How Public Health Systems Can Better Support Refugees: A Study on Migrant Health

Violent military conflict, unstable political regimes, human rights violations, widespread poverty, and environmental disasters have fueled current global instability to unprecedented levels, resulting in the highest number of displaced persons since World War II. Among the 79.5 million people who have been displaced worldwide, about two-thirds come from Syria, Iraq, South Sudan, the Central African Republic, and Myanmar. The United Nations High Commissioner for Refugees (UNHCR) estimated a total of 1.1 million refugees from Myanmar specifically since the Rohingya refugee crisis escalated in 2017. Myanmar has been greatly affected by conflict between the country’s army and ethnic armed groups, beginning shortly after their independence in 1948. Political repression is rampant. With a military regime that has been in place for many decades, ethnic minorities such as the Rohingya Muslim community are more vulnerable to systemic oppression and violence within Myanmar. The region is also especially vulnerable to natural disasters like floods and landslides. For Burmese migrants, pull factors, including employment opportunities, higher wages, improved physical security, and better healthcare make receiving countries like Australia a viable resettlement destination. Refugees flee their home countries in search for security and safety, but often experience significant health challenges between displacement and integration, repatriation, or resettlement.

As a whole, refugee groups have been found to have poorer health outcomes compared to those from non-refugee backgrounds. A lack of access to healthcare in a person’s home country can present a myriad of challenges. Language barriers and low health literacy often obstruct migrants from receiving proper health care because they are unable to adequately communicate with their physician in the countries they immigrate to. If they are unfamiliar with how to access health care systems they may not seek services at all, and inaccessibility is compounded if there is also a lack of transportation. Differences in cultural beliefs and practices can further the dissonance between patients and physicians and influence how refugees view health care and the appropriate treatments.

A community based participatory research study conducted at the Swinburne University of Technology was developed in collaboration with members from the Myanmar migrant community to investigate the social determinants of health and experiences of Myanmar refugees in Australia. Community based participatory research (CBPR) emphasizes the recognition of community strengths and keeps, and the study’s design was based on a foundation of safety, trustworthiness, choice, collaboration, and empowerment for this group. The design of the study acknowledged the emotionally difficult process of migrating and the potential for participants to be re-traumatized through their engagement in research. By directly involving the participants in the research design, the community was able to use their agency to discuss topics they wanted to in a focus group setting. This method helped to account for the public health problems of local relevance and relate to multiple social determinants of health impacting this particular community.

The study’s findings about health from the perspectives of the Myanmar refugees centered around themes of their migration journey, social connection, work, and education. Participants explained that navigating personal health was challenging due to the cultural transition between the healthcare system in Myanmar and that of Australia. Accessing healthcare in their home country is difficult because the government offered little to no services, especially for those who lived in small villages. Australia has a more structured healthcare system that offered services upon the participants’ arrival, and while these were immediately accommodating, cultural differences in healthcare affected their ability to take full advantage of it. Prescriptions were not required for medication in Myanmar, and they had to adapt to the limitations of obtaining medication in Australia. In addition, participants said it was difficult acclimating to the appointment system and locating medical specialty offices for referrals. Procedural and geographic differences were a barrier to receiving healthcare services. Their health was also dependent on finding and sustaining work to support a healthy lifestyle. Migrating presented issues of linguistic barriers, lack of relevant experience, and travel limitation, making it difficult to find feasible jobs. Participants rely on government welfare support to pay for essential and immediate expenses like food, and healthcare, but the aid was not enough to bar financial challenges. Financial distress from unemployment negatively affected participants’ health as it deterred them from buying healthy foods and decreased their physical activity. Social connections and community engagement proved to be a crucial factor in maintaining good physical and mental health. Participants shared that being part of a close-knit community is culturally significant, and sought out communities of the same ethnicity upon arrival. Eventually, participants’ communities expanded to a multi-ethnic Myanmar community as they found support from attending ethnically organized events, celebrations, sports, and church. Social connections also provided resources for new arrivals; participants said they would share local resources for food, social opportunities for exercise, and tips on navigating the healthcare systems.

As healthcare systems continue to evolve, the development of studies and programs to assist refugees in achieving access to timely and appropriate health care needs to become a priority. Cultural awareness and sensitivity on the part of healthcare providers is necessary for identifying the misalignments of health care with cultural beliefs and treating patients accordingly. When presenting treatment options, it is important for health care providers to offer informed consent to patients, religious and cultural consideration. A failure to do so could damage the provider-patient relationship, create distrust in the healthcare system, and lead to nonadherence. In addition, allocating resources and funds to agencies that aid refugees with guidance in adhering to appointments and treatment plans can enhance their ability to maneuver the healthcare system. Reforming health insurance coverage to be more accessible for those with lower income is another crucial aspect of ensuring better access to healthcare for new refugees.

Migration is a complicated demographic pattern and causes a variety of effects ranging from socio-political barriers to actual physical consequences. In the case of the migration of refugees from Myanmar, there are a number of social, political, and economic factors at play that can heavily influence the lives of these newly settled refugees. It is vital that refugees do not lose their personal descriptions of culture and community, as this proves to be a hugely beneficial social factor that can increase their overall health and wellness. Specifically, the social networks that migrants bring with them or create play an important role in the ways that migrant health may manifest in receiving countries across the globe. Providing medical care for resettled migrants requires an understanding of the historic biosocial conditions, and a culturally competent approach to the individual and the community. Receiving countries must work cooperatively to ensure safe passage for displaced individuals, adequately fund refugee aid, and integrate responses to meet the long-term social, health, and economic needs of refugees. Expanding legal protections for refugees, funding multilateral organizations to improve transitory living conditions with a focus on public health, and developing systems of data sharing to spread innovative approaches and promote accountability are all necessary steps to take. By tailoring research and primary care services to meet the needs of refugee populations and promote independence through culturally and trauma-informed approaches, the integration of social services with primary clinical care is possible. Within the context of this study, it is also clear that involving members of the community of interest as researchers is hugely important for understanding how to change health behaviors.

Sources:

Wong, C., White, C., Thay, B., & Lassemillante, A. (2019, December 23). Living a Healthy Life in Australia: Exploring Influences on Health for Refugees from Myanmar. Retrieved November 9, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982124/