1. 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

2. 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

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

4. Migration in N.I. 1970’s / 80’s-Net emigration 1990’s-Balanced migration >2000- Net immigration and population growth >2004- Rapid increase from A8 @65,000 to NI (04-08) 2/3 from A8 Construction and Manufacturing 2% of population in Belfast

5. 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

6. Health Card Registrations Increase by 50% between 2005-2007 Registrations 07 - 19,400 08 - 15,400 > 50% A8

7. Main applicants to Workers Registration Scheme 04-06 Poland7,050 Lithunania3,255 Slovakia2,170 Total 14,395 (04-06) Year to June 079100 Year to June 087800

8. Work Permits04/0508/09 Indian760315 Philippines685 85 Ukraine530<20 Roumania265 20 Pakistan420<20 China255130 Bulgaria115 290

9. English as an additional language 08/09 Primary4660-2% population Secondary2142 -1% population

10. Births to mothers born outside NI Almost doubled between 2001-2006 from189 to 365 In 2008, 9% of all births to mothers born outside NI, from 3% in 2001 50% from new EU states

11. Issues Language (Within HSC, requests for interpreting service increased dramatically 2004-2007 - Mandarin, Cantonese, Polish) Access to information Lack of understanding for the system Isolation Employment (exploitation and unrecognised qualifications) Cultural differences and religious needs

12. Issues continued Racial prejudice and harassment Hate crime, mainly assaults and criminal damage - 315 incidents in S.Belfast 08/09 under reported Housing – overcrowding homelessness child exception

13. Health Problems Diabetes - 12.4% 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

14. 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

15. 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

16. 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