A blog entry by Dr Agnes Turnpenny, University of Kent
Professor Catherine Needham, co-investigator in the Sustainable Care programme, organised a seminar on ‘Social care, healthcare and superdiversity’ on 19th November 2019 at the University of Birmingham. The seminar started with Professor Sue Yeandle setting the broader conceptual scene, followed by Professor Jenny Phillimore, director of the Institute for Research into Superdiversity (IRiS), and Dr Kelly Hall from the Department of Social Policy, Sociology and Criminology who presented findings from their recent research. This blog summarises the key findings presented at the seminar and offers a personal reflection on these topics.
Dr Agnes Turnpenny
Jenny Phillimore’s presentation on ‘migrant healthcare seeking’ provided important insights into this increasingly topical issue. The study set out to capture the concept and dynamics of healthcare bricolage in superdiverse communities. The term superdiversity refers to a complex and dynamic form of diversity, with ‘old’ and ‘new’ migrations in a rapidly changing environment. It represents a shift from ethno-nationalistic categories, defined predominantly by cultural characteristics, to the recognition of the complex identities and life trajectories, shaped by intersections of race, class, gender and education (etc.), among residents in a particular area. Traditionally, the use of group-specific approaches has been advocated to address the ‘special’ needs of diverse/minority groups in the UK. While such approaches may be useful in certain contexts, they are less effective for complex issues and difficult to implement in the absence of a critical mass of people who ‘fit’ the same ethno-cultural category. Jenny’s study applied ‘bricolage’ as the conceptual and analytical framework to understand how people in superdiverse communities access healthcare. Bricolage – a term widely used in sociology – is about using and mobilising resources actively and creatively to deal with challenges and create individual solutions. Superdiversity offers many opportunities for bricolage; the study found that migrants are often active users of multiple and transnational systems, knowledge, and resources (for example some Eastern European migrants travelled to their home country for medical investigations or treatment). These findings challenge a common discourse that portrays migrants as passive recipients or ‘problem’ users of health services; they also reveal that effective bricolage is highly dependent on individual resources (‘cultural capital’) as well as money, time, networks, and knowledge/understanding of how ‘the system’ works. Jenny argued that a system that pushes migrants to rely on bricolage to solve their problems fails them at multiple levels: some problems are too great to be solved in this way, and those who lack resources are left behind.
The second presentation, by Dr Kelly Hall, discussed older British migrants in Spain and their experiences of care: the strategies they use to access care, and what these arrangements look like. Kelly interviewed 34 British retirees living in Spain in 2019. Her findings reveal the complexities of ageing as a migrant and the multiple strategies and resources people draw on to meet their care needs. While a ‘planned return’ is an option for some, significant needs can emerge quickly, resulting in a ‘crisis return’, or forcing people to make arrangements in Spain. Access to Spanish services is limited for several reasons. These include language barriers and local services not being seen as responsive to individual, especially lower-level, needs. People thus tend to rely on private care arrangements made through voluntary and community networks or British-run private agencies. Although people were often satisfied with the quality of care, some gaps were evident, particularly for those with extensive or complex needs and/or without significant assets. Participants in the research also acknowledged that informal networks (‘friends’) and transnational family caring arrangements ‘can only do so much’.
At a time of intense debate about the impact of migrants and migration on public services in the context of Brexit – a debate that often dehumanises migrants as a burden on public resources, or views them as commodities without care needs – these studies offer an alternative perspective, one that emphasises migrant agency – choices, resources, aspirations – but also acknowledges that the uneven distribution of risks, and inadequate supply of services, often results in poor outcomes and exclusion.