The uses of psychosocial epidemiology in promoting refugee health

Mental health in complex emergencies

Mental health is becoming a central issue for public health complex emergencies. In this review we present a culturally valid mental health action plan based on scientific evidence that is capable of addressing the mental health effects of complex emergencies. A mental health system of primary care providers, traditional healers, and relief workers, if properly trained and supported, can provide cost-effective, good mental health care. This plan emphasises the need for standardised approaches to the assessment, monitoring, and outcome of all related activities. Crucial to the improvement of outcomes during crises and the availability to future emergencies of lessons learned from earlier crises is the regular dissemination of the results achieved with the action plan. A research agenda is included that should, in time, fill knowledge gaps and reduce the negative mental health effects of complex emergencies.

Refugee families during asylum seeking

The mental health of refugee families with children during the asylum period is a neglected research area in psychiatry. The present paper describes the situation of 10 refugee families residing at an asylum centre in Finland. Case vignettes are presented to illustrate the situations of these families. The study shows a high rate of depressive and post-traumatic stress disorder-related symptoms among adult refugees. The case vignettes suggest that during the asylum period, many children and adult members of the family are not in a post-traumatic situation, but they live constantly in a distressing situation. The foremost distress amongst the asylum seekers appeared to be fear of deportation and separation from family members. Most of the adults and all children had not received any psychiatric or psychotherapeutic assessment or treatment. It is likely that current procedures for dealing with the asylum seekers contributes to the level of stress, family confusion and psychiatric problems in already traumatized refugee families.

Public health nihilism vs pragmatism: history, politics, and the control of tuberculosis

Tuberculosis (TB) began to decline in the Western world in the mid- to late 1800s. In the United States, the disease receded until the mid-1980s, when that trend was reversed. Although the TB epidemic in the United States subsided in response to public health interventions, it sparked a controversy regarding the relative value of targeted public health measures vs broad social reform. That controversy, which echoed earlier debates calling for structural reform over public health programs, was further strengthened by the historical and demographic studies of Thomas McKeown. His influential thesis maintains that clinical and primary prevention efforts had little effect on TB mortality. In this paper, the historical literature is used to examine whether public health had a significant impact on the decline of TB mortality rates in several countries. Specifically, the paper describes the arguments for and data affirming the efficacy of 2 major public health interventions over time: segregation of those infected with pulmonary TB and eradication of bovine TB. This review finds support for the hypothesis that public health measures, along with other factors, led to falling rates of TB mortality beginning in the late 19th century.