Refugee health in the United States
Special considerations are needed to provide appropriate medical treatment for refugee migrants to the United States, who often face extreme adversity, violent and/or traumatic experiences, and travel through perilous regions.
[7][8] Because of the often hasty circumstances of their departures from their origin countries, refugees usually lose access to their medical records, and continuity of care is difficult to establish upon entry to the United States.
[9] In addition, the living conditions of resettlement or housing insecurity upon coming to the United States further impact refugees' health by inserting them into communities or situations where access to care is limited.
The US health insurance system is complicated - especially for refugees - in that they only receive 8 months of general care after resettlement and there are many different federal, private, and nonprofit organizations that are involved in this process.
[11] In a 2017 study, a Somali woman's struggle to get pills that were Kosher in order to respect her religious beliefs is an example of how culturally appropriate care and treatment is a barrier to refugee individuals adequately being treated by the healthcare system.
This approach has resulted in a significant number of mental health referrals and treatments, indicating a need for increased psychological support for newly arrived refugees.
Pre-migration stressors typically involve potentially traumatic experiences in the individual's country of origin, often encompassing the compelling reasons for seeking asylum.
Refugees often experience further mental trauma after migrating due to hostility from native citizens, or even authorities at detention centers and ports of entry, which is further exacerbated by long wait times for asylum application decisions.
[22] Within the Cambodian refugee group, higher rates of PTSD and major depression were associated with factors such as old age, having poor English-speaking proficiency, unemployment, being retired or disabled, and living in poverty.
[22] Researchers have identified a number of factors contributing to mental illness in refugee populations, including language barriers, family separation, hostility, social isolation, and trauma prior to migration.
These critiques have brought to the rise of incorporating "trauma and violence informed" approaches to refugee mental health services that aim in acknowledging the sources of psychological stressors within structural, cultural, and systemic inequities.
[35][36] There is limited evidence supporting current oral health interventions for refugee children in the United States, with lack of participation being a major barrier.
[47] US refugees have elevated rates of chronic diseases, including obesity, diabetes, hypertension, malnutrition, and anemia,[48][49][50] compared with US-born residents or first-generation immigrants.
[52] Second, refugee beliefs and home-country culture, in conjunction with postresettlement socioeconomic status (SES; which is often lower), influence what types of food can be purchased and consumed.
In addition to birth control, female refugees were less likely to access prenatal and maternal care than native-born or other immigrant US populations despite receiving equal coverage in the United States.
While refugee mothers are less likely to access prenatal and maternal services due to social and economic barriers, they are often more susceptible to cesarean sections, low birth rates, and other health issues.
While men also experience sexual violence, women are an especially vulnerable population because of shifting gender roles and power dynamics as they flee their home country and migrate and resettle in a new place.
The guidelines are developed in accordance with Section 212(a)(1)(A) of the Immigration and Nationality Act (INA), which outlines the reasons an alien is ineligible for a visa or admission to the United States, specifically based on health grounds.
At these locations, US Public Health Service personnel review refugees' medical documents and perform limited inspections to look for obvious signs of illness.
[75] A 2012 study conducted by Kullgren et al. found that the most prevalent reasons for delayed and/or unmet healthcare for adults in the United States were lack of affordability and accommodation.
[85] According to the review, adequate communication is needed to understand the reason for patient arrival, the underlying symptoms, the diagnosis, the future diagnostic tests required, and the prognosis and treatment plan.
[85] Results from a 2011 interview centered study has shown that linguistic and cultural cognitive barriers constitute the biggest hurdles in providing equitable care for refugees.
[85] The paper recommended professional interpreters for their knowledge on the healthcare system and health care vocabulary over using family and friends due to privacy reasons as well as biases that could impact patient decisions.
[8] In terms of health literacy, many refugees don't understand the importance of a healthy diet and exercise in managing and preventing chronic diseases like Diabetes.
[8] A qualitative 2018 study by Sian et al. stated that structural barriers include transportation, geographical distance, waiting times, service availability, and general health infrastructure and organization.
[88] The Immigrant Access to Health and Human Services project found that both rural and urban areas may lack adequate public transportation systems or be too expensive to navigate through taxis.
[88] Common characteristics of refugee communities include larger families living in crowded housing, low-paid front line workers in a variety of industries, limited English skills, poor access to and use of healthcare services, high degrees of financial and food insecurity, low rates of health insurance and high degrees of stress.
[91] A longitudinal study conducted in 2001 by Singh et al. found that immigrant men and women had significantly lower risks of mortality than their U.S. born counterparts.
[94] The low socioeconomic status of refugees is associated with numerous health risks such as malnutrition, smoking, injuries, unemployment, family dysfunction, psychosocial stress, and more.
[8] Moreover, lack of insurance is associated with reduced access to healthcare and according to data from the National Survey of American Families, 22 percent of immigrant children are uninsured, more than twice the rate for U.S. born citizens.
