PCC Eastern European Economic Migrants JSNA and CCC Migrant Populations JSNA Stakeholder Scoping Workshop - 14 October 2015

1. Meeting health needs –
are migrant populations
disproportionately affected by
infectious diseases?
Lynsey Emmett, Epidemiological Scientist
14th October 2015

2. 2 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Background
• Valuable contribution of migrant populations
• Number of people migrating to the UK has been greater
than the number emigrating since 1994 (by more than
100,000 since 1998)
• East of England scoping exercise in 2008
• integration dependent upon equitable access to health
care and positive health outcomes alongside employment,
education and housing
• Unmet health needs
• Reports – increased burden of infection in some UK born
populations

3. 3 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
What is a migrant?
Complex – effect on data and analyses
Person who changes their usual country of residence
- Country of birth different to country of residence
- Nationality is different to country of residence
- Changes country of residence for a period of at least a year
Strengths and weaknesses

4. Understanding migration statistics
4
ONS International
Passenger
Survey
ONS UK
Census
DWP Migrant
Workers Scan
ONS GP
registrations
Home Office Asylum
seekers, worker
registration scheme
Gangmaster
registrations
ONS Annual
Population
Survey
ONS Labour
Force
Survey
DWP
National
Insurance
Number
registrations

5. 5 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Understanding migration statistics
Key points
• Before 1964
No systematic attempt to measure extent of
international migration (census data – diff
births/deaths)
• 1964 to 1990
International Passenger Survey (IPS)
• 1991 onwards
Long term international migration series
IPS + other data sources

6. 6 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Migration in the UK 1991-2014
• ONS long term
international
migration
• Changes
residence for at
least a year
• Net migration:
• 1991-5 –
av. 37,000
• 2010-14 –
av. 234,000
Source: House of Commons, Migration Statistics Briefing Paper

7. 7 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Migration in the UK 1964-2014
Source: House of Commons, Migration Statistics Briefing Paper

8. 8 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
From where do people
migrate to the UK?
2013 –
• 14% British
nationals
• 38%
nationals of
other EU
• 47%
nationals of
non-EU
countries
Nationality, country of birth, country of last residence
Source: House of Commons, Migration Statistics Briefing Paper

9. 9 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Why do people migrate to the UK?
WORK
STUDY
Source: House of Commons, Migration Statistics Briefing Paper

10. 10 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Migration in the East of England
• Region with 4th highest proportion of population born abroad
(11%, 37% in London)
• 101% increased between 1995 (308,707) to 2013 (621,145)
• Luton highest number (62,872) as well as highest population
share (31%) of non-UK born residents in the region
• Residents born in Poland represent the most numerous non-
UK born group in the East of England (62,100) followed by
residents born in India, Ireland, United States and Pakistan
• Cambridge had the highest number (3187) and proportion
(21%) of short term residents
Source: Migration Observatory, Oxford

11. 11 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Migration in the East of England
Source: Migration Observatory, Oxford
• 48% male,
52% female
• 43% aged
20-39 years
• Most
common
25-29 years
and 30-34
years

12. 12 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Migration in the East of England
Fenland – 211%
(2641 to 8209)
Peterborough – 148%
(15,268 to 37,892)
Source: Migration Observatory, Oxford

13. Health needs of migrant populations
13

14. 14 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Health needs
TB
 73% of cases were born abroad
 Majority born in South Asian (57%), sub-Saharan Africa
(27%)
 77% of non-UK born cases in 2010 were diagnosed two or
more years after arrival in the UK
 Higher proportion of non-UK born cases present with extra-
pulmonary cases (54% to 31%)
 Highest rates of TB in the UK are in ethnic minority groups

15. 15 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Health needs
HIV
 65% new HIV diagnoses between 2001 and 2010 were
among those born abroad
 Majority from Africa (87%)
 80% acquired their infection heterosexually
 22-30% of MSM diagnosed 2001-2010 were born abroad
(majority Europe excluding UK)
 Heterosexuals who were born outside of the UK were more
likely to be diagnosed late than those born in the UK (63%
vs. 50%)

16. Project aims
16
- Background information on migration trends
in and characteristics within the region
1. To map the migrant population within the EoE and
how this has changed over time
2. To describe the characteristics of the migrant
population within the EoE

17. Project aims
17
3. To estimate the burden of infection (HIV, TB,
STI(?)) within the migration population within the
East of England
4. To undertake a comparison of the burden of
infectious diseases in the migrant population versus
UK born residents
- Provide a resource on burden of infectious diseases in
migrant populations in the East of England

18. What is the rate ofTB in migrants in the East of England?
18 Migrant health - TB
Average rate of TB
in Migrants = 53.3
per 100,000
Average rate of TB
in Anglia and
Essex: 6.7 per
100,000
Average rate of TB
in South Midlands
and
Hertfordshire:13.0
per 100,000
England rate of TB
:14.1 per 100,000

19. Age and gender of migrants withTB in the East of
England in 2013
19 Migrant health - TB
120 70 20 30 80
0-19
20-39
40-59
60-79
80-99
Count
Agegroup
Female Male

20. Country of birth of migrants withTB in the East
of England
20 Migrant health - TB
0%
10%
20%
30%
40%
50%
60%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentageofnon-UKbornpeople
(%)
Year
Pakistan,
Bangladesh and
India
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentageofnon-UKbornpeople
(%)
Year
North-Eastern
European countries
Estonia, Latvia and
Lithuania joined the
EU in 2004

21. HIV and STIs
21
0
50
100
150
200
250
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
NumberofnewHIVdiagnoses
UK
Africa
All other countries
New HIV diagnoses by world region of birth

22. HIV and STIs
22
Gonorrhoea diagnoses by world region of birth
0
20
40
60
80
100
120
140
2010 2011 2012 2013 2014
Europe (excluding UK)
Caribbean
Sub-saharan Africa
other world region
Unknown

23. 23 Meeting health needs – are migrant populations disproportionately affected by infectious diseases?
Thank you….