“I ask God for medicines and my doctors deliver them to me”: How do older Pakistanis living in London experience multi-morbidity?

Problem

Multi-morbidity, or the co-existence of two or more medical conditions, is an escalating epidemic on a global scale. Living with multiple illnesses increases risk of mortality and decreases quality of life. The effects of multi-morbidity are exacerbated in vulnerable groups, such as those living in poverty, the elderly, ethnic minorities and migrants; where intersectional risk factors compound and result in poor outcomes that are blamed largely on those who are already disadvantaged. London is an increasingly super-diverse city with a South-Asian population, including those of Pakistani origin, who are known to have higher levels of multi-morbidity and an earlier onset of chronic illness than the native population. Urdu is the UK’s third most commonly spoken immigrant language and Urdu-speaking Pakistani patients form a significant ethnic group in London. Existing research on this population has historically focused on health literacy and ‘compliance’ through a biomedical lens. Little is known about how Pakistani patients experience chronic illness in its broad sense, within the context of their life histories and the migrant experience and the relationships that facilitate and maintain their patient-hood.

Approach

We interviewed 15 first-generation Pakistani migrant patients living with >2 chronic illnesses and on >10 regular medications ,aged between 53 and 87, recruited from 7 GP practices in East London. Patients completed an in-depth interview with a bilingual researcher in Urdu at home, lasting on average 1 hour and 12 minutes. The interviews were designed to induce a narrative of patient’s experience of health in the context of their life story, and were subsequently translated into English and transcribed.

Findings

Through analysis we identified the central relational triad of family, faith and health to how these patients make sense of and manage their experiences of chronic illness. Stressful events within the family were identified as precipitants for ill health; whilst care provided by family was a crucial source of support in withstanding the ‘burden of treatment’. Health, good or bad, was seen as God’s will and to be accepted stoically. Narratives of being a ‘good patient’ were linked to gratitude to the UK healthcare system, in direct contrast to personal experiences in Pakistan where access had been restricted due to cost or availability of quality care.

Consequences

As the UK becomes progressively globalised, healthcare practitioners, providers and policy-makers need to better understand the impact of culture on health behaviours. This research could indicate that for older Pakistani patients operating within a collectivist culture with a wide web of concern, neo-liberally rooted public health agendas that focus on individualised responsibility and self-management strategies maybe limited in success. More authentic conversations about the effects of culture on responses to and experiences of chronic illness are needed.