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12 January 2004updated 24 Sep 2015 12:01pm

The truth about ’’health tourists’’

The idea of Britain as an innocent, being taken for a ride by ruthless visitors, is absurd. We were

By Andrew Simms

”Happy New Year; we don’t want your sort here.” Only a few days into 2004 and it looks like being another year in which the two big political parties compete to be the toughest kid on the refugee policy block. In the past few weeks of charity and goodwill to all, we have had proposals to take the children of failed asylum-seekers into care, to withdraw free health treatment from the same group of people, and to demand NHS payments in advance from business travellers and foreign HIV sufferers. As though asylum-seekers and refugees didn’t generate enough foam in parliamentary mouths, we now also have “economic refugees” and “health tourists”.

The idea of an economic refugee is a strange one. It usually means someone who has arrived here to “exploit our superior standard of living”, having scandalously refused to know their place and stay in happy poverty at home. Yet who were the first economic refugees? They were the second sons of Britain’s imperial aristocratic families who, denied a direct inheritance, were sent out to make their fortunes in the furthest corners of the empire. Expatriate employees of the British East India Company could enjoy larger houses, more servants, bigger feasts and greater moral lassitude than they could at home.

But we didn’t just export our superfluous aristocracy. As an observer in Barbados noted in 1655, “England doth cast forth its rubbish: rogues and whores and such like people are those which are generally brought here.” Like their modern successors, the economic refugees of the 17th and subsequent centuries (also known as colon-ists) were reluctant travellers, largely driven by economic or social necessity.

Today’s elite economic refugees are the employees of European and US multinational companies stationed in subsidiary offices in developing countries. Such international corpocrats enjoy a freedom of movement across national borders and a lifestyle that the indigenous people in the countries where they work can only dream of. But they are never called economic refugees. The logic is that, if you are a corpocrat living it up on a tax-free western salary (big house, servants, pool) in a poor country with a low cost of living, you are generously contributing to development. But if you are a skilled professional from a poor country, doing unattractive menial work on low pay in a rich country with a high cost of living, then you become an economic refugee.

Leave aside the mountains of research that show how refugees and immigrants make a disproportionately positive contribution to urban areas suffering economic decline. And don’t even mention how Britain steals countless trained professionals from the health and education services of countries – in sub-Saharan Africa, for example – that can little afford to see them go. Turn instead to the new object of competitive political outrage, the health tourist.

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The health tourist is a political offshoot of the sponging single mother, the secretly wealthy and/or aggressive beggar and the lifestyle homeless person. In other words, it is largely a figment of that political imagination on the prowl for another voiceless, marginalised or completely non-existent social enemy to demonise.

When the issue was conjured up in the summer of 2003 no hospitals were complaining about the burden of overseas visitors. It was, and still is, being spun as a new burden placed on the system by poor, ethnic-minority visiting freeloaders. But which foreign nationals are second most likely to access our health services? According to academic research commissioned by the BBC, the answer is refugees from the shattered and privatised public services of the United States. No one in the health service wants to act as the immigration police. The Royal College of Nursing wants to shift the task of vetting patients on to GPs. Nothing to do, I am sure, with the upbraiding of Beverly Malone, the RCN’s general secretary, for “pulling strings” in 2002 to get her mother, a US citizen, a quick NHS operation.

Doing anything to make it more difficult for visitors, tourists, immigrants or refu-gees to get healthcare is, anyway, counter-productive. If the illness is contagious, you risk a wider health crisis. Public safety demands that sick people be treated. And if a British Asian family’s elderly relatives come to visit from India – and stay, as many do, for a couple of months – why should their tax-paying British family not expect their parents to receive health treatment if they need it, without being made to feel like criminals? Some resident expatriates prefer in any case to travel back to their country of origin for treatment.

What of people who travel to Britain with the sole intention of using the NHS? If such people have the means to travel privately to Britain, the current system allows the state to retrieve the cost. Even if there are defaults, it is hard to see why such a fuss should be made of this when the NHS Counter-Fraud Service has much bigger fish to fry: it is currently suing six pharmaceutical companies for £30m in damages, for example, for price-fixing and restricting the supply of generic drugs.

John Reid, the Secretary of State for Health, admits he doesn’t have a clue as to how much “health tourism” takes from the UK’s £74bn annual NHS budget. Though the London borough of Newham is one of the most ethnically diverse in the UK, the cost there is reportedly well under 1 per cent of its total budget.

More than anything, the fuss about economic refugees and health tourists rests upon an absurd misrepresentation. It presents Britain as a charitable and well-meaning innocent, being taken for a ride. Yet, according to the United Nations High Commissioner for Refugees, around three-quarters of the world’s 20 million conventional refugees are hosted by developing countries. And Britain itself is a wealthy country. We have become so over a long period of time through the complex and systemic exploitation of economic, political and military advantage over the countries whose people now appear on our doorstep.

Economic policies that we supported through international financial institutions wrecked the economies and career opportunities of millions in developing countries. That is one reason why their local, expensively trained staff are so happy to abandon their homes and domestic health and education services and come to Britain to run ours. According to the Home Office, 27 per cent of employed health professionals are migrants, as are 9 per cent of teachers.

There is another sense in which we are to blame for refugees being forced to leave home. Many “economic refugees” are in reality “environmental refugees”, fleeing the effects of the global warming for which countries such as Britain and the US carry disproportionate responsibility. Projections for 2050 suggest that more than 150 million could be displaced, many times the largest number of political refugees in the world to date. Perhaps international agreements should require countries to accept environmental refugees in proportion to their greenhouse gas emissions.

We should be grateful that people want to come to Britain and contribute to our economy and culture. We should be even more grateful that the poor countries they come from do not demand compensation for all the injustices we have inflicted upon them: the poaching of trained professionals, the failed economic policies dumped on them by the World Bank and International Monetary Fund, the lasting instability wrought by colonialism and the cold war, and the ecological debt of climate change.

Why do both major political parties so strongly favour liberalising the movement of trade and finance and yet remain so hostile to the movement of people? Ted Heath’s warning should ring in our ears: never give an inch to the far right, because it will just take it and demand more. Whether we are talking about trade and finance, or asylum-seekers, “economic refugees” and “health tourists”, we need a rational, managed approach. It should be guided not by insidious political flag-waving, but by a sense of history and obligation, a semblance of justice, and a commitment to environmental sustainability.

Andrew Simms is policy director of the New Economics Foundation. Environmental Refugees: the case for recognition by Andrew Simms and Molly Conisbee is at

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