Whose space is it anyway? The architecture of social exclusion and why it is bad for the public’s health

Abstract

Over the past decade there has been a significant upsurge in nationalist politics and sentiment in both Europe and the USA. Ideas of nationhood and sovereignty have become dominant themes within political discourse, and there has been a rise in the popularity of right wing parties that espouse strict immigration control. In the UK, the concept of ‘health tourism’ has become an issue in relation to the underfunded National Health Service (NHS), with legislation being passed in 2017 with the aim of charging people who were defined as ineligible to use health services. This Act has already begun to have a negative impact on the health of the most vulnerable people in our society, not least undocumented migrants, rough sleepers, and others with insecure status. Many people in these groups are fearful of accessing health services because they cannot afford the upfront treatment charges, while others are deterred because they believe that their contact details will be passed to the UK Border Agency. Public health implications include missed prevention and early stage disease treatment, untreated infectious diseases, reduction in screening and vaccination coverage and an increase in health inequalities. The 2016 presidential election in the USA, and the UK referendum on EU membership, in the same year, both focused on taking direct action against inward migration, which was characterised as having an adverse effect on the economies, infrastructures, social values and health status of both countries. While Mexicans and Muslims were targeted in the USA, in the UK blame was directed at the free movement of EU citizens, especially those from eastern European countries such as Poland, Romania, Bulgaria and the Baltic states. Autochthonous populations (predominantly white and Christian) have become increasingly vocal in their rhetoric of fear: Migrants taking your jobs, Muslims threatening your culture and security, political correctness restricting your liberty to speak your mind, migrants importing diseases and, in the UK, the “deliberate attempt to water down the British identity” (UKIP, 2010) have all contributed to the creation of a hostile environment towards ‘others’ and ‘otherness’. This paper will look at the role of populist politics and contemporary architecture in assisting the demonization of the homeless and migrant populations, and will use the endemic levels of tuberculosis in the UK’s capital city, London, to exemplify the consequences for public health and the health of the public.