Meet the Researcher: Dr Sally Hargreaves

Published: 16 October 2019

Dr Sally Hargreaves is a Lecturer in Global Health at the Institute for Infection and Immunity, St George’s, University of London, having moved in 2018 from Imperial College London. Amid unprecedented rises in migration to the UK and Europe in recent years her research focuses on strengthening the evidence-base around the health needs of diverse migrant groups, and understanding how we can better adapt and deliver health, screening, and vaccination services to improve health outcomes.

Could you describe your most recent research activity?

I am working with Public Health England and other groups, funded by the NIHR, to explore innovative approaches to delivering catch-up vaccination to migrants arriving in the UK. Migrants to the UK include a diverse group of asylum seekers, refugees, labour migrants, EU/EEA internal migrants, and undocumented migrants from multiple regions of the world – with implications for the NHS and public health in terms of how we organise services. Migrants are considered to be an under-immunised group in the UK and Europe because they may come from, and remain in contact with, countries where health and vaccination systems are limited, or have broken down due to war and poverty. However, a migrant’s ability to get catch-up vaccinations and other preventative health-care services in the UK is often restricted by disparities in access to NHS services and inconsistencies in delivery of care. We aim to change this, by introducing new systems into primary care to ensure primary-care staff engage migrants to align them with the UK vaccine schedule.

How does this link into your previous work?

My previous work has been looking much more holistically at the health needs of migrants in the area of infection, exploring the inequalities they face in terms of accessing health-service provision on arrival and the impact that the migration process itself has on health outcomes.

I have a particular interest in rethinking how we meet the health needs of more marginalised migrant groups such as undocumented migrants, refugees and asylum seekers, who may face major barriers to health care on arrival and whose health may subsequently deteriorate. European countries, including the UK, have taken a much more restrictive approach to provision of free health care to certain migrant groups in recent years, which has had a negative impact on their ability to access appropriate health care on arrival and to integrate in the long term.

Last year I received funding from the Wellcome Trust to explore the health needs of labour migrants, a group of migrants who have had very little attention to date in research terms, despite being the largest group of migrants circulating globally.

Also, I have previously worked for several years for Médecins Sans Frontières in tuberculosis control programmes in Nigeria, Russia, and Central Asia and a focus of my research is still very much focused around latent and active tuberculosis in migrant populations. I supervise several students working in this area.

How did you originally become interested in migrant health?

I was originally keen on a career overseas with Médecins Sans Frontières, mainly because it was such an immense privilege to work in some of the remote places I got to visit when I worked for them as a researcher, and with such inspirational people.However, through my subsequent work in London, I realised that there were thousands of migrants in Europe facing similar desperate experiences to the marginalised populations I had been working with overseas. My early research in the UK with Professor of Infectious Diseases, Jon Friedland – now Deputy Principal (Research and Enterprise) at St George’s – who I am still working closely with after several years, focused on understanding the health experiences of migrants living in London and exploring ways in which screening programmes could be better strengthened to ensure early identification and treatment of key infections. My interest in migrant health grew from there.

How does your research here fit into the wider picture of global health policies?

In Europe, migrants still face a disproportionate burden of infections including tuberculosis, HIV, and hepatitis, yet these migrants have to some extent been excluded from global health initiatives and dialogue centred around tackling these major global pandemics. The reality is that we will not make European targets for the elimination of tuberculosis and vaccine-preventable diseases unless we improve how we deliver services to migrants residing in the region. This will mean engaging a more diverse range of migrants in a more effective way, considering their perspectives when we design services and do research, and rethinking our approach to their entitlement to mainstream health care. The UCL-Lancet Commission on Migrant Health, of which I am a Commissioner, has done a considerable amount of work in the last couple of years exploring how we can minimise health risks associated with certain types of migration, and working to influence the global policy debate around migration and health to ensure that the universal health coverage agenda also applies to migrants residing in high-income countries.

How has working at St George’s influenced your research?

Since arriving at St George’s last year I have made numerous connections with a range of interesting researchers who have overlapping interests in migrant health. I am keen to strengthen the evidence-base in the field of migrant health and to move towards doing more robust large-scale studies – including trials – to test the effectiveness and cost-effectiveness of innovative approaches to health-service delivery in migrant populations, with the aim of informing policy-making in this area.

What motivates you in your work?

Tens of thousands of migrants are currently stranded in Greece and in other Europeean countries in transit camps, and many hundreds of migrants continue to risk their lives attempting to cross the Mediterranean and, more recently, the English Channel. This is happening on our door-step, it isn’t going away anytime soon, and I feel that as a social scientist there are opportunities to contribute – even in a small way – to the evidence-base and policy discussions about improving these people’s lives.

What are your interests outside St George’s?

This year I learned to sail, largely an attempt to keep up with my two children and husband. This definitely isn’t an easy thing to master – capsising in mid-April isn’t as fun in your mid-40s! Other than that, I like traveling anywhere in Asia whenever the chance arises.