Migrants and medicine in modern Britain

In the late 1960s, an ugly little rhyme circulated in Britain’s declining industrial towns:

‘I come to England, poor and broke
go on dole, see labour bloke
fill in forms, have lots of chatters,
kind man gives me lots of ackers:
“Thank you very much”,
and then he say
“Come next week and get more pay;
You come here, we make you wealthy
doctor too, to make you healthy.”

…

Send for friends from Pakistan
tell them come on as quick as can;
Plenty of us on the dole
lovely suits and big bank roll;
National Assistance is a boon
all the darkies on it soon –

…

Wife want glasses teeth and pills –
all are free we get no bills;

…

Bless all white man, big and small
for paying tax to keep us all.
We think England damn good place
too damn good for white man’s race;
If he not like coloured man –
Plenty room in Pakistan.’

—‘Portrait of Blackburn – Jeremy Seabrook compares the situation of the immigrants today with that of the working class 50 years ago’ (The Listener, 27 August 1970)

At the time, seemingly unstoppable mass migration from Britain’s former colonies had triggered a succession of new laws aimed at restricting entry to Britain, followed by a new political emphasis on ‘race relations’ intended to quell international dismay and reduce internal racial tensions. The poem captures exactly the fears that Enoch Powell capitalised on so successfully in his infamous ‘Rivers of Blood’ oration. All migrants, it assumes, are leeches on the British body politic and the Welfare State. Migrant filth and fertility, even simple migrant need, would drive out indigenous Britons, excluding them from jobs, homes, and the health services that they themselves funded.

The doggrel of resentment is depressingly persistent. Often entitled ‘Ode to the White Man’, the verses reproduced here were collected by a British journalist documenting life in the declining northern textile town of Blackburn. The poem was probably in circulation even earlier, given its use of the World War Two military slang ‘ackers’ for cash. Yet ‘Ode to the White Man’ has survived and adapted readily to the changing populations and sites of migration. On the internet, ‘white men’ – now Irish, Canadian, Australian, and American as well as English – subsidise ‘regal’ ‘illegals’, thriving on the supposedly lavish largess of American Medicaid, Australian ‘baby bonuses’, and the British NHS. They are in turn enjoined to find opportunities in Mexico, Vietnam, Kosovo, and of course Pakistan. (Some of the many alternatives have been collected online; note that they are no less offensive then the original. Others include a 1970s version of the British verse and a Canadian version.) Instantly adaptable to the latest migration ‘crisis’ or wave of xenophobia, ‘Ode to the White Man’ reflects abiding international stereotypes of migrants as grasping ‘takers’, intent on exploiting the generous welfare provision of the developed world – of which they are presumed to have intricate and sophisticated knowledge.

Yet this strand of the migration discourse – however persistent – never threaded through British culture alone or unchallenged. If anti-immigrationists (and racists) played on popular anxieties about migrants as vectors of disease, or burdens on the NHS, their opponents were equally keen to deploy medical evidence. Since the 1950s, moral panics about ‘imported illness’ have been repeatedly rebutted by the epidemiological surveys that they prompted. By and large, researchers found that British conditions triggered or exacerbated migrant ill-health on the rare occasions where their rates of illness exceeded those of the indigenous population. Clammy and crowded slums offered ideal conditions for tuberculosis infection; young men far from home caught, rather than transmitted venereal disease; and poverty, fears of racial violence and unfamiliarity with (not over-use of) welfare services led to malnutrition among migrants and their children.

Similarly, representations of migrants as ‘deadweights’ on the social services – and especially the health services – have historically been received with nothing short of glee by political cartoonists and social commentators eager to relish the irony. Long before he condemned migrants, Enoch Powell actively recruited Caribbean nurses to satisfy the voracious labour needs of the young NHS. Migrant doctors and nurses have remained essential to maintaining its services ever since, a fact that has become a truism of migration discourse. Indeed, even a candidate in the recent Labour Party leadership campaign reiterated the argument that Britons are ‘more likely to be treated by somebody who’s non-British than to be queuing behind them.’

The National Health Service is, we have been told, ‘the closest thing the English have to a religion.’ Perhaps it is unsurprising that anxieties about a service so close to our hearts also colour discussions about immigration. Both, it seems, are as intimately and inextricably connected to British identity in the twenty-first century as they were in the twentieth. But the relationship between migration and medicine in Britain has never been simple or one-sided, in politics, in the press, or in the everyday hubbub of the Health Service itself. Scrutinising it through any single lens – whether of race, class, politics, or nationality – can only obscure our vision.

Headline image credit: Waiting room anteroom doctors by TryJimmy. Public domain via Pixabay.