- Gender Reassignment
- Marriage & Civil Partnership
- Pregnancy & Maternity
- Race & Ethnicity
- Religion and Belief
- Sex & Gender
- Sexual Orientation
For some groups of people, a combination of factors such as discrimination, prejudice, stigma and life circumstances, steadily increase their risk of poor health.
Some of these people are protected by equality laws. Many of them use health services where their additional needs can be met through Inequalities Sensitive Practice.
Asylum Seekers and Refugees
An Asylum Seeker is a person who has submitted an application for protection under the Geneva Convention and is waiting for the claim to be decided by the Home Office.
A refugee is someone who has had their asylum claim accepted.
While it is relatively easy to account for the number of people seeking asylum living in Glasgow, it is more challenging to establish the number of refugees. There are no reliable figures available on the number of refugees in the UK, Scotland or Glasgow.
Issues for Asylum Seekers and Refugees
Many of those arriving in Scotland are families with children who are fleeing violence and persecution in their own country. They are coming here because they are vulnerable. We are well-equipped to help. A support structure is already in place for all nationalities seeking asylum. Central government meets the reasonable costs of looking after asylum seekers, so local services will not suffer.
Recent research in Glasgow showed that key issues for people from minority ethnic communities include:
- safety – racism, hate crime and relationships with the police;
- social opportunities – culturally appropriate sport and leisure services;
- health – awareness of services, issues around isolation, lack of culturally sensitive services;
- employment – high priority issue, some variations in employment levels across ethnic groups;
- learning – English language classes and culturally sensitive learning opportunities; and
- other priority areas – suitable housing.
- Health Rights and Entitlements of Asylum Seekers & Refugees in Scotland
- Tell It Like It Is – busting the myths about Asylum Seekers and Refugees
- Asylum Seekers and Refugees Useful Web Addresses
- Equality Act 2010 – a Briefing for Refugee and Migrant Community Organisations
- Glasgow Asylum Destitution Action Network – help and support for destitute asylum seekers in the Glasgow area
Useful Weblinks for Asylum Seekers and Refugees
Amnesty International – Working to protect Human Rights Worldwide
Asylum Aid – Asylum Aid is a charity which provides free legal advice and representation to refugees and
asylum-seekers seeking safety in the UK from persecution. We also campaign for the fair
treatment of refugees in the UK
Asylum rights – Asylum Rights in the 21st Century – a critical resource
Asylum statistics – The Research Development and Statistics Directorate (RDS) is an integral part of the Home
Office. The RDS statistics on immigration, asylum and nationality cover asylum applications and
decisions and appeals, and numbers of asylum seekers supported, detained and removed.
Asylum support – focuses on all matters that concern people seeking asylum, together with a
directory of hundreds of online resources relating to: asylum and refugees, conflict, country
data, court cases. deportation, detention, discrimination, funding, gender, government, human
rights, human trafficking, law, media, migration, policy and studies
Publications available online include:
- Asylum seekers: meeting their healthcare needs British Medical Association Board of Science and Education October 2002
- Access to health care for asylum seekers January 2001
- Asylum seekers – health in the UK October 2002
- Asylum seekers & health : a BMA & Medical Foundation for the Care of the Victims of Torture
- Statistics from BMA /Refugee Council refugee doctor database April 2003
Centre for Research in Ethnic Relations Database (UK) – The database includes resources relating to ethnic relations including citations of pamphlets, reports and journal articles. Many of the records are concerned with health issues.
Caring for Dispersed Asylum Seekers – A Resource Pack
Urgent update: unaccompanied asylum seeking children: special grant
1999/2000 (DH Publications)
90 Meeting the health needs of refugee and asylum seekers in the UK an information
and resource pack for health workers (DH Publications)
89 Nationality, Immigration and Asylum Act 2002 (DH Publications)
84 Interdepartmental Working Group on Tuberculosis guidance on tuberculosis control
Department of Health (DH Publications)
75 NEARLY A FIFTH OF GPS IN PMS (Press releases)
74 Adult asylum seekers accommodation special grant (ASAG) report no 30 LAC
(98)5 (DH Circulars)
72 Asylum Seekers Accommodation Special Grant (ASAG) Report No 24 LAC
(97)6 (DH Circulars)
Allocation of DDRB ú60 million to GPs Seniority payments and deprivation payments
allowance for practices providing a quality service Model local development schemes
HSC 1999/107 (DH Circulars)
71 Asylum seekers accommodation grant amendment to audit certificate LASSL
(99)19 (DH Circulars)
61 Guidance on accommodating children in need and their families
Diversity Rx – promotes language and cultural competence to improve the quality of health care
for minority, immigrant, and ethnically diverse communities
Ethnic Minorities Law Centre, Glasgow – The Ethnic Minorities Law Centre is a recognised Scottish charity and has been operating since 1991 as a non-profit making company limited by guarantee providing ethnic minority
communities with access to professional services to address unmet legal needs.
e-library – The NHS Scotland e-Library is a direct response by NHS Education for Scotland to provide equitable access to information and learning resources to all NHS staff regardless of geographic location, staff category or discipline.
European Council on refugees – ECRE is an umbrella organisation of 74 refugee-assisting agencies in 31 countries working towards fair and humane policies for the treatment of asylum seekers and refugees.
Forced Migration on line – Forced Migration Online (FMO) provides instant access to a wide variety of online resources
dealing with the situation of forced migrants worldwide. Designed for use by practitioners, policy makers, researchers, students or anyone interested in the field, FMO aims to give comprehensive information in an impartial environment and to promote increased awareness of human displacement issues to an international community of users.
HARPWEB – A directory of information and resources concerning health needs of asylum seekers and
HARP’s Mental Health and Well Being Web Resource. – This website has been designed to help health professionals in assisting asylum seekers and refugees with mental health issues.
Health Education Board for Scotland – On 1 April 2003, the Health Education Board for Scotland (HEBS) and the Public Health Institute of Scotland (PHIS) merged to become NHS Health Scotland.
The Health Education Board for Scotland is Scotland’s national agency for health education,
health promotion, health advice and health information
HIV/AIDS Carers and Family Support Group – HIV/AIDS Carers and Family support group provide support and services to carers, families, partners and friends who have a loved one with HIV or AIDS.
IND latest Information – Up to the minute news and views on immigration and nationality in the UK.
Irish Centre for Migration – This site provides background facts and figures, documentation, comparative reports and links.
MEDACT – The members of the network aim to share information and best practice amongst those working
to facilitate improving the health of refugees
Medical Foundation for AIDS and Sexual Health – This site tells you about work with health professionals and policy-makers. It also gives information about current policy and practice, and provides links to a wide range of other useful
sources of information.
Medical Foundation for the Victims of Torture – Founded in 1985 the Medical Foundation for the Victims of Torture provides care and rehabilitation to survivors of torture and other forms of organised violence,
Multikulti – The Multikulti website aims to support citizenship through the delivery of culturally
appropriate accurately translated information on health and welfare areas.
Positive Action in Housing – This web site provides information on the purpose of the body, its recent activities and
campaigns. The site also offers access to recent news stories, articles and speeches arranged
thematically. Topics covered include: race and housing in Scotland, racial discrimination and
harassment of refugees, new housing legislation and Scottish housing policy.
Positively women – Positively Women aims to: empower women living with HIV to make informed choices and to
ensure that the voice of HIV positive women is heard
The RAM Project Refugees – asylum seekers and mass media – promoting best practice in media representation of refugee and asylum issues
Refugee action – Refugee Action is an independent national charity that enables refugees to build new lives in
the UK. We provide practical advice and assistance for newly arrived asylum seekers and longterm commitment to their settlement through community development work.
Refugee Action Report – Is it safe here?
Refugeenet – Refugeenet is the website of the EU Networks on Reception, Integration and Voluntary
Repatriation of Refugees and is a source of information and ideas related to the Integration ofRefugees in Europe.
The Refugee Survival Trust – This web site provides access to basic information on the aims of the organisation and its current work.
It includes links to recent government reports relating to refugees and asylum seekers
Joseph Roundtree – The Joseph Rowntree Foundation is one of the largest social policy research and development
charities in the UK. It spends about £7 million a year on a research and development
programme that seeks to better understand the causes of social difficulties and explore ways
of better overcoming them.
The Refugee Council (UK) – The Refugee Council is a registered charity giving help and support to refugees arriving and
living in Britain. This site gives details of the council’s work, their interpretation of press coverage of the refugee situation in Britain and accounts from refugees themselves about their experiences. Also offers training courses across the UK for people working with refugees and asylum seekers.
Refugee Health in London – This excellent report gives an overview of many of the health issues for asylum seekers
Scottish Asylum Seekers Consortium – The Scottish Asylum Seekers Consortium was set up in December 1999 to manage and monitor the commissioning and provision of accommodation and other services for asylum seekers.
It has the long-term objective of developing sustainable settlement arrangements for those who will remain in Scotland.
Scottish Executive – The Scottish Executive Health Department (SEHD) is responsible for health policy and the
administration of the National Health Service in Scotland
Scottish Refugee Council – The Scottish Refugee Council is a Scottish Charity providing advice, information and assistance to asylum seekers and refugees in Scotland.
Scottish Refugee Integration Forum Action Plan – Copy available on line
Scottish Refugee Integration Forum: Action Plan – Progress Report Aug 2003
Six month progress report on implementation of SRIF Action Plan.
The Transcultural Nursing and Healthcare Association
The Foundation of Nursing Studies – (FoNS) is an independent charity that works in partnership
with nurses, midwives and health visitors to develop, promote and improve patient care.
UNHCR -The Office of the United Nations High Commissioner for Refugees was established on
December 14, 1950 by the United Nations General Assembly. The agency is mandated to lead
and co-ordinate international action to protect refugees and resolve refugee problems
worldwide. Its primary purpose is to safeguard the rights and well-being of refugees. It strives
to ensure that everyone can exercise the right to seek asylum and find safe refuge in another
State, with the option to return home voluntarily, integrate locally or to resettle in a third
Data from a range of support organisations indicate that many ex-service personnel can be vulnerable to a range of health and social inequalities, for example homelessness or mental health problems such as depression and stress. They can have difficulty finding employment, claiming benefits and with social isolation.
Health Concerns regarding ex-service personnel
Research has found that depression is a more common mental health condition than post-traumatic stress disorder in UK ex-service personnel. Only about half of those who have a diagnosis are seeking help currently, mainly from their GP. Only a small number of individuals seek help from specialists.
A considerable number of people leaving the forces or finishing a posting find it difficult reintegrating into their communities and to civilian life in general. In Glasgow, research showed that armed forces veterans made up more than 1 in 10 of the homeless population in the city.
A number of national organisations provide a range of information, advice and practical support including the Ministry of Defence, Soldiers, Sailors, Airmen and Families Association and Veterans Scotland. Local councils will provide housing support and advice.
And a wide number of national and local charities also offer specialist support
How many Scottish Gypsy Travellers are there?
Organisations that work with Gypsy/Travellers believe Scotland’s community comprises 15,000 to 20,000 people. Numbers are uncertain because people are reluctant to self-identify as a Gypsy for fear of prejudice or official interference.
Who are Gypsy Travellers?
Gypsy Travellers refers to all travelling communities who regard ‘travelling’ as an important aspect of their ethnic/cultural identity. They come from Scotland, other parts of the UK and other parts of Europe. Other groups of travellers include new travellers (previously new age travellers) or occupational travellers (show or fairground). Gypsy Travellers are the only one of these groups to be protected by equalities legislation.
Discrimination and Prejuduce
Gypsy Travellers experience discrimination in health, housing, education, work and from settled communities. This is due to negative stereotypes and prejudice towards Gypsy Travellers. Many Gypsy Travellers face harassment and verbal and physical hostility from local communities.
The following points highlight a few key areas of concern from among the severe, wide-ranging inequalities and problems faced.
- Gypsies and Travellers die earlier than the rest of the population.
- They experience worse health, yet are less likely to receive effective, continuous healthcare.
- Children’s educational achievements are worse, and declining still further (contrary to the national trend).
- Participation in secondary education is extremely low: discrimination and abusive behaviour on the part of school staff and other students are frequently cited as reasons for children and young people leaving education at an early age.
- There is a lack of access to pre-school, out-of-school and leisure services for children and young people.
- There is substantial negative psychological impact on children who experience repeated brutal evictions, family tensions associated with insecure lifestyles, and an unending stream of extreme hostility from the wider population.
- Employment rates are low, and poverty high.
- There is an increasing problem of substance abuse among unemployed and disaffected young people.
- There are high suicide rates among the communities.
- Within the criminal justice system there is a process of accelerated criminalisation at a young age, leading rapidly to custody.
- Policy initiatives and political systems that are designed to promote inclusion and equality frequently exclude Gypsies and Travellers.
- There is a lack of access to culturally appropriate support services for people in the most vulnerable situations, such as women experiencing domestic violence.
- Gypsies’ and Travellers’ culture and identity receive little or no recognition, with consequent and considerable damage to their self-esteem.
- The lack of systematic ethnic monitoring of Gypsies and Travellers who use public services
Although little Scottish specific data exists on the health of Gypsy Travellers, wider UK studies consistently show that Gypsy Travellers have significantly poorer health even when compared to other economically disadvantaged UK residents from minority populations.
Why do people become homeless?
The reasons why people become homeless can be varied and complicated, however some of the most common factors might be-
- A person losing their job and the resulting financial and personal health problems
- Relationship problems
- Harassment by neighbours
- A disaster such as fire or flooding
Some groups of people are more likely to become homeless because they have fewer rights, have particular needs or are less able to cope by themselves. These include:
- young people
- old people
- people with children
- people with physical or mental health problems
- people on benefits or low incomes
- people leaving care
- ex-armed forces personnel
- asylum seekers and refugees
How many Scottish homeless people are there?
The Scottish Government has published the latest round of homelessness statistics covering 1st April 2020 to 31st March 2021, available here: Homelessness in Scotland: 2020 to 2021 The figures show that Glasgow City remains the local authority with the most households assessed as homeless, and West Dunbartonshire had the highest rate of households assessed as homeless and East Dunbartonshire the lowest.
Health and Homelessness
Poor health is not only a consequence of homelessness but can also contribute to someone becoming homeless. More generally there is a greater risk of ill health and of premature death amongst the homeless population than amongst the population at large. There are a wide range of health problems which are more common amongst homeless people. These include persistent conditions as well as anxiety, stress, self-harm, other mental health problems and infectious diseases.
Homelessness and other forms of inequality
As well as being associated with homelessness, certain forms of inequality such as poverty and unemployment, gender based violence, disability, mental health and addictions can also be the main cause of a person becoming homeless. Homeless people can feel that there is a stigma attached to being homeless. This perception of social stigma is something that is common to a number of marginalised groups.
People Involved in Prostitution
What is prostitution?
Prostitution is the act of sexual activity in exchange for some form of payment such as: money, drink, drugs, consumer goods or a bed or roof over the person’s head for a night. This may take place in a variety of settings including private accommodation, brothels or on the street. NHS Greater Glasgow & Clyde considers prostitution to be a form of commercial sexual exploitation which is created by demand and is harmful to the person involved.
The Scottish Government, CoSLA and key partners including NHS Scotland are committed to preventing and eradicating all forms of violence against women and girls, as detailed in the Equally Safe strategy. Prostitution in Scotland is predominantly caused by men’s demand to purchase sex from women. In Scotland, prostitution is also caused by men’s demand to purchase sex from men. Men’s privilege to purchase sex is a form of structural inequality, which primarily takes advantage of gender inequality, and is further compounded by various life circumstances and vulnerabilities including poverty, homelessness and experience of other forms of gender-based violence.
Health Impact of Prostitution
The physical, emotional and psychological consequences of prostitution can be profound and include rape and sexual assault, addiction, anxiety and depression, post-traumatic stress disorder, self harm and suicide.
Poor health consequences also impact on vulnerable young people, the families of the individuals involved, on the men who purchase sex, their partners and on the social health of the wider community.
Many individuals involved in prostitution have reported experiences of emotional abuse, physical violence, sexual abuse and rape and sexual assault perpetrated by men purchasing sex. The core harm of being involved in prostitution is the psychological trauma of having to repeatedly submit to unwanted sex. Given this, the health consequences of involvement in prostitution are significant and enduring.
Women and men involved in prostitution are denied positive experiences of sexual health as defined by the World Health Organisation, namely:
“The possibility of having pleasurable and safe sex experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”
Prostitution and other marginalised groups and protected characteristics
Many individuals are criminalized as a result of their involvement in prostitution and this makes it more difficult for them to exit prostitution and to access the labour market. There is also a correlation with other marginalised groups such as prisoners and ex- offenders.
What NHSGGC is doing to respond to prostitution
NHS Greater Glasgow & Clyde recognises that prostitution is a significant health and social concern which can affect individuals and communities across Scotland. As with other health concerns the NHS has a lead role to play in tackling the causes and impact of prostitution.
Many people affected by prostitution are reluctant to come forward to agencies, often through fear or shame, but do present across the whole range of primary and acute health settings. Consequently, health workers are in a unique position to provide help and support.
NHS Greater Glasgow and Clyde provide a range of activities aimed at identifying individuals involved in prostitution in order to assess and address their health needs. These actions include sensitively enquiring of service users about any current or previous involvement in prostitution as part of core practice within key services, and ensuring care pathways adapt care and treatment to take any disclosures into account.
We also provide specific services for women and men involved in prostitution via the G3 Priority Clinic provided by Sandyford Sexual Health Services G3
To eradicate the harm caused by prostitution, the circumstances which allow prostitution to exist must be challenged and we work with partner agencies to challenge male demand for prostitution through involvement in White Ribbon Scotland and local multi-agency partnerships on violence against women.
- Equally Safe – Scotland’s strategy to eradicate violence against women
- Equally Safe – challenging men’s demand for prostitution: consultation analysis
- Scottish Social Attitudes Survey 2019 – violence against women key findings
- Range of resources from the Women’s Support Project
- See Publications/Gender-Based Violence
People with Literacy Issues
Adult literacy issues have a direct impact on access to health information and to the quality of patient experiences of using NHS and other healthcare services.
Literacy is defined in Scotland as:
“the ability to read and write and use numeracy, to handle information, to express ideas and opinions, to make decisions and solve problems, as family members, workers, citizens and lifelong learners”.
The Adult Literacy and Numeracy in Scotland report published back in 2001 estimated that 23% of the Scottish population have significant difficulties with reading, writing and numbers. The report also estimated that up to 40% experience some difficulties.
The latest research on Literacy in Scotland found that one of the key factors linked to lower literacy capabilities is poverty, with adults living in 15% of the most deprived areas in Scotland more likely to have literacies capabilities at the lower end of the scale.
Literacy issues are therefore linked to socio-economic inequality and social class inequality. This can be due to poor experiences at school and lack of opportunity or other barriers early in life.
Other groups such as asylum seekers or refugees may have additional needs in relation to literacy. Also, some disabled people may have support requirement in relation to literacy, such as someone with a learning disability.
Why does literacy matter to health?
The way the health service produces information and the way practitioners communicate with their patient’s needs to take literacy issues into account. Otherwise this might impact on people’s health by-
- Reducing access to health services or limiting people’s health choices;
- Leading to poorer health outcomes by not giving appropriate information on screening, prevention, medication or treatment.
- People with limited literacy skills may find it difficult to:
- Understand and use health information such as instructions for medication, food labels and safety warnings;
- Access services which support their health needs;
- Keep appointments;
- Find their way through complicated health systems;
- Interact with health care providers;
- Seek appropriate medical attention. Some people with limited literacy skills may use health services more frequently, while others often wait until their health problems reach crisis point.
Most research shows that adults with lower literacy capabilities are also more likely to have health problems, including problems with sight, speech, hearing and learning, as well as other disabilities or health problems lasting more than six months.
Prisons in Scotland
There are 15 prisons in Scotland – . Greater Glasgow & Clyde currently has three prisons – HMP Barlinnie and HMP Greenock and HMP Low Moss.
Prisoners in Scotland
During the year 2019-2020 there were 8600 prisoners in Scotland. Of this total 8198 were male and 402 female.
Prisoners and Health
People in prison have poorer health than the population at large. Many will have had little or no regular contact with health services before coming into prison, and research within prison populations reveals strong evidence of health inequalities and social exclusion.
- The majority of prisoners are male with an average of 35.9. The proportion of prisoners aged over 55 has doubled in the last 10 years. In Scotland males account for around 95% of the prison population.
- Most prisoners are in custody for periods of weeks or months, rather than years.
- Prisoners are six times more likely to have been a young father.
- A high percentage of prisoners will have experienced physical or sexual abuse in younger years.
- 34 per cent of male prisoners and 30 per cent of female prisoners had previously been in care.
- In 2019, black, Asian and minority ethnic (BME) offenders represented 4 per cent of the Scottish prison population.
- Approximately 80 per cent of prisoners in Scotland have some kind of mental disorder with 14 per cent having a history of psychiatric disorder
- Between 20 and 30 per cent of offenders have learning disabilities or difficulties that interfere with their ability to cope with the criminal justice system.
- The majority of people (70 per cent) received into prison test positive for illegal drugs.
- People aged 60 and over are now the fastest growing age group in the prison population.
Links to other Inequalities
Scotland’s prisoners, like prisoners everywhere, are more likely to come from the most deprived areas. In fact a prisoner is 3 times more likely to come from the most deprived 10 per cent of areas. It almost invariably follows that the communities which suffer most from crime are the poorest communities, and that the people who are most likely to be victims of crime are poor people. Those who are released from prison will be, almost invariably, released into poverty, inequality and social exclusion. Against this backdrop it is perhaps unsurprising that for many, prison offers respite care from their experiences in the community.
Though female offending rates had gone through a period of growth, the fact that men account for 95% of the prison population must be considered as an issue in its own right. The key messages that are given to young boys around what it means to be a boy or a man appear to be failing significant numbers if this is the result.
Access to primary health care
Access to coordinated health services within prison and on leaving prison can significantly impact the likelihood of re-offending and further imprisonment. Half of those sentenced to custody are not registered with a GP prior to being sent to prison.
Prison can exacerbate the factors that affect re-offending. Mental and physical health can deteriorate. A third of prisoners lose their house. Two-thirds lose their job. More than a fifth experience increased financial problems and over two-fifths lose contact with their family.
People serving a year or less make up 60 per cent of those received into prison under sentence. Forty-seven per cent of adults are re-convicted within one year of being released. For those serving sentences of less than 12 months this increases to 66 per cent.
Into the community
Many ex-offenders and offenders suffer from many complicated, interrelated problems and require input from a wide range of agencies. These include housing, addictions, mental health, health and social care, and benefits services. Many prisoners will be in prison for short periods of time. They return to their communities as residents with repeated and often disjointed contact with local agencies.
Around 30 per cent of people released from prison will have nowhere to live. Those with sentences less than 12 months frequently have no planned care management plan and are prone to falling through the ‘gaps’ in care provision.