Populations are constantly changing.
It may not be very obvious, but there
is complex interplay between births,
deaths and migration that creates a
local population dynamic which can
be difficult to predict. While this has
always been the case, there has been much more
mobility within the UK and internationally in recent
years. This has important implications for many
of the social factors that can influence health:
household size and overcrowding; social support;
family cohesion and minority community issues.
Historically, migration has been a major factor
in population dynamics in Scotland. However
most of this migration has been emigration rather
than immigration. Since 2004, that has changed
somewhat. Table 1 shows the Scottish population
by ethnicity taken from the 2001 Census. In
all there were over five million people living in
Scotland. Of these, 501,263 (9.9% of the total
population) described themselves as being from
white minority ethnic groups and 101,677 people,
or just over 2% of the population, described
themselves as from other minority ethnic groups.
Table 1: Scottish population by ethnic group
% of total population
% of minority ethnic population
Other white British
Other South Asian
Black Scottish/ black
Any mixed background
Any other background
All minority ethnic population
Source: 2001 census
However, these figures do not take into account
the unprecedented entry of workers from Eastern
Europe into Scotland from the 10 accession
countries that joined the European Union (EU) on 1
May 2004 – Cyprus, the Czech Republic, Estonia,
Hungary, Latvia, Lithuania, Malta, Poland, Slovakia
and Slovenia. People from Cyprus and Malta
already had full rights to work in the UK while
those of the others (the so called A8) have some
restrictions placed on their ability to find work
and claim benefits. As movement within the EU
is free, obtaining accurate information about the
numbers of people from the A8 countries working
in Scotland is difficult. What systems there are,
such as the Workers Registration Scheme (WRS)
and National Insurance registrations, present an
Of all A8 nationals entering the UK, some 7%
of the total have chosen to come to Scotland.
Estimates of the number vary, with official figures
suggesting 40,000 – 50,000 registered for work in
Scotland. Unofficially, the number may be around
100,000 with perhaps 30,000 in Lothian alone.
During 2004 to 2006, the years from which we
have better figures, Polish immigrants represented
65% of the total, with Lithuanian (11%) and Slovak
(10%) being the next largest groups.
The population is young, with over 80% aged
between 18 and 34 years. Over half (56%) are male.
The largest proportion find work in the hospitality
and catering industry (29%) followed by food/
fish/meat processing (14%). In Lothian, there are
populations in each council area involved in a range
of businesses and industries and representing a
significant proportion of those in employment (Table 2).
Typically, they do not have dependants and 55%
of workers indicated on their WRS application form
that they intended to stay in the UK for less than
three months, with only 14% intending to stay longer
than one year. This is certainly changing as more
families come to Scotland to join partners already
here or establish relationships and have children.
However, the fact that the population is very mobile
and turns over quickly does need to be understood
by public services such as the NHS. For instance,
essentially fit young men intending to be in Lothian
for only a short while are unlikely to see registering
with a GP as a high priority – especially if their
language skills are limited.
Table 2: Total number of National Insurance allocations by Great Britain, Scotland and Lothians
%change 2002/03 to 2005/06
Migrants as a % of working age in employment
Source: UK Department of Work and Pensions
Table 3 summarises the source countries
of new residents entering Scotland specifically.
Whilst Polish migrants form the largest
proportion, non-European countries follow them
most closely. Migrants make up the largest
proportion of working age people in employment
in the city regions.
Table 3: Overseas nationals entering Scotland and allocated a National Insurance Number
An added complexity arises from the Fresh
Talent Initiative. This scheme, which does not
operate in other parts of the UK, seeks to retain
and attract talented workers to address Scotland’s
decreasing population. Since June 2005, over
3,000 international graduates from Scottish
educational institutions have applied through the
scheme to remain in Scotland, many of whom will
have remained in, or relocated to, Lothian.
Clearly, migrant workers now make up a
significant proportion of the Lothian population
and the numbers continue to rise. At present,
although the migrant population is predominantly
young, fit and healthy, every clinician in Lothian
is likely to have encountered migrant workers
over the past few years. Their use of services
within the NHS reflects the age structure with
family planning, maternity care, obstetrics
and gynaecology, out-of-hours, accident and
emergency and general practice being the health
care needs that have to be met. However, the
group demographics will change and we are
already seeing migrants settling, the birth of
children, older family members migrating to assist
with childcare needs and demand for paediatric
and other services.
The NHS in Lothian – and indeed all those
involved in the business of public health – need
to be aware of the large changes in our local
population and how the population’s needs
could change over time. We can expect that
patterns of chronic diseases will emerge in these
migrant groups that may reflect the underlying
epidemiology of disease in their countries of
origin. For example, hepatitis or cervical cancer
rates are higher in Eastern European countries
than in the UK. We are certain to see differences
in lifestyle factors, such as the very high rates of
smoking in Polish migrant workers.
NHS Lothian has responded to this recent
wave of A8 migration and, having a relatively
large minority ethnic population, continues
to place high priority on safeguarding their
health. Some of the changes already made
are outlined in Box 1. There is also a range of
websites, such as one with information about
services in Scotland in Polish (http://www.polishinformationplus.co.uk/index.aspx), which can assist professional and local people alike.
Clearly migration and health is not just
a Lothian issue. We will continue to
link with other NHS Boards and public
organisations that are working in this area.
Improved access to health services and
better delivery of healthcare is needed
for migrant workers and all other minority
ethnic populations in Lothian.