Compulsory health screening for tuberculosis and HIV infection in asylum seekers and migrants would cause more problems than it solved, argues a report published in the United Kingdom last week.
The report found that screening of migrants was likely to be ineffective and costly and might have negative consequences. It was written by the Institute for Public Policy Research, an independent think tank on social policy, in response to the UK government's current deliberations on health screening for migrants arriving in the country.
The report acknowledged that the United Kingdom was experiencing increases in tuberculosis and HIV that were associated with immigration, and that these were important public health challenges. However, it found evidence that screening for tuberculosis on entry into a country was largely ineffective and pointed out that HIV screening raised considerable ethical and legal issues. There was also the risk that compulsory screening could cause people who knew they were infected to go underground. "If anything, this would merely increase the risk of infection spreading," the report warned.
Limiting screening to migrants and asylum seekers would miss many other high risk groups, the report argued. For compulsory health screening to be fully effective in diagnosing infection, it would have to be applied to all tourists, visitors, and students coming to Britain and to all British citizens returning from travelling abroad. An alternative would be to introduce pre-entry screening for permanent migrants to Britain in high risk countries.
However, the report's author, Dr Richard Coker, senior lecturer in public health at the London School of Hygiene and Tropical Medicine, London, pointed out: "This is likely to be enormously expensive because of the associated infrastructural and recurring costs because of the large number of countries where such systems would be needed."
The report recommended that a "welcome health check" for all migrants entering the United Kingdom would provide a more effective measure to improve health and reduce infection. It noted: "Immigrants and asylum seekers suffer from a range of health problems, some of which are communicable diseases, but many of which are not. Screening may offer them a means to provide for, and assist access to, health services readily."
The report suggested that the priorities for tuberculosis control should remain prompt diagnosis and treatment of cases, achieved by effective support of current community based services. To meet the public health challenge of HIV associated with immigration, policies should encourage—rather than force—people at risk of infection to be tested. These recommendations were based on a detailed review of information and research on the medical, legal, and ethical issues surrounding screening before and on entry to a country.
Heaven Crawley, associate director at the Institute for Public Policy Research, said: "The public association between infectious diseases and immigration is a powerful one and is at the heart of many wider concerns about the impact of migration on Britain. The government should avoid the temptation of introducing compulsory screening in order to cool the political heat on this issue because the evidence about the positive benefits of such policies is weak."
Migration, Public Health and Compulsory Screening for TB and HIV can be downloaded at http://www.ippr.org