An In Depth Analysis of Tuberculosis Concerns Among

Introduction

This essay will critically discuss the statement that “Health is the highest priority for migrants in the UK at risk of contracting tuberculosis”. Then the essay will provide recommendations for improvement. The term tuberculosis (TB) is a contagious bacterial infection caused by Bacinus Mycobacterium Tuberculosis that are spread through sneezing and coughing with some possible symptoms including nightsweats, tiredness, excretion of blood in cough, weight loss and fever which typically affects the lung (Centers for Disease Control and Prevention, 2019). Although, it is not just limited to the lungs but once it gets inside the body, it expands to the entire system and can travel to the brain, the joint, liver, to the Spinal Cord and kidney. TB is one of the deadliest infectious diseases of the world and has surpassed HIV/AIDs due to a single infectious agent (World Health Organisation, 2018).

Background

World Health Organisation (2018) stated that two hundred thirty thousand children died of TB including children with HIV related TB, also, an estimate of one million children fell ill each year as a result of TB infection. In the year 2017, 10 million people became ill with TB and 1.6 million died from the disease including 0.3 million people with HIV (World Health Organisation, 2018). Globally, an estimate of 480,000 people developed multidrug resistant TB which is a threat to the public health.
The target of the Millennium Development Goals (MDGs) of revising and halting the epidemic by 2015 has been globally met withan estimate of fifty million people having been saved through TB treatment and diagnosis between the period of 2000 and 2017. However, by 2030, the aim of Sustainability Development goals is to eradicate Tuberculosis epidemic (World Health Organisation, 2018).Previously, there has been an increasing considerable recent migrant in the UK that had cause significant implications for Public Health Services (Hargreaves and Friedland, pp. 27-43, 2012). Migrants carry the most burden of tuberculosis in the UK with 70 percent of newly diagnosis (Seedat, et al., 2014).
Additionally, in 2017, the rate of cases of TB was 9.2 per 100.000 population, however, during the same year, the figure of number of patients went went down to the number of 5,010 and this was the lowest since 1990 in comparison to the year 2016 in which a total of 5616 number of cases were recorded (Public Health England, 2018). 71 percent of people report officially with TB was born outside the United Kingdom. In addition, it has also been confirmed that 12.6 percent of individuals who had been identified with TB, are afflicted by a problem of the social factor. TB in major deprived people is more than seven times higher in comparison to the least deprived population (Public Health England, 2018). In the UK, the marginalised groups of people affected by TB include the prisoners who use drugs, migrants from countries with high epidemic, the homeless, the individuals diagnosed with HIV, and in most cases the infant. These group of individuals are threat of TB compare to the main people (Semenza, eta l., 2010). TB services require extensive effort caring for the people within the period of six months of TB treatment (Craig, et al., 2014) due to numerous risks of social factors causing individual compliance to the medication of TB.

Social Determinates of TB

Over the past decade, TB has been related with poverty (Potter and Milner, 2018) as a condition associated with poverty such as unable to use the appropriate clinics. Factors which affect accessibility of the migrants for healthcare are related to social determinants of health because of the challenges encountered during the process of migratory process (Bhopal, 2007) and as such have a significant impact on the illness risk (Krieger, 2008). In most cases, some migrants get to their destination in good health but later in their lives, the advantages which they had while they arrived at their destinations get eroded completely (Anikeeva et al., 2010) due to stresses which the migrants have to undergo which are linked to employment struggles, language barriers, lack of social support and acculturation process (Anikeeva et al., 2010). Relating to TB, direct transmission of active disease may occur by the specific stressors and environmental conditions the migrants experienced during and after the migration process (Dhavan, et al., 2017). An individual migrant health priority is determined by the availability of social and economic opportunities which influence health. An official record of infectious diseases, for instance TB, which are statutorily notifiable diseases in the UK, provide a better mean of propagation of awareness on health outcomes amongst the immigrants as a group and as country of birth is recorded routinely (Abubakar et al., 2012). Furthermore, in the UK, based on the authority to use health services, these group of people are not entitled to some services, for example, free medical care, expect for an urgent treatment (Jayaweera, 2011). Additionally, in agreement with a re-definition of no distinctive features of permit which has been a part of the Immigration Act (2014) and which says that every recent interim entrant to the United Kingdom such as international students, workers and family members uniting with British citizens on the point-based system as well

as the dependant must be charged an extra payment for entry visa, to be able to use the services of NHS (Grove white, 2014). Furthermore, there are also more restrictions limiting the rights of some undocumented migrants like the UK born children of undocumented parents to such services but to some service, such as Accidents and Emergency hospital services which have been granted on public and humanitarian protection grounds is free to access (Jayaweera, 2014). These restrictions and conditionality imply that in the UK, there is classification of rights to healthcare.

Screening for Tuberculosis

According to Public Health England (2014) UK policy clearly identifies port of entry chest radiography and identification screening for immigrants coming from a country with high prevalence of TB (Pareek et al., 2011). In addition, the purpose of the initial screening aims to detect TB infection (Public Health England, 2014). This strategy targeting immigrants reduces the number of new immigrants arriving from countries which are have high burden of Tuberculosis and curtails diagnostic delay through improving accessibility of services and awareness raising (Glaziou et al., 2018).

The UK government has recently shut down its port of entry TB screening due to it having not been cost effective as well as is poorly run and discriminating (Seedat et al., 2014). This will affect the new migrant’s ability to gain access and benefit from the screening programme for TB (Stagg et al., 2012). Moreover, migrants who intend to reside in the UK for a long period of time and who could be coming from a high prevalence country are needed to be engaged in screening program early because TB is well known to get reactivate after three to five years of the migrant’s arrival to a new country (Steedat et al., 2014).

Numerous challenges can influence treatment seeking behaviours and accepting screening by migrants including immigration status, communication problems, discrimination, loss of social support, acculturation problems and issues related to successfully adapting to new surroundings. These can be aggravated by fear of TB as well as the stigma correlated to a positive diagnosis to TB treatment (Seedat et al., 2014). In terms of acculturation, knowledge about TB among migrants is shaped by cultural beliefs, frequently arising from experiences in the country of origin (Wieland, et al., 2012). Undoubted thoughts including misconceptions about TB risk, transmission and causation of the disease can act as barriers to clinical treatment. TB has been in several ways erroneously attributed to climate change, pneumonia and witchcraft. For instance, Somali women strongly believed TB to be a punishment for past ill deeds (Wieland et al., pp.14-22, 2012). Additionally, immigrants may prefer traditional systems of healing and care rather than medical treatment upon arrival (Gerrish et al., pp.34-36, 2012) making the migrants to turn to self-diagnosis before accessing public healthcare services (Department for communities and Local Government, 2015).As a result, cultural beliefs that led to delay in seeking and up taking of treatment and non-adherence may increase the chances of TB transmission in such societies. In contrast, cultural beliefs held by migrants are sometimes not challenges to treatment seeking and up taking screening, but instead it promotes such behaviour. The higher prevalence of TB in migrant’s origin countries could lead to greater awareness of the disease. According to Bakhsh (2006), individuals born in UK are quite familiar with the disease and the treatment of it so as not to ignore any of

these. Also, in New York, the Chinese medical beliefs are quite frequently complementary to clinical TB treatment to lower the side effects of TB drugs (Hayward et al., 2018). TB related stigmatisation of immigrants has also contributed to the reason migrants does not seek treatment. Most culture belief consider TB to be dirty and sinful (Wieland et a., pp.14-22, 2012), meaning that the feelings of shame and guilt and risk of discrimination which lead to stigmatisation have an influence on migrants’ attitudes towards prevention, treatment and diagnosis which further hinder TB control and enable it to be transmitted in certain ethnic groups of migrants (Coutwright and Turner, 2010). Many migrants suffering from TB may chose not to report their illnesses to avoid discrimination and social stigma (Coutwright and Turner, 2010). Stigma prevented most immigrants from sharing information with their medical professionals regarding TB related symptoms (Gerrish et al., pp. 45, 2012). In addition, migrants would not want to identify their contacts due to concerns about social repercussions (Gerrish et al., pp54-63, 2012). Feelings of stigma caused by attitudes in the country of origin are possibly to be exacerbated by the negative stereotyping of migrants’ groups as diseased because of the association of TB with immigrants which may lead to discrimination and xenophobia of infected immigrants (Festenstein, 2010). For instance, based on the study carried out amongst Somali migrants in the UK, it has been discovered that, in Somali personnel, TB is entails social isolation and high stigma (Festenstein, pp. 101, 2010).

The stigma attributed with TB led to expectations of shame, social isolation and low self-esteem, in most cases extending to the entire family. Although majority of them are enlighten that TB is contagious, they also believe that individuals remain infectious even after treatment (Gerrish et al., 2018). TB was frequently taught to be hereditary and as such it is difficult to eliminate. This led to the fear that diagnosis would ruin marriage possibilities and friends of the patients would not return to normal social interactions with them after treatments (Hayward et al., pp.78, 2018). This makes infected migrants to always segregate themselves and conceal their illness (Gerrish et al., pp.54-67, 2012).

Access to Healthcare

In the UK, migrants may have troubles in accessing healthcare because migrants face challenges in accessing healthcare services for TB treatment including fear of dearth of trust and breach of confidentiality due to the use of interpreters (Kulane et al., 2010), not being able to access the community health systems and having problems from language barriers (Kulane et al., pp. 26-31,2010). Thus, in most situations where there are minimum economic berries to accessing health facilities, there are always cultural considerations regarding accepting and taking up of the treatment regimens (Hayward, et al., 2018).

According to Wieland et al., (2012), it is proven that structural barriers to using health care services such as transport troubles attributed with poor services in deprived areas (Wieland, et al., 2012) and inflexible opening hours for medication that do not fit with the migrant’s patient lifestyles and working hours. Although economic barriers involve not only direct costs attributed with the disease but also indirect costs such as job losses (Hayward, et al., 2018) Although TB treatment is free for all in the UK, asylum seekers and refugees have poor access to health services (Taylor, 2009) since access to health care services varies across different migrant populations. Improper residence status is possible to lead to considerable delays in seeking assistance for medical treatment, due to lack of certainty surrounding the migrant right to services and fears of deportation, since migrant patient affected from TB can officially be deported even after receiving ongoing treatment (Hayward et al., 2018). In addition, irregular migrants would not like to give information about their migratory route (Kulane et al., pp.78, 2010) and their contact information. Migrants may encounter troubles in completing their long-term TB treatment if they do not have employment and if they are residing for a short-term they they will have problems of repeated consultations (Wieland et al., pp.67, 2012). It is difficult to contact them only of the fact that most do not reside in their legal address but with friends and family (Kulane et al., pp. 55, 2010).

Contrarily, there is evidence that state that UK born citizens also encounter delays from the beginning of the symptoms to the starting of the treatment compare to the foreign born. Besides, the rate and extent of completion of TB treatment is marginally higher in migrants compared to the UK citizens (Public Health England, 2014). Although, these observations could be considered to be controversial, it could be identified amongst the UK citizenry; TB issues are observed to occur in the prisoners, narcotic addicts and substance abusers and amongst the homeless and the treatment is often lost to the poor adherence and follow up processes (Public Health England, 2014). In addition, migrants are at higher risk of contracting TB based on the difference specific factors as discussed earlier, which do not affect the UK born citizens.

Recommendations

The government should provide measures to tackle the socio-economic causes which affect access of the migrants to proper healthcare services and also implement laws for all boroughs in the UK to offer BCG vaccination and lower the cost of TB treatment completion.

Conclusion

This essay has discussed the health priorities of the migrants in the UK, given possible reasons for screening migrants for TB and factors which affect the access of migrants to healthcare services. Looking at the socio-economic factors which affect migrants regarding their access to healthcare in this essay, it has been highlighted that the health of the migrant population is a significant concern for the government. However, some recommendations have been given above for policymakers.

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