Refugee Health in the United States: A Socio-Cultural Perspective 公开
Mukangu, Doris (Fall 2017)
Abstract
Problem/Background: Very few studies have addressed priority health issues affecting refugee health post-resettlement, especially from a socio-cultural perspective. Herein lies a gap regarding how to adequately address barriers that this unique population encounters in being able to fully utilize the healthcare resources available to them. The uniqueness of this population can be attributed to the fact that they are represented by different ethnicities, languages, literacy levels, educational backgrounds, and sub cultures, to name a few. The United Nations (UN) states the world refugee situation as the worst migration crisis since World War II. “Refugee crisis: More than 200 migrants drown and freeze to death as first fortnight of 2017 sets new record” Dearden, L. (2017, January) The Independent; “Tens of thousands of migrants and refugees are working their way north through the Balkans” Reid. S (2017, July) The Daily Mail…these are examples of many of the headlines that plague the news almost every day. Once these refugees flee their countries, they are typically housed in refugee resettlement camps. Due to limited resources in the camps, refugees have numerous acute and chronic health issues that are not attended to and may often persist post-resettlement. During resettlement, a lot of attention is given to infectious diseases, but very little attention is given to chronic illnesses. Moreover, post-resettlement, follow up for identified diseases may prove to be a challenge due to a myriad of barriers in accessing healthcare. One of the barriers being navigating the medical system in their new home country.
Key Aims: The purpose of this study is to use secondary data to explore refugee health in the United States post-resettlement from a socio-cultural perspective. The second purpose is to examine how the public health community can better deliver healthcare to the thousands of refugees that are resettled in the United States every year. Lastly, this study will explore the various themes that have emerged from various research studies conducted in refugee communities using a SEM theoretical construct.
Methods: A total of 1515 peer reviewed articles with 51 core articles regarding the subject of resettlement and public health are included in this systematic literature review. The aim of this study is to explore priority health issues in the refugee community in the United States post-resettlement and to suggest how service providers can best serve this unique population.
Conclusion: Three themes emerged from the literature related to refugee health issues post-resettlement that pointed to socio-cultural barriers. The results suggest that the public health community should re-evaluate the current methods of providing health care to the refugee community and implement evidence-based interventions from a socio-cultural perspective. A social-ecological model construct is recommended to unearth underlying healthcare challenges in this unique population.
Table of Contents
Chapter 1- Introduction……………………………………………………………… 1
Background…………………………………………………………………… 1
Refugee Resettlement in the United States of America…………………….. 6
Security and Safety Concerns………………………………………………… 6
Volunteer Agencies (VOLAG’S)……………………………………………..... 9
Refugee Resettlement in Clarkston, Georgia………………………………... 11
Education………………………………………………………………………. 13
Employment and Business…………………………………………………….. 13
Theoretical Framework – Social Ecological Model (SEM)…………………. 15
Purpose Statement…………………………………………………………….. 16
Research Question…………………………………………………………….. 16
Significance Statement………………………………………………………... 16
Definition of Terms………………………………………………………….... 18
Acronyms……………………………………………………………………… 20
CHAPTER 2 – Literature Review……………………………………………… 23
Introduction…………………………………………………………………… 23
Background…………………………………………………………………… 24
Health Care in Refugee Camps…………………………....................... 24
Pre-Departure Treatment………………………………………………. 25
Post-Arrival Medical Screening……………………………………….. 25
Major Refugee Health Challenges in the United States……………………. 26
Access to Healthcare ………………………………………………………… 27
Non Communicable and Chronic Diseases………………………………….. 28
Malnutrition……………………………………………………………. 29
Vitamin Deficiency…………………………………………………….. 29
Cancer………………………………………………………………….. 30
Infectious Diseases……………………………………………………………. 31
Tuberculosis……………………………………………………………. 31
Human Immunodeficiency Virus (HIV) AIDS………………………… 32
Hepatitis B……………………………………………………………… 32
Mental Health…………………………………………………………………. 33
Post-Traumatic Stress Disorder (PTSD)……………………………….. 33
Suicide………………………………………………………………….. 34
Disabilities……………………………………………………………… 35
Autism………………………………………………………………….. 35
Female Genital Mutilation/Cutting………………………………………….. 36
Conclusion……………………………………………………………… 37
CHAPTER 3 – Methodology…………………………………………………………. 39
Introduction…………………………………………………………………… 39
Sources………………………………………………………………………..... 39
Themes…………………………………………………………………………. 40
CHAPTER 4 – Results………………………………………………………………. 41
Themes………………………………………………………………………..... 41
Theme l. Culturally and Linguistically Appropriate Services (CLAS)… 41
Theme ll. Contextually Tailored Programs……………………………… 44
Theme lll. Collaborative Approach……………………………………… 45
Table of Findings……………………………...................................................... 48
Analysis………………………………………………………………………….. 56
CHAPTER 5 – Discussion……………………………………………………………… 58
Introduction……………………………............................................................... 58
Key Study Findings……………………………………………………………… 59
Individual Level…………………………………………………………… 59
Interpersonal Level……………………………………………………….. 60
Community Level…………………………………………………………. 61
Organizational Level………………………………………………………. 62
Policy Level……………………………………………………………….. 64
Limitations………………………………………………………………………. 66
Implications……………………………………………………………………… 66
Conclusion……………………………………………………………………….. 66
Recommendations………………………………………………………………….67
References…………………………………………………………………………………..68
LIST OF FIGURES
Figure 1. Refugee Resettlement Worldwide by Country of Origin…………………………3
Figure 2. Refugee Resettlement Process to the United States………………………………..4
Figure 3. Refugee Resettlement Process upon arrival in the United States………………,,,10
Figure 4. Clarkston Residents and its Population of Refugees and Immigrants from around the World…..………………………………………………………………………….10
Figure 5. Social Ecological Model……………………………………………………….…....15
LIST OF TABLES
Table 1. FGM…………………………………………………………………………………..37
Table 2. Finding………………………………………………………………………………..48
Table 3. Levels of Social Ecological Model…………………………………………...58
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