Influence of the social determinants of health on access to healthcare services among refugees in Australia

Abstract

Refugees in Australia are not fully utilising the healthcare system for several reasons and this may be affecting their overall health outcomes. This qualitative systematic review examined the influence of the social determinants of health on refugees' access to healthcare services in Australia. Electronic databases were searched using terms relating to refugees, social determinants, healthcare services, barriers, enablers and Australia. Only peer-reviewed studies published in English since 2006, which focused on refugees and specifically discussed social determinants influencing refugees' access to healthcare services in Australia, were included. The studies were critically analysed using standard Critical Appraisal Skills Programme Tools. Eight studies were included in the review. Findings reveal multiple factors influence refugees' access to healthcare in Australia, and these can be conceptualised within a social-ecological model of health; that is, they operate across individual, interpersonal, environmental, organisational and policy levels. The novel finding of this review was the re-occurrence of similar influences across multiple healthcare service settings in Australia. The prevalence and re-occurring nature of the social determinants of health suggests that refugees are experiencing multilayered barriers to accessing Australian healthcare. All levels of a social-ecological model must be addressed in any attempt to break down these barriers.

Syrian refugees’ experiences with mental health services in Turkey: “I felt lonely because I wasn’t able to speak to anyone”

“…The studies show that refugees get less benefit from mental health services than locals. 10,11 Language and cultural differences 12,13 are considered the most important personal characteristics that pose a barrier to access to health services. Hence, translators are used for communication, and family members do that when translators are not available.…”

“…Refugees use mental health services less frequently than the host community although they suffer more from mental health problems . Cultural and linguistic differences are considered the most important factors that impede refugees’ access to health services . Therefore, translators are employed, and family members may also act as translators when no translator is available.…”

“…Other barriers to health services include: being female, low socioeconomic status and financial difficulties, transportation problems, inadequacy of social aids, state of health, lack of information about health/disease, beliefs regarding health, lack of information about the health care system, the cause of migration, period of stay in the host country, being unregistered, being unemployed and the fear of deportation . The feel of insecurity about mental health care services and the fear of being stigmatized by others also hinder access to mental health services . There are also barriers that arise from service providers such as health care staff turnover, their stigmatizing attitudes, their lack of awareness and experience of the refugees’ special needs, and their lack of knowledge about refugees’ language and culture .…”

“…Refugees are unfamiliar with the host country's health care system because they come from other countries . Structural barriers include: the lack of physicians and health care staff who have the same culture and language, insufficient number of translators, long queues and waiting periods, paid health care services inability to afford transportation costs, and problems with their ID cards …”

Regional primary health care organisations and migrant and refugee health: the importance of prioritisation, funding, collaboration and engagement

“…Almost 30% of Australia’s population were born overseas, 1 and over the past 10 years, Australia has accepted more than 170,000 refugees 2 . While health status may vary somewhat by migrant cohort (and in some contexts be affected by the ‘healthy migrant effect’ 3 ), in general, it is recognised that a combination of pre‐migration, migration and post‐migration factors mean the health service needs of people from migrant and refugee backgrounds are more complex than for many other Australians 4–6 . In particular, people from refugee and asylum‐seeking backgrounds (hereafter ‘refugees’) have worse health outcomes, especially in relation to mental health 7,8 …”