Refugee Health Part I: Significance and Challenges
The seemingly endless presidential campaign has finally reached its end. As one of the most contested election in U.S. history, this election gave rise to numerous issues that have emerged as national priorities. One of them is the refugee crisis, exacerbated by the turmoil in the Middle East and fueled by the recent terrorist attacks both domestic and abroad and the country’s long held fear of outsiders. Unfortunately, the one issue that has not been gained enough attention is refugee health. While many Americans have spent many hours arguing who and how to let people in or not in to this country, the health and well-being of those who finally made their ways here is a topic yet to be discussed. In moral sense, the health of those escaping humanitarian crisis in their home countries and who we deemed safe enough to let in is the moral obligation of ours as the health of any other fellow Americans. Refugee health is also an economic and public health issue as many tend to have preexisting health conditions and poorly managed health records that can jeopardize American public health and burden the government medical programs. According to the U.S. Department of State, New York State has taken in more than 1,200 refugees since last year, the third most in the nation. They are from countries like Iraq, Somalia, Ukraine, Burma, and Syria. They are the at-risk population in our backyards in our community whom we need to readily embrace and protect from falling into poverty and serious health conditions, both physical and mental.
The challenges frequently experienced by refugees can be illustrated by the “triple trauma paradigm,” according to Harvard Public Health Review. In this model, the primary trauma leads to the initial flight from the home country, the second trauma occurs during the flight or time in refugee camp, and then the third trauma occurs during resettlement. The primary and secondary traumas stem from the physical conditions of their home countries and refugee camps which often include poverty, war, torture, loss of loved ones, and starvation. In fact, according to Center for Victims of Torture, the prevalence of torture in the refugee population in the U.S. is estimated to be 44%. The abject physical conditions and the instability of life at home bring both physical and mental distress to refugees that often manifest itself later as depression, PTSD, and unmanaged chronic diseases. Yet, when refugees finally make their ways to their new country, they often do not get a chance to address their previous sufferings. Rather, resettlement brings its own stressors. Refugee families must find housing, navigate new social institutions, start a new job, locate new schools, all simultaneously while learning a new language and culture. Their physicians may want them to take medications on time, see a surgeon, get an MRI, and be evaluated by a therapist, but their priorities fall into ensuring first that basic needs are met for their families. These different priorities between medical professionals and refugees delay their chance of recovery from previous traumas and often worsen their preexisting conditions. These competing demands of different social institutions easily overwhelm refugees and result in lack of adherence and waste of valuable resources in the health care system.
There is a cycle of lack of access and poor health outcomes among refugee population. Recent studies have shown that low health literacy among refugees reduces utilization of necessary medical care, and the resulting, untreated health problems create more barriers to learning English. In fact, to many refugees, the concept of preventive medicine and primary health care are entirely foreign and may appear as an unaffordable luxury given the anxiety about their current lives. This limited patient understanding of the medical system and inadequate provider knowledge about refugee life further isolate them and prevent them from accessing adequate medical care. The anti-immigrant sentiments in the U.S. further burdens refugee life with discrimination as well. As a consequence, many refugees are at great risk of developing depression and anxiety and exacerbating any preexisting chronic illnesses and further isolation from the society. The medical system can do its part to stop this continuous cycle of isolation and poor health. By taking an integrative, preventive approach to the health of refugee population, their resettlement process can become truly settling with the moral and economic standards of our country.
ISP Intern, ’17 Cornell