases, such as HIV, hepatitis C, and hepatitis B is also greater than in host populations and can be as high as 2.3%, 1.3%, and 14%, respectively, depending on country of origin.
Global migration means that host country healthcare workers encounter unique challenges to how they can effectively meet their professional obligations to all patients. This was highlighted when Cleland et al (2012) undertook a study in north-east Scotland to explore 14 community pharmacists' perceptions of communication barriers during the provision of care to migrants from central/Eastern European states. Barriers to the provision of optimum care included communication; confidentiality when family/friends translated for patients; and frustration with the process of the consultation.
A decade later, the COVID-19 pandemic – according to Lokugamage et al (2021) – has had a disproportional effect on morbidity and mortality experienced by ethnic minorities in the UK. But Lokugamage et al (2021) have also identified what they consider to be an ethical dimension, claiming that structural racism has contributed to these health inequities. For example, they cite evidence that Asian women are nearly twice as likely to die giving birth than white women, with black women up to five times more likely to die; that diabetes risk is two to six times higher among South Asian patients compared with white British, resulting in concomitant increases in morbidity and mortality; and that admission rates for those being sectioned under the Mental Health Act 2017–2018 were higher than average among black, Asian and minority ethnic groups, compared to white groups. Further, Lokugamage et al (2021) note that ethnic minority groups are under-represented in UK clinical trials but cite ‘one UK randomised control trial that found implicit bias in dentists' clinical decisions on tooth restorability, with root canal therapy being recommended to white patients and black patients recommended extractions.’
In terms of a pharmaceutical context within the ongoing challenges of addressing race and migrant-related issues, Condon et al (2020) explored parents' experiences of using child health services for their pre-school children post-migration to south-west England. These families had migrated to the UK from Romania, Poland, Pakistan, or Somalia within the last 10 years. The study found that Romanian parents distrusted medication prescribed in the UK for childhood ailments like cough or nappy rash, claiming that the remedies available in Romanian pharmacies were more effective; and in asserting their parental autonomy, Pakistani and Somali mothers described being able to buy antibiotics from pharmacies in their home countries if necessary. In addition, Romanian parents ‘disputed the availability of antibiotics in Romania; some maintained that it was only possible to access antibiotics via a doctors' prescription, while others claimed bribery could be used to access the drugs one wanted’ (Condon et al, 2020). Interestingly, the authors reported that in all migrant groups changing attitudes to antibiotics were apparent, with parents increasingly favouring the UK stance that relatively few ailments require antibiotic medication.
That health disparities between white British people and diverse ethnic groups, refugees and migrants in the UK do exist is supported by evidence. Whether these disparities point to racism as a social determinant of health, or whether the role played by higher rates of deprivation and resulting poor health outcomes among minority ethnic groups exerts an influence is a question worthy of further debate.