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User:Cheynehoke/Refugee health in the United States

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Healthcare barriers

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Resettled refugee communities find themselves particularly vulnerable to healthcare barriers and are often unable to attain and sustain health and wellbeing for themselves and their families due to structural inequities, poor social determinants of health, and a lack of access to health care resources. According to a 2009 study by Morris et al., refugees face a higher risk of low birth weight, poor educational outcomes, and higher rates of chronic physical and mental illnesses compared to United States Citizens.[1]

According to a 2011 paper by Carrillo et al., healthcare disparities between races and ethnic groups affect health status and access, and healthcare access barriers can play a role in understanding the reasons behind these disparities.[2] The paper described how healthcare barrier models like the Health Care Access Barriers (HCAB) model provide a framework for analyzing, categorizing, and detailing the determinants of health status.[2] The HCAB model categorizes measurable healthcare barriers into financial, structural, and cognitive groups.[2] Researchers have used this model to analyze the root causes for refugee health barriers and aid in interventions.[3] For example, a 2016 study conducted by researchers in Jordan found that the common perceived structural barriers for Syrian refugees in Jordan included long waiting times, extensive service procedures and long distances.[3] According to the study, financial barriers consisted of high costs of medical service, medicine and transportation.[3] Cognitive barriers consisted of lack of trust, discrimination, and knowledge of the location and structure of the health care systems.[3] These barriers are also stated in refugee studies in the United States and other countries as well.[3][4][5] The paper by Carrillo et al. also detailed other health care access models like the Anderson's Behavioral Model of Health Services Use and its variations which have also been used to model access barriers.[2]

According to a health assessment report based in San Diego, the five most major perceived health care barriers consisted of language, transportation, lack of insurance, cultural barriers, and lack of knowledge of the U.S. healthcare system.[6] A 2011 clinical review stated how those barriers apply to many of the three million refugees who have entered the United States over the past three decades.[6][7] And in just the last decade, around 600,000 refugees have arrived in the United States.[8] A 2018 patient-centered review stated that poor health care access before arrival, discrimination, and trauma have contributed to the increased likelihood of major health issues in refugees as compared to other immigrants.[8] The 2011 study by Asgary and Segar, which involved interviews with asylum seekers and expert providers/representatives of advocacy organizations, proposed that all levels of the healthcare system from the refugees and providers to the policymakers should work together to address healthcare barriers.[9] To do so, the paper suggested that governmental, non-governmental, medical and legal organizations all work together to provide accessible medical care for refugees.[9] A Metropolitan Policy Program has suggested that the maintenance and formation of local, state, and nationwide health assistance should include health care access and language skills.[10]

As a result of the COVID-19 pandemic, a survey conducted in 2021 found that refugee communities primarily composed of African and Southeast Asian were suffering disproportionately from the effects of the pandemic.[11] Specifically, 76% reported difficulty paying for food, housing and healthcare, 70% reported lost income, and 58% indicated concern about paying bills.[11]

Structural barriers

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A refugee man is lying on a shelf. There are multiple shelves in the background on which there are blankets. The shelf serves as the bed for the man.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.[12] All of those barriers could physically hinder health access.[12] A 2012 research brief found that structural barriers could also overlap with economic and cognitive barriers.[13] For example, lack of interpretation services and the literacy to pass a drivers test would constitute as both structural and cognitive barriers.[13]

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.[13] According to the study conducted by Asgary and Segar, patients often do not have the time off work to access healthcare services.[14] They found that refugees often prioritize employment, shelter and food over healthcare services.[14] A book on nursing research states that clinic structure and hours constitute a structural barrier because they overlap with working hours and require long waiting times that exceed what refugees can set aside.[15] The immigrant health project stated that providers are often unable to understand a refugee's specific experiences and style and language of communication.[13] They suggest the inclusion of research based education for providers to better empathize with their patients.[13]

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.[11] Factors such as these exemplify the poor social determinants of health that may lead to adverse health outcomes in resettled refugee populations.

The Healthy Migrant Effect

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The "healthy migrant effect" is a phenomenon wherein first-generation born immigrants arrive in the United States with an overall better quality of health than U.S. born citizens of the same racial or ethnic background.[16] 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.[17] A 2002 study that compared the hospital utilization records and mortality rates of foreign born and U.S. born New York residents discovered that immigrants were healthier and had longer life expectancies than U.S. born citizens.[18] However, structural inequities faced by refugees such as lack of access to housing, employment, education, and healthcare eventually reduce the immigrant health advantage, leaving them with worse health outcomes than the general population.[16]

Financial barriers

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Resettled refugees face financial barriers to food, housing, and healthcare which can result in adverse health outcomes. Data has shown that approximately 21 percent of immigrant children in the U.S. live in poverty as opposed to 14 percent of native-born children.[19] The low socioeconomic status of refugees is associated with numerous health risks such as malnutrition, smoking, injuries, unemployment, family dysfunction, psychosocial stress, and more.[20]

A 2016 study on refugee insurance access stated that financial barriers for refugees made healthcare less accessible and affordable and could include differing state health insurance coverage policies, inadequate income, and insurance restrictions by employers.[21] For the first eight months, most refugees have access to a health insurance called Refugee Medical Assistance (RMA).[22] Other refugees may be eligible for more long term coverage through health insurance plans like Medicaid or the Children's Health Insurance Program, which last for several years.[21] To allow refugees to look for cheaper health insurances, The Affordable Care Act created the Marketplace.[21] According to the 2016 study, policies like the Patient Protection Act and Affordable Care Act have aimed at expanding health insurance coverage to refugees through the Medicaid program or health insurance marketplaces, but healthcare access differ between states because the states have implemented their health insurance programs differently.[21] Research implies that the Department of Health and Human Services could provide subsidies to refugees seeking to purchase health exchanges, and during the screening process, federal agencies could also consider health status when resettling refugees and place them into states with more suitable health insurance policies.[21] According to a 2018 study on healthcare access barriers, though refugees have access to free healthcare services from federally qualified health centers (FQHCs), nonprofit hospitals and General Assistance (GA), specialist care like dentist and eye care are often unaffordable.[23]

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.[24]

References

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  1. ^ Morris, Meghan D.; Popper, Steve T.; Rodwell, Timothy C.; Brodine, Stephanie K.; Brouwer, Kimberly C. (2009). "Healthcare Barriers of Refugees Post-resettlement". Journal of Community Health. 34 (6): 529–538. doi:10.1007/s10900-009-9175-3. ISSN 0094-5145. PMC 2778771. PMID 19705264.
  2. ^ a b c d Carrillo, J. Emilio; Carrillo, Victor A.; Perez, Hector R.; Salas-Lopez, Debbie; Natale-Pereira, Ana; Byron, Alex T. (6 May 2011). "Defining and Targeting Health Care Access Barriers". Journal of Health Care for the Poor and Underserved. 22 (2): 562–575. doi:10.1353/hpu.2011.0037. ISSN 1548-6869. PMID 21551934. S2CID 42283926.
  3. ^ a b c d e Ay, Merve; Arcos González, Pedro; Castro Delgado, Rafael (January 2016). "The Perceived Barriers of Access to Health Care Among a Group of Non-Camp Syrian Refugees in Jordan". International Journal of Health Services. 46 (3): 566–589. doi:10.1177/0020731416636831. PMID 26962004. S2CID 11950354.
  4. ^ Matlin, Stephen A.; Depoux, Anneliese; Schütte, Stefanie; Flahault, Antoine; Saso, Luciano (24 September 2018). "Migrants' and refugees' health: towards an agenda of solutions". Public Health Reviews. 39 (27): 27. doi:10.1186/s40985-018-0104-9. ISSN 0301-0422. PMC 6182765.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  5. ^ Ineza, Darlene; Fairfield, Kathleen. "Barriers to Healthcare Access for New Mainers" (PDF): 1–35. {{cite journal}}: Cite journal requires |journal= (help)
  6. ^ a b Brouwer, Kimberly; Rodwell, Timothy (June 18, 2007). "Assessment Of Community Member Attitudes Towards Health Needs Of Refugees In San Diego" (PDF): 1–119. {{cite journal}}: Cite journal requires |journal= (help)
  7. ^ Downes, Elizabeth; Graham, Anjalie (March 2011). "Health Care for Refugees Resettled in the US". Clinician Reviews. 21 (3): 25–31.
  8. ^ a b Kotovicz, Fabiana; Getzin, Anne; Vo, Thy (2018). "Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists". Journal of Patient-Centered Research and Reviews. 5 (1): 28–35. doi:10.17294/2330-0698.1577. PMC 6664339. PMID 31413994.
  9. ^ a b Asgary, Ramin; Segar, Nora (6 May 2011). "Barriers to Health Care Access among Refugee Asylum Seekers". Journal of Health Care for the Poor and Underserved. 22 (2): 506–522. doi:10.1353/hpu.2011.0047. ISSN 1548-6869. PMID 21551930. S2CID 207267668.
  10. ^ Singer, Audrey; Wilson, Jill (September 2006). "From 'There' to 'Here': Refugee Resettlement in Metropolitan America". The Brookings Institution: 1–31.
  11. ^ a b c Feinberg, I; O’Connor, M H; Owen-Smith, A; Dube, S R (2021-02-18). "Public health crisis in the refugee community: little change in social determinants of health preserve health disparities". Health Education Research. doi:10.1093/her/cyab004. ISSN 0268-1153. PMC 7928937. PMID 33599272.
  12. ^ a b George, Siân; Daniels, Katy; Fioratou, Evridiki (3 April 2018). "A qualitative study into the perceived barriers of accessing healthcare among a vulnerable population involved with a community centre in Romania". International Journal for Equity in Health. 17 (1): 41. doi:10.1186/s12939-018-0753-9. ISSN 1475-9276. PMC 5883264. PMID 29615036.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  13. ^ a b c d e Pereira, Krista; Crosnoe, Robert; Fortuny, Karina; Pedroza, Juan; Ulvestad, Kjersti; Weiland, Christina; Yoshikawa, Hirokazu; Chaudry, Ajay (May 2012). "Barriers to Immigrants' Access to Health and Human Services Programs". ASPE: 1–19.
  14. ^ a b Asgary, Ramin; Segar, Nora (6 May 2011). "Barriers to Health Care Access among Refugee Asylum Seekers". Journal of Health Care for the Poor and Underserved. 22 (2): 506–522. doi:10.1353/hpu.2011.0047. ISSN 1548-6869. PMID 21551930. S2CID 207267668.
  15. ^ Hinshaw, Ada Sue; Feetham, Suzanne L.; Shaver, Joan (1999). Handbook of Clinical Nursing Research. SAGE Publications. ISBN 9781452261881.
  16. ^ a b Fennelly, Katherine (2007-03). "The "healthy migrant" effect". Minnesota Medicine. 90 (3): 51–53. ISSN 0026-556X. PMID 17432759. {{cite journal}}: Check date values in: |date= (help)
  17. ^ Singh, G. K.; Siahpush, M. (2001-03). "All-cause and cause-specific mortality of immigrants and native born in the United States". American Journal of Public Health. 91 (3): 392–399. doi:10.2105/ajph.91.3.392. ISSN 0090-0036. PMC 1446566. PMID 11236403. {{cite journal}}: Check date values in: |date= (help)
  18. ^ Muennig, Peter; Fahs, Marianne C. (2002-09). "Health status and hospital utilization of recent immigrants to New York City". Preventive Medicine. 35 (3): 225–231. doi:10.1006/pmed.2002.1072. ISSN 0091-7435. PMID 12202064. {{cite journal}}: Check date values in: |date= (help)
  19. ^ Edberg, Mark; Cleary, Sean; Vyas, Amita (2011-06-01). "A Trajectory Model for Understanding and Assessing Health Disparities in Immigrant/Refugee Communities". Journal of Immigrant and Minority Health. 13 (3): 576–584. doi:10.1007/s10903-010-9337-5. ISSN 1557-1920.
  20. ^ Kawachi I, Kennedy BP, Wilkinson RG. Society and population health reader, volume i: income inequality and health. New York: The New Press; 1999.
  21. ^ a b c d e Agrawal, Pooja; Venkatesh, Arjun Krishna (2016). "Refugee Resettlement Patterns and State-Level Health Care Insurance Access in the United States". American Journal of Public Health. 106 (4): 662–663. doi:10.2105/AJPH.2015.303017. ISSN 0090-0036. PMC 4816078. PMID 26890186.
  22. ^ "Health Insurance". Office of Refugee Resettlement | ACF.
  23. ^ Ineza, Darlene; Fairfield, Kathleen. "Barriers to Healthcare Access for New Mainers" (PDF): 1–35. {{cite journal}}: Cite journal requires |journal= (help)
  24. ^ Capps R. Hardship among children of immigrants: findings from the national survey of American families. Number B-29 in a series of reports entitled new federalism: national survey of American families. Washington, DC: Urban Institute; 1999.
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