Introduction: migration as a public health issue
Migration is often discussed through the lenses of borders, economics, welfare state, or policy. But it is also a public health issue. Migrants, including refugees and asylum seekers, face multiple and overlapping health challenges – from trauma, PTSD and other mental health issues to structural and institutional barriers in accessing healthcare and secure housing. While these are well recognized, they do not fully capture the key determinants of the health and wellbeing of migrant populations.
In my research on “Migrant Health and Integration in the UK”, I argue that we need to look beyond traditional social determinants (e.g. poverty, housing, employment) and consider something broader: the emergence of a “hostile ecosystem”. This is not simply confined to the UK’s well-known “hostile environment” policy – a policy approach designed to deliberately make life harder for illegal migrants which has had substantially negative implications on the wider minoritized communities (e.g. the Windrush scandal). The hostile ecosystem that is coined in this study refers to a multi-layered system shaped by anti-migrant political rhetoric, policy decisions, and public attitudes, operating at transnational, national, and local levels – and profoundly shaping the health, wellbeing, and integration processes of migrants.
Introduction: migration as a public health issue
Migrants’ health is usually framed in relation to pre-migration conditions in the origin country, journey-related risk factors, and conditions in the settled country. The latter, again, is often framed in terms of vulnerability: limited access to services, re-traumatization, and poor living and/or working conditions. There is no doubt that all these factors can be key determinants of health and wellbeing. Many migrants experience significant stress during their journey, unsafe or overcrowded accommodation, and prolonged waiting times in the immigration processes. Mental health conditions such as stress, anxiety, depression, and PTSD are common, often compounded by uncertainty and separation from family. There is, however, another key determinant of migrant health and integration, namely far-right anti-migrant politics that manifest itself through hostile language, policies, and attitudes. This is arguably one of the most consequential determinants of migrant health and integration in the contemporary UK, Europe and beyond.
To capture this political determinant, I propose the framework of “transnational hostile ecosystem”.
The rise of anti-migrant politics and policy
In recent decades, we have seen the global rise of anti-migrant and far-right politics, from the US to Europe and beyond. Across countries, migrants are increasingly framed through an “us vs them” narrative – often as “threats” to security, culture, identity or “burdens” on the economy, welfare state, or the society. Crucially, these once marginal narratives are no longer confined to fringe groups or political parties. Instead, these anti-migrant, xenophobic narratives have become mainstream across liberal democracies such as the UK not just shaping public opinion and attitudes but also influencing policy landscape. We now have ever more restrictive and hostile immigration regimes underpinned by hostile legislations (e.g. 2014 Immigration Act) and policies (e.g. the hostile environment policy).
The UK’s hostile environment policy, introduced in 2012 by Theresa May, extended immigration control into daily lives of not just immigrants but also the wider society. This policy involves immigration status checking in order to access housing, employment, banking, and even healthcare. That is, employers, landlords/landladies, banks, etc. are legally required to check people’s immigration status, monitoring whether they have “right to rent”, “right to work”, and so forth. Policies such as “No Recourse for Public Funds”, prolonged asylum decision-making, and restrictive accommodation arrangements have created structural insecurity, leaving many migrants in situations of substantial financial precarity, legal uncertainties, and dependency. Importantly, such policies are not simply experienced as bureaucratic changes, but lived as chronic stressors – as frequently stressed by the participants of this research.
Everyday experiences and their impact on health
These hostile discourses and policies have also shaped everyday life of migrants, including their interactions with the wider society in public spaces – on buses, in neighbourhood parks, in GP reception areas and so on. Migrants report experiences of racism, microaggressions, hate crimes, or being treated with suspicion. Many have reported that they have been told to “go back to your country” by a member of public on a bus or in other public spaces. Thus, some have said that they avoid public spaces due to fear. This results in less engagement with the wider society, which hinders the process of integration.
While some may see these experiences as trivial, they are most certainly consequential for health, wellbeing, and integration of migrants. They accumulate, generating chronic stress, anxiety, and social withdrawal.
Towards a more welcoming ecosystem
If a hostile ecosystem can harm health, the reverse can also be true: a welcoming ecosystem can improve it.
We need to recognize that political choices shape health outcomes, which means that addressing migrant health inequalities requires more than service-level interventions. It requires challenging the narratives, policies, and attitudes that produce hostility in the first place.
Our language, policies, and attitudes towards migrants should be welcoming, inclusive, and anti-racist, not stereotyping, marginalizing, scapegoating, not to mention dehumanizing. Reframing migrant health through the lens of a hostile ecosystem allows us to see the wider political determinants of health and wellbeing – and importantly, to imagine alternatives. We can create more welcoming and inclusive systems, structures, institutions, and communities.
A different ecosystem is possible.