Rip off the labels

Those of us who work in the social policy field are used to
attaching labels to groups of people. Working class, unemployed,
poor, socially excluded, vulnerable, disabled people, older people,
ethnic minorities, immigrants, refugees and so on. The fact that
members of these groups differ widely from each other may be
abundantly clear to those who work closely with them, but for
others less directly connected, it is tempting to

Labels, of course, invite stereotyping. They detract from the
individuality of those we herd together for ease of description.
They strip out diversity and tend to obscure the strengths and
abilities of the people concerned. Asylum seekers, whose health
needs are discussed in this issue, are a case in point. They may
arrive with their health seriously impaired. They may have been
traumatised by war and violence, or by torture. But each child,
woman and man adds up to a great deal more than a bundle of needs
and an application for safe haven in the UK. They come from
different countries, cultures and political circumstances. And,
while they should certainly get as much help as possible from
health and social care workers, the key to their eventual good
health may lie in recognising their individuality and their

According to a King’s Fund report in 2000, many asylum seekers
consider themselves in good health -Êhaving arrived in a state
of mind that is more conducive to well-being. Nor are such findings
counter-intuitive, if we think of an asylum seeker as one who has
achieved an extraordinary feat of survival and self-determination.
This suggests resilience and optimism -Êpsychological traits
associated with good mental and physical health. A positive
attitude is surely consistent with the act of crossing continents
for a better life.

What these individuals need more than anything, then, is help to
build and strengthen their survival skills, so that they are better
able to safeguard their own health. Tragically, though, what is
more likely to happen is that asylum seekers, once embraced by the
UK processing system, experience a decline in their health. We
might speculate that anyone, British born or not, given similar
treatment -Êisolation, dispersal, regimentation, dependence,
poverty, squalor, racism, uncertainty and fear -Êwould start
to feel pretty low. If we had to endure these conditions while
coping with the effects of recent physical or psychological
traumas, we’d be lucky not to fall very seriously ill indeed.

What might be done, then, to improve the chances of asylum seekers
minimising risks of illness and enjoying a long and healthy life?
Of course, decent health and social care services matter. But they
must be acutely sensitive to the needs and experience of the
individuals they encounter. That means acknowledging their
individuality, being aware of the diverse cultural, social and
economic circumstances from which they have come, providing
interpreters, and delivering outreach services to contact those who
would not (for a range of reasons) make the first contact.

No less important is to enable asylum seekers to use their own
skills to help prevent illness and promote good health. Most
obviously, many who seek asylum are qualified doctors, nurses and
paramedics. Efforts are under way to bring their qualifications
into line, but there are still far too many health professionals
barred from practising in the UK.

Another strategy is to train individuals as lay health advocates,
to act as bridges between different groups of asylum seekers and
refugees, and the health and social care system. These advocates
are ideally based within the groups and communities they represent.
They can help to identify people whose health is at risk, act as
interpreters or help access translation services, give basic health
advice, act as guides to health and social care, and advise local
managers on how to provide appropriate services. Here, too, there
are promising developments, with a programme based at the
University of East London to train health advocates for ethnic
minorities. There is much to be said for extending this approach
beyond London and specific ethnic groups, to neighbourhoods across
the UK.

Last but not least, asylum seekers -Êlike all of us
-Êneed to be provided with respect, opportunity and the means
to look after themselves and their families. They must to be
recognised as individuals, not as faceless members of a labelled

Anna Coote is director of public health, the King’s

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