Migration, Neighbours and Health: The intersection of geography and wellbeing

Migration, Neighbours and Health: The intersection of geography and wellbeing Bruce Newbold School of Geography & Earth Sciences newbold@mcmaster.ca x27948 January 2014

Refugee health and health care use • Discussion today reflects: • Statistical analysis of large, national data sets (LSIC, NPHS) • Series of key informant interviews and focus groups / interviews with refugees and service providers in Hamilton • Results capture difficulties refugees face…

Journey to Health • Health issues / needs within refugee population more than sum of parts, and reflects their own journeys: • Pre-Journey • Journey: In Transit • Refugee Camps • Journey to Canada • Post Arrival-Health Care: Challenges for Provider and Client

Pre-Journey • Health status and health care may be compromised by conflict, cultural roles and expectations, environmental conditions, loss of family members who provide security, income or food, limited budgets, and poverty. “But I have to say that people in my country had never seen a doctor because they live in villages that were too far away from the city, we only had five hospitals in the whole country at that time.” (#500)

Journey: In Transit • Being a refugee starts with the act of fleeing their home in search of safety and starting on a precarious journey with no certain end point • Lack of health care during journey = disrupted care and management of health • Violence “The process of that journey from where they were exiting to where they are landing has interrupted the management of [care]”

Refugee Camps • Interim settlement in ‘safe’ refugee camps – far from reality: • Violence common in camps • Health care - should be equivalent to host country, but frequent lack of access to care and/or interrupted care and management • Impact on children via disruption / separation of family • Time in camp – food, water, shelter, security reality “If they come from a refugee camp there will be a different health status. [Depending] on how long they have been in the camp.” (#502)

Journey to Canada • Length of journey • Starting over in host country “I think all immigrants and refugees share a level of migration stress. The big difference with refugees is the experience of persecution or trauma and the fact that they often arrive with far less resources and they didn’t choose to come. I mean the fact that this wasn’t in their life plan, is huge. I mean it’s a huge difference.”(#507)

Post-Arrival Health & Health Care • Health care providers challenged by the lack of continuity of care amongst refugees, along with different levels, types, and availability of health care over the journey • Barriers to health care on arrival “The other barriers are just an absence of continuity around health information from previous experiences. And not having that understanding of what actually has happened. You have to construct, sometimes, many times reconstruct and, in most cases we listen to families and to the people.” (#505)

Refugee Health: National Perspectives • LSIC: suggestive of needs within this population. • Refugees are: • More likely to have greater health needs as measured by SAH, physical health, and mental health issues • More likely to experience declines in health than economic or family-class immigrants • Experience more rapid declines in health than economic or family-class immigrants • At greater risk if a visible minority

Refugee Health: Hamilton Perspectives • Barriers to care (i.e., language, cost, knowledge, and social roles) assume greater role amongst refugees (compared to immigrants) • Lack of ‘basics’: stress for providers and refugees alike • Access to food, shelter, transportation, and employment were ranked as high or higher than access to health care services per se. • Lack of access to primary health care and/or interrupted services • Refugees have more tenuous contact to health care than immigrants • Lack of resources for women, children, and mental health

Refugee Health: Hamilton Perspectives • Refugees have lower use and more tenuous contact to health care than immigrants • Disjointed health coverage and funding formulas for programs and services: • Refugee settlement as a Federal Issue, Health Care is a Provincial Issue, and Social Assistance is a municipal issue. • Individual health coverage is also problematic: • Removal of IFHP • May not have access to OHIP • Expensive private insurance options

Refugee Health: Hamilton Perspectives • Provider perspective: the diversity of refugee origins, cultures, and legal status can make the provision of health care equally difficult. • Providers need to be aware of the history and background of their clients and the various health insurance programs available to refugees while providing culturally competent care. • But, lack of available cultural information and health records, limited budgets, jurisdictional issues • Stressed and overloaded organizations

Conclusions • Bottom line:health care difficult to access and receives low priority

Questions?

Migration, Neighbours and Health: The intersection of geography and wellbeing