The health of Britain's Polish migrants: a suitable case for history taking and examination

In 2004 eight new countries (the A8) were admitted into the European Union (EU), allowing their citizens full rights of settlement and employment in the UK. Initial estimates by the Labour government were that between 5000 and 13 000 people would migrate to the UK, which proved a gross underestimate. Although exact population data is difficult to obtain precisely because of free movement, it is estimated that at least 2 million have actually done so, around half this number from Poland alone.¹ This migration has had a significant impact on both the UK and the migrants themselves, including their health. Little has been published about health issues affecting the Polish community, which begs the question: what does the piecemeal evidence so far suggest? In short, it is cause for concern.

Polish organisations are reporting high levels of suicide, depression, and poverty amongst migrant workers.² Most worrying are unreleased figures from the Polish embassy indicating that a fifth of the 250 Poles who died in Britain in 2007 took their own lives.² The emerging data has prompted MP Daniel Kawczynski, who is of Polish descent, to call upon the Polish government to improve support services for this population.²

The causes of these health outcomes are necessarily multifactorial and interlinked, although key determinants deserve particular consideration, mainly those relevant to psychological health. Bashir Qureshi has noted, anecdotally, that Eastern Europeans appear to have high rates of depression and somatisation disorder.³ A study from Sweden comparing rates of attempted suicide in immigrants from selected countries showed the risks in Polish men and women to be 42% and 95% higher respectively than in indigenous Swedes.⁴ A likely contributory factor in the Polish community is heavy alcohol intake,⁵ which may be both a cause and consequence of depression. Polish migrants also fare badly where smoking, the major preventable cause of illness, is concerned. A survey of Ireland's Polish population indicated that 61% of men and 47% of women smoke, compared with a 35% prevalence in ‘home’ Poles and 31% of indigenous Irish;⁶ the picture in the UK is likely to be similar.

Given the well-known association between deprivation and ill health,⁷ a significant factor with a negative impact on the health of migrants is relative deprivation. Poles are over-represented in occupations such as catering and construction, where poorly paid, hard physical work is the norm.² Over-crowding in rented accommodation is rife, the migrants accepting relative poverty in the UK in order to try and save money with a view to sending it to families back home.

In addition, difficulties accessing health care have been noted, with high rates of presentation to emergency departments not only with trauma and acute illness, but for minor and chronic illness better suited to primary care.⁸ There has been a paucity of both research and service provision targeted at the healthcare needs of this population; exceptions such as the Barka project demonstrate their potential efficacy.⁵ Based in Hammersmith and Fulham, a London borough with a large established Polish community in addition to more recent migrants, it was a 6-month collaboration between the borough council, a Polish charity, and the Broadway Centre that worked with homeless migrant workers, who invariably had alcohol addiction, to refer them for treatment or to reconnect with their families.

The wider context in which the recent wave of Polish migration to the UK occurred is probably relevant. The UK government had, by not applying any caveats to citizens of A8 countries settling here (in contrast to France and Germany), always been, at least tacitly, in favour of substantial immigration. It also portrayed The UK's economic boom at the time to be rather more substantial than it actually was, making moving here appear a beguiling option. Yet the reality was rather different: a land of milk and honey for bankers, sports stars, and anyone deemed a celebrity, sure enough, but for most the boom was built on the fragile foundations of a credit-fuelled consumer spending spree. The consequences of this flawed approach has been a major factor in the downward trend in the economy, one consequence of which has been that a number of Poles have left the UK. In tandem with this the Polish economy has been expanding healthily.

Short-termism and materialism cannot paper over worrying social trends such as the sharp reduction in social mobility,⁹ a fact particularly noticeable among immigrants. Immigrant success stories from humble beginnings have been a heartening feature of the UK's landscape for generations. Many within the prosperous Jewish community are the descendants of tailors, while many feisty Irishmen who own construction firms started work in the trade as young men armed with no more than a shovel and a fierce work ethic; these are but two examples. For new migrants, however, the playing field appears much narrower, not least because the Holy Grail of corporate profit has spawned an economic structure demanding a flexible, transient, and ultimately disposable workforce,¹⁰ a structure the government is in no hurry to dismantle. Far from it; they have a notable tendency to genuflect to the requirements of big industry, as it has shown in other aspects of public policy such as the ill-conceived extension of licensing hours.¹¹ The welcome afforded to Polish migrants appears to have patronising undertones, not only to the Polish community but also to the UK's sickness benefit claimants, the de facto long-term unemployed for who the government, by inference, seems to harbour no real ambition beyond the predictable, platitudinous rhetoric.

Meanwhile, irrespective of how many individuals return home, based on the sheer scale of recent migration, the Polish community will continue to be a substantial presence in the UK. The emerging data suggests that their healthcare needs may be considerable, and behind mere statistics are human stories suggesting that this is a community much more vulnerable than first imagined. More research into and service provision for health matters of importance to the Polish community is overdue. Better late than never, for on the matter of Polish health so far, few participants have emerged with much distinction.