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Blukacz A, Oyarte M, Cabieses B. Adequate housing as a social determinant of the health of international migrants and locals in Chile between 2013 and 2022. BMC Public Health 2024; 24:2021. [PMID: 39075425 PMCID: PMC11285377 DOI: 10.1186/s12889-024-19491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Adequate housing is a fundamental right and a social determinant of health. It also represents a historically contentious topic in Latin America. Migratory flows to Chile have become increasingly precarious in the past few years, limiting opportunities for adequate housing, with potential repercussions on the health of international migrants and the general population. This study aims to analyse adequate housing as a social determinant of health among international migrants and locals between 2013 and 2022 in Chile. METHODS Observational cross-sectional study based on repeated versions of the nationally representative Socioeconomic Characterization Survey in Chile. Adequate housing indicators adapted from the United Nations Housing Rights Programme guidelines were analyzed with relation to individual health, distinguishing between the local and international migrant populations. Logistic regression models were fitted for housing indicators with migration as the main independent variable and for short-term and long-term healthcare needs in locals and immigrants with housing as the main dependent variables. Models were adjusted for sociodemographic variables and considered the complex sample design. RESULTS Descriptive findings indicated higher availability of services and infrastructure among international migrants, and a disadvantage for habitability, location, and affordability by quintiles compared to locals. Logistic regression models, adjusting for demographic variables, revealed significant associations between migration status and overcrowding (OR 6.14, 2022), poor housing materiality (OR 5.65, 2022) and proximity to healthcare centres (OR 1.4, 2022) compared to locals. Experiencing hazardous situations consistently predicted short-term healthcare needs in both migrants (OR = 1.4, 2022) and locals (OR = 2.8, 2022). Overcrowding predicted both long and short-term healthcare needs among locals across the years and long term needs among migrants in 2013 and 2015. CONCLUSIONS We found significant inequities in adequate housing between migrant populations and locals in Chile, and some inequities among both populations based on structural socioeconomic deprivation. Experiencing hazardous situations emerged as a social determinant of health among international migrants in 2022, potentially suggesting growing challenges related to social exclusion in urban areas. However, limitations such as exclusion criteria of the survey and sample sizes for data on the migrant population potentially suggest that housing challenges and their impact on health are underestimated.
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Affiliation(s)
- Alice Blukacz
- Centro de Salud Global Intercultural, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo y Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile
| | - Marcela Oyarte
- Unidad de estudios, Instituto de Salud Pública (ISP), Santiago, Chile
| | - Báltica Cabieses
- Centro de Salud Global Intercultural, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo y Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile.
- Department of Health Sciences, University of York, York, UK.
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Ziersch A, Walsh M, Due C. Housing and health for people from refugee and asylum-seeking backgrounds: findings from an Australian qualitative longitudinal study. BMC Public Health 2024; 24:1138. [PMID: 38654272 DOI: 10.1186/s12889-024-18616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND For people from asylum-seeking and refugee backgrounds, housing and the re-establishment of home are key social determinants of health. Research highlights the inequities faced by asylum seekers and refugees in the housing markets of high-income resettlement countries, resulting in their overrepresentation in precarious housing. There is also emerging evidence of the relationship between housing and health for this population relating to lack of affordability, insecurity of tenure, and poor suitability (physical and social). The mechanisms by which housing impacts health for this group within these housing contexts, is however, understudied - especially overtime. This qualitative longitudinal study aimed to address this gap. METHODS Semi-structured interviews were conducted with 25 people from asylum-seeking and refugee backgrounds in South Australia, recruited through a community survey. Thematic analysis of interview data across three time points over three years identified four material and psychosocial mechanisms through which housing contributed to health outcomes via psychological and physical stressors - physical environment; stability; safety; and social connections, support and services. The study also identified additional health promoting resources, particularly elements of ontological security. The dynamics of these indirect and direct mechanisms were further illuminated by considering the impact of international, national and local contexts and a range of intersecting social factors including gender, country/culture of origin, family circumstances, immigration status, language skills, income, and health status. CONCLUSIONS Rebuilding a sense of home and ontological security is a key resettlement priority and crucial for wellbeing. More comprehensive strategies to facilitate this for refugees and asylum seekers are required.
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Affiliation(s)
- Anna Ziersch
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia.
| | - Moira Walsh
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia
| | - Clemence Due
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia
- School of Psychology; University of Adelaide, Adelaide, Australia
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3
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Phung B. Caring for resettled refugee children in the United States: guidelines, challenges and public health perspectives. Front Public Health 2023; 11:1046319. [PMID: 37818302 PMCID: PMC10561301 DOI: 10.3389/fpubh.2023.1046319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/07/2023] [Indexed: 10/12/2023] Open
Abstract
The global refugee crisis has become an urgent, pressing humanitarian issue, with an estimated 37 million children forcibly displaced from their homes due to conflict, persecution, violence and other human rights violations by mid-2022. Of these children, only a small percentage are eligible for resettlement in a new country. This narrative review examines the physical health needs of resettled refugee children (RRC) in the United States. By analyzing nutrition and growth, infectious diseases, and general health care/screening measures, a set of comprehensive, evidence-based guidelines and public health perspectives are formulated to facilitate ongoing discussion to ensure that RRC receive equitable health care access. An urgent call to action emphasizes cross-border collaboration between governments, public health experts, refugee populations, and disease preparedness authorities in order to prioritize the physical health of RRC. This review will provide primary care providers, public health professionals, social service workers, and community advocates with up-to-date recommendations to meet the health needs of RRC in the U.S.
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Affiliation(s)
- Binh Phung
- Department of Pediatrics, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
- Department of Epidemiology and Public Health, Yale University, New Haven, CT, United States
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Yashadhana A, Alloun E, Serova N, de Leeuw E, Mengesha Z. Place-making and its impact on health and wellbeing among recently resettled refugees in high income contexts: A scoping review. Health Place 2023; 81:103003. [PMID: 36966669 DOI: 10.1016/j.healthplace.2023.103003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/28/2023]
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5
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Ziersch A, Due C, Walsh M. Housing in Place: Housing, Neighbourhood and Resettlement for People from Refugee and Asylum Seeker Backgrounds in Australia. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2023; 24:1-24. [PMID: 36855611 PMCID: PMC9950696 DOI: 10.1007/s12134-023-01008-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 03/02/2023]
Abstract
Housing is an important part of building a new life for people from refugee and asylum seeker backgrounds. However, relatively little is known about how housing and neighbourhood experiences affect resettlement and integration. This paper explored experiences of housing and neighbourhood for refugees and asylum seekers in South Australia, Australia. A survey was completed by 423 participants, recruited through service providers, community networks and snowball sampling. Data was analysed using frequencies, chi-square analyses and multivariate logistic regression. The study identified aspects of housing and neighbourhood that were important to participants, as well as highlighting key problems. Housing satisfaction and neighbourhood satisfaction were positively associated, but housing satisfaction was lower than neighbourhood satisfaction. Both were significantly associated with overall satisfaction with life in Australia, although only neighbourhood satisfaction remained significant in the final multivariate model (alongside region of origin, visa and financial situation). Overall, the findings suggest that where housing is situated may be more important for resettlement satisfaction and integration than the housing itself. Policy and practice implications of the findings are discussed, alongside considerations for conceptualising integration.
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Affiliation(s)
- Anna Ziersch
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Clemence Due
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Moira Walsh
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Brake TM, Dudek V, Sauzet O, Razum O. Psychosocial Attributes of Housing and Their Relationship With Health Among Refugee and Asylum-Seeking Populations in High-Income Countries: Systematic Review. Public Health Rev 2023; 44:1605602. [PMID: 37213704 PMCID: PMC10193459 DOI: 10.3389/phrs.2023.1605602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Objectives: Housing as a social determinant of health should provide not only shelter, but also a feeling of home. We explored psychosocial pathways creating a sense of home and influencing the relationship between housing and health among asylum seekers and refugees (ASR) in high-income countries. Methods: We performed a systematic review. To be included, studies had to be peer-reviewed, published between 1995 and 2022, and focus on housing and health of ASR in high-income countries. We conducted a narrative synthesis. Results: 32 studies met the inclusion criteria. The psychosocial attributes influencing health most often identified were control, followed by expressing status, satisfaction, and demand. Most attributes overlap with material/physical attributes and have an impact on ASR's mental health. They are closely interconnected with each other. Conclusion: Psychosocial attributes of housing play an essential role in the health of ASR; they are closely associated with material/physical attributes. Therefore, future research on housing and health of ASR should routinely study psychosocial attributes, but always in association with physical ones. The connections between these attributes are complex and need to be further explored. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021239495.
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Ermansons G, Kienzler H, Asif Z, Schofield P. Refugee mental health and the role of place in the Global North countries: A scoping review. Health Place 2023; 79:102964. [PMID: 36628805 DOI: 10.1016/j.healthplace.2023.102964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
Post-migration factors significantly influence refugee mental health. This scoping review looks at the role of place in refugee mental health. We included 34 studies in Global North high-income countries that elaborated on the place characteristics of facilities, neighbourhoods, urban and rural areas, and countries. While the role of place remains under-theorised, all studies reveal common characteristics that support a strong relationship between place of residence, refugee mental health and wellbeing outcomes in post-migration context. Given that refugees often have little or no choice of where they ultimately live, we suggest future research should focus on how characteristics of place co-constitute post-migration refugee mental health risks, protections, and outcomes.
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Affiliation(s)
- Guntars Ermansons
- Department of Global Health & Social Medicine, School of Global Affairs, King's College London, 40 Aldwych, Bush House (NE), London, WC2B 4BG, UK.
| | - Hanna Kienzler
- Department of Global Health & Social Medicine, School of Global Affairs, King's College London, 40 Aldwych, Bush House (NE), London, WC2B 4BG, UK.
| | - Zara Asif
- Department of Global Health & Social Medicine, School of Global Affairs, King's College London, 40 Aldwych, Bush House (NE), London, WC2B 4BG, UK.
| | - Peter Schofield
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, 3rd Floor, Addison House, Guy's Campus, London, SE1 1UL, UK.
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Crawford G, Connor E, McCausland K, Reeves K, Blackford K. Public Health Interventions to Address Housing and Mental Health amongst Migrants from Culturally and Linguistically Diverse Backgrounds Living in High-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16946. [PMID: 36554827 PMCID: PMC9778908 DOI: 10.3390/ijerph192416946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Migrants from culturally and linguistically diverse (CaLD) backgrounds experience factors that may increase health inequities related to a range of determinants of health including housing and mental health. However, the intersection between mental health and housing for migrants is poorly understood. A scoping review searched four academic databases for concepts related to cultural and linguistic diversity, housing conditions, and public health interventions to address homelessness. A total of 49 articles were included and seven key themes identified: housing provision; mental health intersections and interventions; complexity and needs beyond housing; substance use; service provider and policy issues; the role of cultural and linguistic diversity; and consumer experience. The intersection of ethnicity with other social determinants of health and housing was highlighted though there were limited interventions tailored for migrants. Studies generally pointed to the positive impacts of Housing First. Other sub-themes emerged: social connection and community; shame, stigma, and discrimination; health and support requirements; and employment, financial assistance, and income. Consumer choice was identified as vital, along with the need for systemic anti-racism work and interventions. To support secure housing for migrants and mitigate mental health impacts, closer attention is required towards migration factors along with broader, tailored services complementing housing provision.
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Affiliation(s)
- Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA 6845, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Elizabeth Connor
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA 6845, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Karina Reeves
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA 6845, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Krysten Blackford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA 6845, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
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Rana K, Page A, Kent JL, Arora A. Pathways Linking Housing Inequalities and Health Outcomes among Migrant and Refugee Populations in High-Income Countries: A Protocol for a Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16627. [PMID: 36554503 PMCID: PMC9779591 DOI: 10.3390/ijerph192416627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Several high-income countries are currently experiencing an unprecedented and multifaceted housing crisis. The crisis is escalating rapidly, and its negative ramifications are shared disproportionately by migrant and refugee communities. Although housing is often cited as an important social determinant of health, the relationship between housing inequalities and health outcomes in the context of migrant and refugee populations remain under-explored, particularly in high-income countries. This paper presents a protocol for a mixed-methods systematic review which will synthesize the evidence on the key housing and health inequalities faced by migrant and refugee populations in high-income countries. It will inform the identification of pathways linking housing inequalities to health outcomes. The protocol for this systematic review was developed with guidance from the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews using a convergent integrated approach to synthesis and integration, and the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement. Quantitative, qualitative and mixed-methods studies reporting the association of housing inequalities with physical and mental health outcomes among refugee and migrant populations in high-income countries will be included. Medline, Web of Science, Embase, PsycINFO, Scopus and CINAHL will be searched for peer-reviewed literature. This will be supplemented by gray literature searches using Google Scholar, MedNar and WHOLIS. Two reviewers will independently screen and select studies, assess the methodological quality and conduct data extraction. This systematic review will elucidate the different pathways linking housing inequalities and health outcomes, which may guide the development of targeted housing and public health interventions to improve the health and wellbeing of migrant and refugee populations. The review is registered with PROSPERO (CRD42022362868).
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Affiliation(s)
- Kritika Rana
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Jennifer L. Kent
- The University of Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, NSW 2008, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
- Health Equity Laboratory, Campbelltown, NSW 2560, Australia
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010, Australia
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10
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Conzatti A, Kershaw T, Copping A, Coley D. A review of the impact of shelter design on the health of displaced populations. JOURNAL OF INTERNATIONAL HUMANITARIAN ACTION 2022; 7:18. [PMID: 37519834 PMCID: PMC9425791 DOI: 10.1186/s41018-022-00123-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/22/2022] [Indexed: 08/01/2023]
Abstract
There are currently millions of displaced people encamped in low-quality shelters that jeopardise the health of these displaced populations. These shelters, which exhibit poor thermal regulation and air quality, are often inhabited by households for several years. Recently, the internal environment of shelters has been recognised as a determinant of the health of the occupants and the indoor air quality (IAQ) and internal temperatures have been identified as critical factors affecting occupants' health. Attempts by researchers and private companies to develop healthier shelter solutions have mainly prioritised factors such as rapid deployment, transportability and sustainability. Via a systematic bibliometric analysis of the existing literature, this review examines the impact of shelters' internal environment on occupant health. Self-reports and building simulation are the most common methodologies reported in the literature, but there is a disconnect between the reported shelter issues and their impact on health. This is likely due to the multifaceted and site-specific factors analysed. Indoor air quality, thermal comfort and overcrowding are the most commonly identified shelter issues, which are strongly related to the presence of infectious and airborne diseases. An analysis of the available literature indicates that there is still a lack of clear guidance linking shelter quality to health. Moreover, evidence of the impact of shelters on health is harder to find, and there is a gap regarding the metrics and the methodology used to evaluate shelter quality. Therefore, further research is necessary to provide evidence of the impact of shelter design on health through transdisciplinary approaches.
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Affiliation(s)
- Anna Conzatti
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
| | - Tristan Kershaw
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
| | - Alexander Copping
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
| | - David Coley
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
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Li N, Li RYM, Yao Q, Song L, Deeprasert J. Housing safety and health academic and public opinion mining from 1945 to 2021: PRISMA, cluster analysis, and natural language processing approaches. Front Public Health 2022; 10:902576. [PMID: 36117599 PMCID: PMC9472747 DOI: 10.3389/fpubh.2022.902576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/25/2022] [Indexed: 01/22/2023] Open
Abstract
Housing safety and health problems threaten owners' and occupiers' safety and health. Nevertheless, there is no systematic review on this topic to the best of our knowledge. This study compared the academic and public opinions on housing safety and health and reviewed 982 research articles and 3,173 author works on housing safety and health published in the Web of Science Core Collection. PRISMA was used to filter the data, and natural language processing (NLP) was used to analyze emotions of the abstracts. Only 16 housing safety and health articles existed worldwide before 1998 but increased afterward. U.S. scholars published most research articles (30.76%). All top 10 most productive countries were developed countries, except China, which ranked second (16.01%). Only 25.9% of institutions have inter-institutional cooperation, and collaborators from the same institution produce most work. This study found that most abstracts were positive (n = 521), but abstracts with negative emotions attracted more citations. Despite many industries moving toward AI, housing safety and health research are exceptions as per articles published and Tweets. On the other hand, this study reviewed 8,257 Tweets to compare the focus of the public to academia. There were substantially more housing/residential safety (n = 8198) Tweets than housing health Tweets (n = 59), which is the opposite of academic research. Most Tweets about housing/residential safety were from the United Kingdom or Canada, while housing health hazards were from India. The main concern about housing safety per Twitter includes finance, people, and threats to housing safety. By contrast, people mainly concerned about costs of housing health issues, COVID, and air quality. In addition, most housing safety Tweets were neutral but positive dominated residential safety and health Tweets.
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Affiliation(s)
- Na Li
- Rattanakosin International College of Creative Entrepreneurship, Rajamangala University of Technology Rattanakosin, Bangkok, Thailand
- College of Computer Science and Information Engineering, Qilu Institute of Technology, Jinan, China
| | - Rita Yi Man Li
- Sustainable Real Estate Research Center, Department of Economics and Finance, Hong Kong Shue Yan University, Hong Kong, Hong Kong SAR, China
| | - Qi Yao
- School of Literature and Journalism, Chongqing Technology and Business University, Chongqing, China
| | - Lingxi Song
- Chakrabongse Bhuvanarth International Institute for Interdisciplinary Studies, Rajamangala University of Technology Tawan-Ok, Bangkok, Thailand
| | - Jirawan Deeprasert
- Rattanakosin International College of Creative Entrepreneurship, Rajamangala University of Technology Rattanakosin, Bangkok, Thailand
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Coulburn L, Miller W. Prevalence, Risk Factors and Impacts Related to Mould-Affected Housing: An Australian Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1854. [PMID: 35162876 PMCID: PMC8835129 DOI: 10.3390/ijerph19031854] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
In response to an Australian governmental inquiry into biotoxin-related illness, the purpose of this integrative review is to bring together the current state of evidence on the prevalence, risk factors and impacts related to mould-affected housing in an Australian context, in order to inform building, housing and health research, practice and policy. The robust integrative review methodology simultaneously sought quantitative and qualitative studies and grey literature from multiple disciplines, identifying only 45 studies directly relating to Australian housing and indoor mould. Twenty-one studies highlight negative health impacts relating to indoor residential mould, with asthma, respiratory, allergy conditions and emerging health concerns for chronic multiple-symptom presentation. The majority of studies reported risk factors for indoor mould including poor housing conditions, poor-quality rental accommodation, socioeconomic circumstance, age-related housing issues and concerns for surface/interstitial condensation and building defects in newer housing. Risks for indoor mould in both older and newer housing raise concerns for the extent of the problem of indoor mould in Australia. Understanding the national prevalence of housing risks and "root cause" associated with indoor mould is not conclusive from the limited existing evidence. Synthesis of this evidence reveals a lack of coverage on: (1) national and geographical representation, (2) climatical coverage, (3) housing typologies, (4) housing defects, (5) maintenance, (6) impact from urbanisation, and (7) occupant's behaviour. This integrative review was key in identifying emerging housing and health concerns, highlighting gaps in data and implications to be addressed by researchers, practice and policy and acts as a comprehensive holistic review process that can be applied to other countries.
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Affiliation(s)
- Lisa Coulburn
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Wendy Miller
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia
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Abstract
The impact of COVID-19 on various aspects of our life is evident. Proximity and close contact with individuals infected with the virus, and the extent of such contact, contribute to the intensity of the spread of the virus. Healthy and infected household members who both require sanctuary and quarantine space come into close and extended contact in housing. In other words, housing and living conditions can impact the health of occupants and the spread of COVID-19. This study investigates the relationship between housing characteristics and variations in the spread of COVID-19 per capita across Sweden’s 290 municipalities. For this purpose, we have used the number of infected COVID-19 cases per capita during the pandemic period—February 2020 through April 2021—per municipality. The focus is on variables that measure housing and housing conditions in the municipalities. We use exploratory analysis and Principal Components Analysis to reduce highly correlated variables into a set of linearly uncorrelated variables. We then use the generated variables to estimate direct and indirect effects in a spatial regression analysis. The results indicate that housing and housing availability are important explanatory factors for the geographical spread of COVID-19. Overcrowding, availability, and quality are all critical explanatory factors.
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Walther L, Rayes D, Amann J, Flick U, Ta TMT, Hahn E, Bajbouj M. Mental Health and Integration: A Qualitative Study on the Struggles of Recently Arrived Refugees in Germany. Front Public Health 2021; 9:576481. [PMID: 34805055 PMCID: PMC8599120 DOI: 10.3389/fpubh.2021.576481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Forcibly displaced people are at particular risk of mental health problems and also face specific integration challenges upon resettlement. Existing literature suggests that there may be a bidirectional relationship between mental health and integration. The present study seeks to understand the relationship between integration processes and mental health problems or significant negative emotional experiences among adult refugees in Germany. Method: Applying a qualitative approach, we conducted 54 semi-structured interviews with refugees and asylum seekers who arrived in Germany between 2013 and 2018 currently residing in Berlin, Leipzig, or the Duisburg area in North Rhine-Westphalia. Data was collected between December 2018 and September 2019. We analyzed transcripts inductively using thematic analysis. Results: Five themes covering the various links between integration and mental health problems or significant negative emotional experiences were identified. First, we found that the mental health consequences of past adverse experiences, as well as ongoing worries about those left behind in the homeland, can seriously impede refugees' ability to pursue activities key to integration. Second, the process of applying for and securing asylum can result in uncertainty and fear, which, in turn, burden the individual and may impact motivation for integration. Third, many of our participants described mental health ramifications related to feeling stuck and thwarted in the pursuit of building a life, especially in securing employment. Fourth, some participants described feeling so overwhelmed by fundamental tasks throughout the integration process, namely, language learning and bureaucratic processes, that these take a psychological toll. Fifth, we identified several forms of social disconnection between refugees and members of the host community due to xenophobia, social and cultural differences, physical and emotional isolation in refugee camps, as well as with co-nationals and fellow refugees. Negative emotions, mistrust, and socio-cultural differences that emerge throughout the integration processes seem to erode social cohesion among refugee communities, potentially further threatening mental health. Conclusion: Mental health problems and integration processes appear to be closely related across different areas of integration. Innovative solutions to challenges identified by members of the refugee community in Germany stand to benefit mental health and integration outcomes simultaneously.
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Affiliation(s)
- Lena Walther
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Diana Rayes
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Julia Amann
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Uwe Flick
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
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15
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Bernardi L, Gotlib IH, Zihnioğlu Ö. Effects of COVID-19-related life changes on mental health in Syrian refugees in Turkey. BJPsych Open 2021; 7:e182. [PMID: 34659792 PMCID: PMC8503067 DOI: 10.1192/bjo.2021.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mental disorders are currently the greatest global health burden. The coronavirus diseases 2019 (COVID-19) pandemic is having an adverse impact on people's mental health, particularly in vulnerable populations, such as refugees. AIMS The present study was designed to examine the association between COVID-19 and changes in mental health in Syrian refugees in Turkey. METHOD We conducted a two-wave panel survey of a representative sample of 302 of the estimated 500 000 Syrian refugees (ages 18 and older) living under humanitarian support in Istanbul (first wave between 9 and 15 July 2020 and the follow-up between 11 and 14 September 2020). We administered seven items from the CoRonavIruS Health Impact Survey in addition to one-context specific item about life changes because of COVID-19, and measures of depression (10-item Center for Epidemiologic Study Depression Scale, CESD-10), anxiety (6-item State-Trait Anxiety Inventory, STAI-6) and perceived stress (Perceived Stress Scale, PSS-4). RESULTS A factor analysis yielded three COVID-19 factors, labelled 'social relationships', 'stress' and 'hope.' We conducted a series of cross-lag panel analyses to test associations between the COVID-19 factors and mental health. We found associations between all COVID-19 factors and CESD-10, between COVID-19 'stress' and STAI-6, and between COVID-19 'stress' and COVID-19 'hope' and PSS-4. CONCLUSIONS Our measures of life changes because of the COVID-19 pandemic are associated with changes in the mental health of Syrian refugees living in Istanbul. It is therefore important that they are provided with services to reduce what may be particularly debilitating consequences of COVID-19.
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16
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Aljadeeah S, Wirtz VJ, Nagel E. Cross-sectional survey to describe medicine use among Syrian asylum seekers and refugees in a German federal state: looking beyond infectious diseases. BMJ Open 2021; 11:e053044. [PMID: 34588262 PMCID: PMC8479972 DOI: 10.1136/bmjopen-2021-053044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of our study was to describe medicine use and document self-reported diseases or conditions for which medicines were used among Syrian asylum seekers and refugees (AS&Rs) in the German state of North Rhine-Westphalia (NRW). We examined in this study differences in the use of medicines among different age and sex groups of the study participants. SETTING Fifteen different refugee shared accommodation centres in the greater Cologne area, a community centre with a language school and consultation office, and other places frequented by the Syrian community. PARTICIPANTS Syrian AS&Rs registered in NRW and residing in the city of Cologne or surrounding areas. PRIMARY OUTCOME MEASURES The prevalence of using at least one medicine in the 7 days preceding data collection, and the use of prescribed medicines and self-medication. RESULTS Of the 1641 Syrian AS&Rs who took part in our study, the overall 7-day prevalence of medicine use was 34.9%. Among adults, headache and hypertension were the most common indications that led to medicine use. By dose, hypertension (954 doses) and diabetes (595 doses) were the first and second most frequent indication. Among children, fever and cough were the most common indication; ibuprofen and hederae helicis folium preparations were the most used medicines. Low prevalence was found of medicine use for the treatment of either infectious diseases or mental disorders. CONCLUSION Among the Syrian AS&Rs in NRW who participated in the study, non-communicable diseases (NCDs) were common presumed causes of use of medication among adults. We encourage future studies to pay more attention to NCDs medicine use among AS&Rs. Researchers should also consider reaching AS&Rs who live in private housing and not limit studies only to newly arrived AS&Rs who live in shared accommodation centres.
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Affiliation(s)
- Saleh Aljadeeah
- Institute of Medical Management and Health Science, University of Bayreuth, Bayreuth, Germany
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Eckhard Nagel
- Institute of Medical Management and Health Science, University of Bayreuth, Bayreuth, Germany
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17
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Cooper B, Behnke NL, Cronk R, Anthonj C, Shackelford BB, Tu R, Bartram J. Environmental health conditions in the transitional stage of forcible displacement: A systematic scoping review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 762:143136. [PMID: 33153751 DOI: 10.1016/j.scitotenv.2020.143136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
In 2019, 30,000 people were forced to leave their homes due to conflict, persecution, and natural disaster each day. Eighty-five percent of refugees live in developing countries, and they often face underfunded and inadequate environmental health services. Many displaced persons live in camps and other temporary settlements long after the displacement event occurs. However, there is little evidence on environmental health conditions in the transitional phase-defined by the United Nations High Commissioner for Refugees as six months to two years after displacement. To address this gap in research, we conducted a systematic scoping review of environmental health conditions, exposures, and outcomes in transitional displacement settings, as well as reported obstacles and recommendations for improvement. Eighty-eight publications met the inclusion criteria. Water supply was the most frequently discussed environmental health topic. Overcrowding was the most common risk factor reported, Vibrio cholerae was the most common pathogen reported, and diarrhea was the most commonly reported health outcome. Obstacles and recommendations were categorized as institutional, political or implementation-based. Identified knowledge gaps included minimal information on setting logistics and on topics such as menstrual hygiene, oral hygiene and fomite contamination. In order to improve environmental health conditions in transitional displacement settings, all levels of government and non-governmental organizations should increase collaboration to improve resource provision. This study is the first to report on environmental health conditions in this important time of transition between the emergency and protracted stages of displacement.
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Affiliation(s)
- Brittany Cooper
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Nikki L Behnke
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Ryan Cronk
- ICF, 2635 Meridian Pkwy Suite 200, Durham, NC 27713.
| | - Carmen Anthonj
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States; Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands
| | - Brandie Banner Shackelford
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Raymond Tu
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Jamie Bartram
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States; School of Civil Engineering, University of Leeds, Woodhouse Ln, Woodhouse, Leeds LS2 9DY, United Kingdom
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18
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Charania NA, Paynter J, Lee AC, Watson DG, Turner NM. Vaccine-Preventable Disease-Associated Hospitalisations Among Migrant and Non-migrant Children in New Zealand. J Immigr Minor Health 2021; 22:223-231. [PMID: 30945094 DOI: 10.1007/s10903-019-00888-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Migrants may experience a higher burden of vaccine-preventable disease (VPD)-associated hospitalisations compared to the host population. A retrospective cohort study from 2006 to 2015 was conducted that linked de-identified data from government sources using Statistic NZ's Integrated Data Infrastructure. VPD-related hospitalisations were compared between three cohorts of children from birth to 5 years old: foreign-born children who migrated to NZ, children born in NZ of recent migrant mothers, and a comparator group of children born in NZ without a recent migration background. VPD-related hospitalisation rates were higher among NZ-born non-migrant children compared to NZ-born migrant and foreign-born children for all of the diseases of interest. For instance, 5.21% of NZ-born non-migrant children were hospitalised at least once due to all-cause gastroenteritis compared to 4.47% of NZ-born migrant children and only 1.13% of foreign-born migrant children. The overall hospitalisation rate for NZ-born non-migrant children was 3495 hospitalisations per 100,000 person years. Among children with migrant backgrounds, higher hospitalisation rates were noted among those of Pacific ethnicity and those with refugee backgrounds. Those arriving on Pacific visa schemes were hospitalised at rates ranging from 2644/100,000 person years among foreign-born migrant children and 4839/100,000 person years among NZ-born migrant children. Foreign-born quota refugee children and NZ-born children of quota refugee mothers were hospitalised at a rate of 4000-5000/100,000 person years. It is important to disaggregate migrant data to improve our understanding of migrant health. Children need to be age-appropriately vaccinated, and other individual and environmental factors addressed, to reduce the risk of infectious diseases.
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Affiliation(s)
- Nadia A Charania
- Department of Public Health, Auckland University of Technology, 640 Great South Road, Manukau, Auckland, 2025, New Zealand.
| | - Janine Paynter
- Department of General Practice and Primary Health Care, University of Auckland, 261 Morrin Road, St. Johns, Auckland, 1072, New Zealand
| | - Arier C Lee
- Section of Epidemiology and Biostatistics, University of Auckland, 261 Morrin Road, St. Johns, Auckland, 1072, New Zealand
| | - Donna G Watson
- Department of General Practice and Primary Health Care, University of Auckland, 261 Morrin Road, St. Johns, Auckland, 1072, New Zealand
| | - Nikki M Turner
- Department of General Practice and Primary Health Care, University of Auckland, 261 Morrin Road, St. Johns, Auckland, 1072, New Zealand
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19
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Hoare T, Vidgen A, Roberts NP. How do people seeking asylum in the United Kingdom conceptualize and cope with the asylum journey? Med Confl Surviv 2020; 36:333-358. [PMID: 33280427 DOI: 10.1080/13623699.2020.1849960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
People seeking asylum experience traumatic events and psychological difficulties in country-of-origin, in 'flight', and during re-settlement. Research with this population has focussed on using quantitative methods to examine psychopathology from exposure to traumatic events, and there is a paucity of qualitative research exploring subjective experiences of this population throughout their asylum journey. Few studies have examined ways asylum seekers might cope with such events. This study aimed to address this gap by employing Constructivist Grounded Theory to understand the ways people seeking asylum conceptualize and cope with their experiences across the asylum process. Semi-structured interviews were conducted with eleven people seeking asylum accessing a third sector mental health project and/or primary-care health service. Four main themes emerged from the data: 'Before Asylum', 'Displacement', 'Identity in the UK' and 'Reflections on the Future'. The stress of the asylum system and adaptation to new environments are core aspects of the theory, along with an exploration of how people cope with these circumstances, via internal psychological strategies and external support sources. Prior experiences (including the development of 'inner strength') impacted upon how participants conceptualized their everyday experiences, and this shaped their considerations for the future. Service implications are discussed.
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Affiliation(s)
- Thomas Hoare
- Child & Family Psychology Department, Aneurin Bevan University Health Board , Newport, UK
| | - Andrew Vidgen
- Rehabilitation and Recovery Service, Adult Mental Health Services, Cardiff and Vale UHB , Cardiff, UK
| | - Neil P Roberts
- Traumatic Stress Service, Cardiff and Vale UHB , Cardiff, UK.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University , Cardiff, UK
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20
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Ziersch A, Miller E, Baak M, Mwanri L. Integration and social determinants of health and wellbeing for people from refugee backgrounds resettled in a rural town in South Australia: a qualitative study. BMC Public Health 2020; 20:1700. [PMID: 33187489 PMCID: PMC7663864 DOI: 10.1186/s12889-020-09724-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There has been a recent focus on resettlement of migrants and refugee in rural settings in Australia and elsewhere. Rural resettlement is seen as an opportunity to revitalise rural communities, to fill the needs of employers in these areas, and to provide a welcoming community within which new arrivals can integrate and settle. However, challenges to rural resettlement have been identified including difficulties securing employment, discrimination and social isolation. These challenges can affect resettlement outcomes including health and wellbeing, though relatively little research has examined these links. In this paper we explored experiences of people from refugee background settling in a rural Australian town, examining interconnections between social determinants of health (SDH) and integration. METHODS Face-to-face interviews were conducted with 44 participants from Southeast Asia and Africa in a rural setting in South Australia, covering experiences of resettlement and impacts on health and wellbeing. Participants were recruited through existing connections within the community and snowball sampling. Audio recorded data were transcribed verbatim and analysed using framework thematic analysis. RESULTS The study findings revealed a mixture of settlement experiences for participants across a range of elements of SDH and integration. A sense of safety and some elements of social connectedness and support were key enablers for integration and health and wellbeing, with main challenges including limitations in employment opportunities, mismatched education provision, experiences of discrimination and constrained access to services. CONCLUSIONS Challenges experienced by refugees resettled in rural areas can affect integration, health and wellbeing and subsequent onward migration intentions. Attention to broader socioeconomic, cultural and environmental conditions, alongside tailored settlement support policies and practices for individual rural resettlement sites, is required to support integration and health and wellbeing.
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Affiliation(s)
- Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Emily Miller
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Melanie Baak
- School of Education, University of South Australia, St Bernards Rd, Magill, SA 5072 Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
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21
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Salman K, Turek JM, Donovan C. Community Health and Wellness Fair: A strategy for Assessment of Social Determinants of Health, Inclusion and Engagement of Newcomers. J Community Health 2020; 46:527-537. [PMID: 32725370 DOI: 10.1007/s10900-020-00901-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Community health fair has been used informally as a way of offering health promotion, education, and screening services onsite to underserved and hard to reach populations such as the newcomers. To utilize an annual health fair for the assessment of the overall perception of health status of newcomers in relation to the determinants of health; and to evaluate its effectiveness as an intervention to engage attendees in their community. The 3rd Annual refugees and immigrant's health and wellness resources fair in Allegheny County. A cross sectional study was designed using questionnaires focused on the health and social determinants of health, with few open-ended questions related to engagement and networking. A total of 107 individuals participated in the study. The age ranged between 18-75 years, 46.9% males and 53% females. The largest representations from Bhutan, Arab Middle Eastern countries, and Ghana. Perception of health was examined in relation to other determinants such as language, regular checkups, employment, income, education, access to health, and psychosocial needs. Results revealed that health perception varied by ethnicity, was influenced by English proficiency, access to health, employment, and regular checkups, while education, and income did not show an impact. A qualitative analysis to the narrative responses revealed that the health fair was very effective in breaking the structural barriers with providers as well as for community engagement. The annual health fair was a successful strategy in the assessment of the health determinants and for community engagement of the newcomers.
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Affiliation(s)
- Khlood Salman
- Duquesne University, 600 Forbes Ave., Pittsburgh, PA, 15286, USA.
| | - Jaime M Turek
- Northern Area Multi Service Center, Community Assistance and Refugee Resettlement Department, 209 13th St, Pittsburgh, PA, 15215, USA
| | - Caley Donovan
- Refugee Caseworker, JFCS Refugee & Immigrant Services, 5743 Bartlett Street, Pittsburgh, PA, 15217, USA
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22
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Kavian F, Mehta K, Willis E, Mwanri L, Ward P, Booth S. Migration, Stress and the Challenges of Accessing Food: An Exploratory Study of the Experience of Recent Afghan Women Refugees in Adelaide, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1379. [PMID: 32098027 PMCID: PMC7068606 DOI: 10.3390/ijerph17041379] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/16/2022]
Abstract
This study explored the migration and food experiences of Afghani women refugees residing in Adelaide, South Australia for 2 years or less. In-depth semi-structured qualitative interviews were conducted with 10 women between May and September 2017. The data were thematically analysed, and the Social Determinants of Health Framework was used to discuss the findings. Five key themes emerged from the data. In the transition country (Iran/Pakistan), respondents experienced (i) trauma, discrimination and exclusion and (ii) familiar food culture, but food stress. In the destination country (Adelaide, Australia) respondents experienced (iii) a sense of precariousness, (iv) unfamiliar food culture and (v) challenges in accessing halal food. Afghani refugees experienced considerable stressors both in the transition and the final destination country but for different reasons. In the transition country, stresses related to the lack of social services and support, discrimination, racism and poverty seemed to have affected their ability to afford food. In Australia stressors pertaining to socioeconomic, housing and employment precariousness, as well as difficulties in accessing halal foods were identified as challenges. Furthermore, food stress in Australia was associated with the cultural appropriateness of food, the complexity of the food system, and the women's lack of skills and experiences in navigating the food system. With increasing refugee and immigration flows globally, it is necessary to acknowledge how food and social determinants intersect for refugee immigrants to ensure positive health outcomes.
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Affiliation(s)
- Foorough Kavian
- College of Nursing and Health Sciences, Flinders University, GPO Box, Adelaide 2100, Australia; (F.K.); (K.M.); (E.W.)
| | - Kaye Mehta
- College of Nursing and Health Sciences, Flinders University, GPO Box, Adelaide 2100, Australia; (F.K.); (K.M.); (E.W.)
| | - Eileen Willis
- College of Nursing and Health Sciences, Flinders University, GPO Box, Adelaide 2100, Australia; (F.K.); (K.M.); (E.W.)
| | - Lillian Mwanri
- College of Medicine & Public Health, Flinders University, GPO Box, Adelaide 2100, Australia; (L.M.); (P.W.)
| | - Paul Ward
- College of Medicine & Public Health, Flinders University, GPO Box, Adelaide 2100, Australia; (L.M.); (P.W.)
| | - Sue Booth
- College of Medicine & Public Health, Flinders University, GPO Box, Adelaide 2100, Australia; (L.M.); (P.W.)
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23
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Ziersch A, Due C, Walsh M. Discrimination: a health hazard for people from refugee and asylum-seeking backgrounds resettled in Australia. BMC Public Health 2020; 20:108. [PMID: 31992261 PMCID: PMC6986068 DOI: 10.1186/s12889-019-8068-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Research has shown that discrimination is harmful to health, but there is relatively little known about discrimination experienced by people from refugee and asylum-seeking backgrounds in resettlement countries and associated health effects. This qualitative-focused mixed methods paper reports on discrimination experienced by refugees and asylum seekers, responses to discrimination, and impacts on health. Methods As part of a broader study of housing, social inclusion and health, surveys were completed by 423 adult refugees and asylum seekers living in South Australia who had been in Australia for up to 7 years. The survey included questions on discrimination based on skin colour, ethnicity and religion, as well as questions on hope, trust, belonging, sense of control and health (including the SF-8). Semi-structured interviews were conducted with 65 survey participants, purposively sampled by visa status, continent and gender, further exploring experiences of discrimination. These and survey open-ended responses were analysed thematically. Results Twenty-two percent of survey participants reported experiences of discrimination since arriving in Australia (14% in the last year), and 90% of these felt that discrimination had harmed their health. Key settings of discrimination were public transport, within the neighbourhood, and in relation to employment. Those who reported discrimination had significantly worse mental health (p < .000) but not physical health. Discrimination was also associated with less sense of belonging (p = .001), lower levels of trust (p = .038), reduced sense of control (p = .012) and less hope (p = .006). Incidents described in interviews and the open-ended survey responses included incivility, physical assault, and denial of services, experienced across intersecting characteristics of race/ethnicity, religion, gender and visa status. Responses to discrimination spanned affective, cognitive and behavioural dimensions, ranging across types of experience, participant characteristics and context, with most individuals reporting multiple response types. While some of the responses were reported by participants as protective of health, participants’ reflections indicated significant negative impacts on mental health in particular. Conclusion Discrimination featured in the resettlement experiences of a significant number of refugees and asylum seekers, with participants reporting clear negative impacts on mental health. Addressing discrimination is a key resettlement and health issue requiring urgent action.
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Affiliation(s)
- Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Clemence Due
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.,School of Psychology Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Moira Walsh
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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24
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Vukčević Marković M, Kovačević N, Bjekić J. Refugee Status Determination Procedure and Mental Health of the Applicant: Dynamics and Reciprocal Effects. Front Psychiatry 2020; 11:587331. [PMID: 33551863 PMCID: PMC7855454 DOI: 10.3389/fpsyt.2020.587331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Maša Vukčević Marković
- Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia.,PIN-Psychosocial Innovation Network, Belgrade, Serbia
| | | | - Jovana Bjekić
- PIN-Psychosocial Innovation Network, Belgrade, Serbia.,Institute for Medical Research, University of Belgrade, Belgrade, Serbia
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25
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Dietrich H, Al Ali R, Tagay S, Hebebrand J, Reissner V. Screening for posttraumatic stress disorder in young adult refugees from Syria and Iraq. Compr Psychiatry 2019; 90:73-81. [PMID: 30763787 DOI: 10.1016/j.comppsych.2018.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/29/2018] [Accepted: 11/04/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In January 2016, 2057 refugees from civil war-torn Syria and Iraq, aged 18.0 to 24.9 years, were first-time entrants into the German unemployment register and thus potentially eligible for the labor market. Civil war and forced migration may affect individuals' mental health. Traumatic experiences in particular are assumed to represent a major barrier, e.g., to labor-market integration. This study aimed to screen the rates of posttraumatic stress disorder (PTSD). Former refugee studies have reported PTSD screening rates between 3% and 44%. METHOD A total of 8.5% (N = 175 of 2057) of respondents were randomly interviewed either by telephone or web-based interviews. A total of 84 respondents (48% out of 175 respondents) were screened using the Essen Trauma Inventory (ETI) based on the DSM-IV, and 91 (52%) respondents used the Short Screening Scale for Posttraumatic Stress Disorder (SSS-PSD). All respondents were additionally questioned regarding psychological impairment (Symptom Checklist 10) and health status (Short Form 12). RESULTS Of the respondents, 59.4% reported at least one traumatic experience. The percentage of positive PTSD screenings obtained using the ETI was 9.5% (N = 84) and 6.6% (N = 91) using the SSS-PSD. The percentage of positive PTSD screenings obtained with both screening instruments was 8% (N = 175; 95%-CI: 3.9% to 12.1%). A total of 19.4% of the subjects were above the SCL-10 cut-off for psychiatric caseness. DISCUSSION The PTSD rate in this sample was in the average range compared to previous estimates from large samples of refugees. Psychiatric caseness was high. The results should be considered for planning labor-market integration programs and the design of supportive schemes.
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Affiliation(s)
- Hans Dietrich
- Institute for Employment Research (IAB), Regensburger Str. 104, 90478 Nürnberg, Germany.
| | - Radwan Al Ali
- Universitätsklinikum des Saarlandes und Medizinische, Fakultät der Universität des Saarlandes, Kirberger Straße 100, 66421 Homburg, Germany.
| | - Sefik Tagay
- University of Duisburg-Essen, Department of Psychosomatic Medicine and Psychotherapy, Virchowstr. 174, 45147 Essen, Germany.
| | - Johannes Hebebrand
- University of Duisburg-Essen, Department of Child and Adolescent Psychiatry and Psychotherapy, Wickenburgstr. 21, 45147 Essen, Germany.
| | - Volker Reissner
- University of Duisburg-Essen, Department of Child and Adolescent Psychiatry and Psychotherapy, Wickenburgstr. 21, 45147 Essen, Germany.
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Gewalt SC, Berger S, Szecsenyi J, Bozorgmehr K. "If you can, change this system" -Pregnant asylum seekers' perceptions on social determinants and material circumstances affecting their health whilst living in state-provided accommodation in Germany - a prospective, qualitative case study. BMC Public Health 2019; 19:287. [PMID: 30866874 PMCID: PMC6417255 DOI: 10.1186/s12889-019-6481-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/25/2019] [Indexed: 11/25/2022] Open
Abstract
Background Pregnant women and new mothers seeking asylum are highly vulnerable and have special needs, yet there is dearth of research related to this group in Germany. This paper reports on material circumstances and behavioural factors as social determinants of asylum seekers’ health during pregnancy and early motherhood. The study aim was to gain in-depth insights into these women’s experiences and perceived needs with a focus on material circumstances whilst living in state-provided accommodation in one federal state in Southern Germany. Methods A qualitative, prospective approach was taken with individual semi-structured interviews of participants during pregnancy and up to the six-week postnatal assessment, aiming at interviewing each woman twice during pregnancy and once after giving birth. Two female interviewers performed interviews assisted by female professional interpreters on the telephone. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to perform content analysis of interview material. Results 21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Content analysis of women’s perceived health-related needs revealed significant health challenges due to considerable constraints in two major themes each with associated categories: a) material circumstances and b) behavioural factors. Participants’ experiences of living conditions included significant challenges in terms of housing and neighbourhood quality e.g. poor hygiene standards with fear of disease and restless sleep due to threats of violence. Consumption potential was severely limited because of a minimal living allowance. Food was a major preoccupation for all participants. Catering services in state-provided accommodation were perceived as unsatisfactory and neglecting religious practices. Institutional food provided adequate calorific intake but participants reported loss of appetite due to bland food, limited variety, little choice and unfamiliar tastes. Self-catering was prohibited further exacerbating this problem. Conclusions Pregnant asylum seekers and new mothers living in state-provided accommodation experienced major restrictions related to material circumstances in this study. Key results identified housing and neighbourhood quality, consumption potential and nutrition as social determinants of health which women perceived to adversely affect their health, especially during pregnancy and early motherhood. Electronic supplementary material The online version of this article (10.1186/s12889-019-6481-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Claudia Gewalt
- Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Sarah Berger
- Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Gewalt SC, Berger S, Ziegler S, Szecsenyi J, Bozorgmehr K. Psychosocial health of asylum seeking women living in state-provided accommodation in Germany during pregnancy and early motherhood: A case study exploring the role of social determinants of health. PLoS One 2018; 13:e0208007. [PMID: 30592728 PMCID: PMC6310271 DOI: 10.1371/journal.pone.0208007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/09/2018] [Indexed: 11/18/2022] Open
Abstract
Background Pregnant women and new mothers seeking asylum are subject to major challenges that may affect their health and increase their vulnerability. The study aim was to investigate asylum seeking women’s experiences and perceived needs during pregnancy and early motherhood whilst living in state-provided accommodation in one federal state in Southern Germany, with a particular focus on psychosocial factors. Methods In this exploratory case study, individual semi-structured interviews were conducted with participants in pregnancy and up to the six-week postnatal assessment. Two female interviewers performed interviews assisted by female professional interpreters. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to content analysis of interview material. Results 21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Women shared experiences and perceived consequences on their psychosocial health. The following five key themes were identified during content analysis: a) psychosocial stressors, b) stressful living circumstances, c) stressful relationships, d) social support and e) coping styles. Psychosocial factors were a significant source of mental stress for participants, especially due to future uncertainties linked with the asylum seeking process. Living circumstances were also marked by stressors including a lack of privacy, verbal and physical threats and experiences of powerlessness. Further strain and emotional pressure were caused by stressful relationships with the unborn child’s father. Social support and personal coping styles provided relief for some participants. Conclusions This study provides in-depth insights into the experiences and perceived needs of pregnant asylum seekers and new mothers living in state-provided accommodation. Key results identified psychosocial factors such as future uncertainties, stressful living circumstances and stressful relationships, as social determinants of health that were perceived to adversely affect women’s health. Adequate social support and individual coping styles increased resilience and counterbalanced psychosocial stressors during the asylum seeking process.
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Affiliation(s)
- Sandra Claudia Gewalt
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Sarah Berger
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sandra Ziegler
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Ziersch A, Due C. A mixed methods systematic review of studies examining the relationship between housing and health for people from refugee and asylum seeking backgrounds. Soc Sci Med 2018; 213:199-219. [PMID: 30142501 DOI: 10.1016/j.socscimed.2018.07.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/28/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022]
Abstract
Housing is an important social determinant of health and a key element of refugee integration into countries of resettlement. However, the way in which housing may affect mental and physical health for refugees and asylum seekers has not been systematically examined. This systematic review aimed to explore the effects of housing on health and wellbeing for this population, in order to identify key pathways for public health interventions. The review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Social Care Institute for Excellence (SCIE) guidelines. We identified publications through a search of Medline, PsychInfo, Scopus, Web of Science, Embase, CINAHL, Cohrane Library, Google, ProQuest, OpenGrey, MedNar and WHOLIS. Eligibility criteria included: publication in English between 1997 and 2017, with findings pertaining to the relationship between housing and health for refugees and/or asylum seekers. Out of 2371 items, 25 papers were included with a further five identified through reference lists. Eleven of the papers explored housing and health for those refugees and asylum seekers living within refugee camps, with 19 focusing on countries of resettlement. All studies identified housing issues for refugees and asylum seekers, with physical housing conditions particularly poor in refugee camps, and issues of affordability, suitability, insecure tenure and mobility as well as difficulties securing housing also highlighted in countries of resettlement. Consistent relationships were found between physical aspects of housing and physical and mental health, with other aspects of housing such as safety and overcrowding linked to mental health. There were a number of methodological issues with most of the studies, making it difficult to specify precise pathways. However, improvements to housing quality particularly in refugee camps, and targeted housing interventions more generally for refugees and asylum seekers would likely have an important public health benefit.
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Affiliation(s)
- Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, SA, 5001, Australia.
| | - Clemence Due
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, SA, 5001, Australia; School of Psychology, University of Adelaide, SA, 5001, Australia.
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