Experiences of refugees and asylum seekers from Sub Saharan Africa in Glasgow: keeping healthy and engaging with primary health care
Glasgow’s population is growing in ethnic diversity, driven in part by increasing numbers of migrants, refugees and asylum seekers. This presents new challenges for the primary health care system, which must effectively meet the needs of individuals from diverse backgrounds with a wide range of needs and potential vulnerabilities. Although an extremely heterogeneous population, for individuals from Sub Saharan African (the focus of this study), these vulnerabilities might include challenges related to migratory experiences, a higher likelihood of living in poverty compared to white Scottish populations and an increased risk of diabetes and cardiovascular diseases. It is crucial to explore the ways in which individual, social, cultural and structural issues intersect to influence these individuals’ experiences of and engagement with primary health care.
Focused ethnography involving refugees and migrants from Sub-Saharan Africa living in Glasgow, to explore perspectives on preventive health and primary healthcare access. A range of methods informed by ethnographic and participatory approaches were utilised including engagement with community groups, mind mapping, go along interviews, and formal interviews. Thematic analysis was conducted in conjunction with the theoretical framework of ‘candidacy’ (Dixon Woods et al 2006), which explores healthcare access for vulnerable groups, and theoretical perspectives from critical medical anthropology.
Participants were broadly positive about accessing primary care in Glasgow. They emphasised maintaining good health through diet, exercise, keeping clean and establishing good social connections. However, many felt unable to lead healthy lives or engage in healthy ‘behaviours’ due to wider structural factors associated with the UK asylum system including poverty, insecurity and lack of a sense of safety. For many this remained the case even once their refugee status had been confirmed.
The experience of seeking asylum in the UK has a deleterious and long-lasting effect on individuals’ capacity to engage in primary care and preventive health services. In order to create fully inclusive healthcare services, efforts to promote health and improve care access must take into account all potential sites of vulnerability to ill health. This is highly relevant in the context of the current refugee crisis as primary care seeks to meet the needs of individuals from increasingly diverse backgrounds in extremely precarious situations.