Health inequalities and the migrant population in Northern Ireland: Exploring the evidence
Written by 13 December 2019
ADR Northern Ireland recently held the second event in its policy and research symposium series, this time focusing on migrants and health inequalities. ADRC Northern Ireland’s Elizabeth Nelson reflects on the topics covered on the day, and why meaningful engagement with stakeholders is so important to the Centre’s work.
Delivered in partnership with Stronger Together, a network for racial equality in Northern Ireland, our most recent policy forum, held in October 2019, brought together academic researchers, policymakers, service providers and community organisations to share best practice and evidence in the fields of health and racial inequality. There were presenters, panellists and participants from Kings College London, Cairde, Equality Commission Northern Ireland, Belfast City Council, Health and Social Care NI, the Public Health Agency, the Northern Ireland Council for Racial Equality, and the British Red Cross.
Getting ‘under the skin’ of data
ADRC NI’s approach centres engagement work with key stakeholders, understanding that not all knowledge is academic or generated within a university setting. While there is a necessary focus on excellence in independent academic research relevant to policymakers and government and the potential this has to impact on policy and service delivery, there is a need to get under the skin of data to understand the societal issues that it illustrates. ADRC NI does this by building engagement into our research from the beginning, weaving alternative viewpoints into the research design so the questions that emerge are dynamic and responsive to communities, policymakers, government and service delivery.
This is why we deliver our knowledge exchange events in partnership with NGOs. In this case, Stronger Together presented the work of its 1:1 project, which works directly with migrant and ethnic minority communities on mental health and accessibility. Their experiences bring to life academic findings, such as those of Dr Kishan Patel from the Centre for Public Health at Queen’s University Belfast, whose record linkage study compared the likelihood of people with poor mental health receiving psychotropic medication between migrant and settled communities and amongst different migrant groups in Northern Ireland. The work found that migrant populations are particularly at risk of not receiving the care for mental ill-health that they require for a range of reasons, including perceptual differences and multiple barriers to health service access.
Emilia Marchelewska, Health Advocacy Officer at Cairde, emphasised the need for inclusive services and policies and culturally appropriate approaches to mental health for minority ethnic communities. This is the focus of Cairde’s work in the Republic of Ireland.
The experiences of the 1:1 project workers and of Cairde echoed issues examined by Dr Jayati Das-Munshi, a former ADRN (Administrative Data Research Network) researcher visiting from King’s College London. Dr Das-Munshi discussed her research investigating physical healthcare inequalities for migrants and ethnic minorities suffering from severe mental ill health in London. According to her work, people with severe mental illnesses such as schizophrenia die 15 to 20 years earlier than the general population, mostly from preventable physical causes. This inequality has been recognised across international contexts, with little sign of a reduction.
The intersection of physical health inequalities with severe mental illnesses and in particular ethnicities remains unclear, however there is a major gap in research given concerns that UK ethnic minority groups may experience inequalities in mental health and psychiatric care. Dr Das-Munshi discussed work assessing minority ethnic physical health inequalities in people with severe mental illnesses, which uses information from more than 1.2 million electronic health records from UK primary and secondary healthcare and is further informed by embedded qualitative studies with service users.
The work of the Public Health Agency (PHA) in Northern Ireland is also crucial in the landscape of access to healthcare for migrants and minority ethnic communities. The PHA is a key funder of Stronger Together, whose work, similar to that of Cairde, focuses on culturally appropriate and responsive support particularly in the field of mental health. Besides providing training for health and social care workers and championing intersectoral partnerships to tackle health inequalities, the PHA, in partnership with the Belfast Health and Social Care Trust, coordinates the Northern Ireland New Entrant Service (NINES) to support migrant access to mainstream health and social care.
Engaging directly with stakeholders and folding their expertise into data-driven research not only adds value to research but creates clear pathways to impact. As the valuable insights gained from data-driven research are made clear, these experts, who have been given a genuine seat at the table, become advocates for our approach. They help not only to stabilise public opinion around data usage, but to demonstrate to government the viability of such research and engagement in developing better policy and better services, that truly support marginalised communities.