Public health crisis in the refugee community: little change in social determinants of health preserve health disparities

Abstract

Structural inequities and lack of resources put vulnerable refugee communities at great risk. Refugees flee their country of origin to escape persecution and flee from war, famine and torture. Resettled refugee communities become particularly vulnerable during times of crisis due to limited English proficiency and poor social determinants of health (SDOH), which create barriers to attaining and sustaining health and wellbeing for themselves and their families. The purpose of this case study was to evaluate SDOH among a refugee community in the Southeastern United States. We surveyed the community twice during a 1-year period to assess various elements of SDOH. Among a primarily African and Southeast Asian refugee community, 76% reported difficulty paying for food, housing and healthcare during the first round of surveys. During the second round of surveys at the beginning of the Coronavirus pandemic, 70% reported lost income; 58% indicated concern about paying bills. There was little change during the 12-month study period, showing that SDOH are an enduring measure of poor health and wellbeing for this vulnerable refugee community.

Strengthening Culturally Competent Health Communication

“…17 In 2 cross-sectional studies in Clarkston before and during the COVID-19 epidemic, more than 66.0% of refugee respondents felt high levels of daily stress. 18 Refugees come to the United States with limited English proficiency, often limited literacy in their own language, and poor-quality, basic, or interrupted education. 6,11,18 When refugees reach the United States, a small, short-term package of services is provided by resettlement agencies contracting with the US Department of Health and Human Services that can include around 6 months of housing and benefits support (eg, health insurance, food stamps), English instruction, and employment placement.…”

“…18 Refugees come to the United States with limited English proficiency, often limited literacy in their own language, and poor-quality, basic, or interrupted education. 6,11,18 When refugees reach the United States, a small, short-term package of services is provided by resettlement agencies contracting with the US Department of Health and Human Services that can include around 6 months of housing and benefits support (eg, health insurance, food stamps), English instruction, and employment placement. 19 Even with this support, Clarkston's refugees continue to struggle with access to basic healthcare, high rates of mortality and morbidity, trauma-induced stress, lack of health insurance, and high rates of poverty and unemployment.…”

“…12,20 Almost 70.0% of Clarkston refugees do not know where to get benefits such as financial assistance, unemployment, or healthcare. 18 Further, healthcare ser-vices in the community are often fragmented or duplicative and myriad needs (eg, eye care, dental care, mental health services) go consistently unaddressed; 12 cultural and language dissonance exacerbate the challenges that refugees face in accessing healthcare services. 6 The lack of culturally and linguistically appropriate health promotion materials has left refugee populations at high risk of not being able to find, understand, or use health information both before and during the COVID-19 pandemic.…”

“…8 Our current work with the refugee community in Clarkston has revealed profound mistrust of some news outlets, public health agencies, and healthcare providers as well as rampant myths and misinformation about COVID-19 (eg, racial/ethnic minorities and people from warm climates cannot acquire the disease, black tea can cure the disease, the disease was developed to eradicate racial/ethnic minorities). 11,18 Disease containment strategies (eg, physical distancing, wearing a face mask, travel restrictions) can exacerbate stigma and xenophobia by encouraging ''othering,'' avoidance, and mistreatment toward people associated with COVID-19. 31 Recent news describes personal attacks against individuals suspected of testing positive for COVID-19, or of unknowingly infecting others.…”

Classifying Refugee Status Using Common Features in EMR

“…Once they have been resettled in host countries, refugees continue to face further challenges accessing and navigating the healthcare system amidst language, literacy, and communication barriers alongside other social determinants of health [5] .…”