Migrant Health & Wellbeing in Belfast Leslie Boydell Associate Medical Director, Public Health Belfast Health & Social Care Trust 5 th February 2010, Brussels Leslie Boydell Associate Medical Director, Public Health Belfast Health & Social Care Trust 5 th February 2010, Brussels

Belfast Health and Social Care Trust Purpose: to improve health and wellbeing and reduce health inequalities Business: to deliver safe, modern, cost- effective health and social care 20,000 staff

Population N Ireland:1,775,000 Belfast: 325,000

Migration in N.I. 1970’s / 80’s-Net emigration 1990’s-Balanced migration >2000- Net immigration and population growth >2004- Rapid increase from to NI (04-08) 2/3 from A8 Construction and Manufacturing 2% of population in Belfast

Sources of information on Migration Health card registration Worker Registration Scheme for A8 but not A2 countries Work permits for those outside EU National Insurance number registrations School census for children with English as a second language

Health Card Registrations Increase by 50% between Registrations , ,400 > 50% A8

Main applicants to Workers Registration Scheme Poland7,050 Lithunania3,255 Slovakia2,170 Total 14,395 (04-06) Year to June Year to June

Work Permits04/0508/09 Indian Philippines Ukraine530<20 Roumania Pakistan420<20 China Bulgaria

English as an additional language 08/09 Primary4660-2% population Secondary % population

Births to mothers born outside NI Almost doubled between from189 to 365 In 2008, 9% of all births to mothers born outside NI, from 3% in % from new EU states

Issues Language (Within HSC, requests for interpreting service increased dramatically Mandarin, Cantonese, Polish) Access to information Lack of understanding for the system Isolation Employment (exploitation and unrecognised qualifications) Cultural differences and religious needs

Issues continued Racial prejudice and harassment Hate crime, mainly assaults and criminal damage incidents in S.Belfast 08/09 under reported Housing – overcrowding homelessness child exception

Health Problems Diabetes % Asians, 8.4% Black 5.4% NI Mental health High levels of suicide in Lithuanians Drugs and alcohol Eligible for GP services and emergency care

Poverty Especially child poverty Especially A8 and A2 countries Asylum seekers paid allowance 30% less than benefit level A8 workers very vulnerable to economic downturn If not worked continuously for 12/12 or registered with WRS no access to benefits A2 limited access to labour

Issues continued Poor organisational leadership Need for co-ordination and inter-organisational collaboration Need for professional training and support Inadequate statistics Small numbers from many countries with diverse needs

Study of Health Visitors’ caseload Language – husbands interpreting for wives Mobile families – no history of immunisations High demand on professional time Not registered with GP – go directly to A&E Don’t know how to access services and support Low car ownership Social isolation Work long hours Child protection issues Child health problems Postnatal depression Domestic violence