Approaches to health provision in the age of super-diversity: Accessing the NHS in Britain’s most diverse city

Abstract

Commentators have argued that we have entered a new era of migration described by Vertovec as a ‘transformative diversification of diversity’. Multiple variables of difference in the ethnicity, immigration status, rights and entitlements, age and gender profiles and patterns of distribution, of new migrants mean that the UK, and many other EU countries, are now home to the most diverse population ever experienced. The onset of super-diversity challenges traditional multicultural models of welfare provision originally based upon an understanding of migrants as large and geographically contained clusters of predominantly postcolonial migrants. These changes are occurring at a time when migration has become highly politicized, multiculturalism is being questioned, a shift is under way towards assimilation and welfare provision has become re-racialized. This paper argues that models of welfare provision need to be rethought to take into account the new reality of super-diversity in a way that is affordable, politically acceptable and meets the needs of all. Using data from research undertaken from studies of health service provision in the West Midlands the paper explores the challenges of meeting the needs of new migrants under existing provision, the costs of failing to adapt to super-diversity and the reasons why provision has failed to adapt. The paper concludes by arguing the need for different approaches to provision, and suggesting some new ways forward.