Hurdles to Health: Immigrant and Refugee Health Care in Australia
Murray, Sally B., Skull, Sue A., Australian Health Review
Refugees and asylum seekers face a number of barriers to accessing health care and improved health status. These include language difficulties, financial need and unemployment, cultural differences, legal barriers and a health workforce with generally low awareness of issues specific to refugees. Importantly, current Australian government migration and settlement policy also impacts on access to health and health status. An adequate understanding of these 'hurdles to health' is a prerequisite for health providers and health service managers if they are to tailor health care and services appropriately. We include tables of available resources and entitlements to health care according to visa category to assist providers and managers.
Aust Health Rev 2004: 29(1): 25-29
IT HAS BEEN SHOWN THAT refugees are particularly vulnerable to poor health1 and that they often experience hurdles that limit or prevent their access to health care. These hurdles include cultural and language differences, an inadequately prepared workforce, and legal and economic barriers. As Australia receives about 12000 humanitarian entrants each year, an adequate understanding of the hurdles faced by refugees and asylum seekers is a prerequisite for health providers and health service managers to tailor management and service provision appropriately.
Hurdle one: economics and employment
Refugees face financial barriers that influence health and health care in a number of ways. Unemployment is common among newly arrived refugees, and those who do attain employment are often employed in low paying jobs or casual employment.2 Income loss or threat of dismissal can result in reduced willingness to take time off from work to access health care.3 Migrant workers are also more likely to accept employment in hazardous occupations.4
Perceived or actual cost of health care also limits access for refugee and migrant patients.5,6-9 This is compounded for most by a lack of knowledge of the right to access bulk-billing or other 'no cost' services.
Hurdle two: cultural difference
Diverse belief systems exist related to health, wellness and illness. These influence healthseeking behaviour, including attitudes to preventive and curative care, attitudes to providers, and expectations of the health care system.5,7,10-13 A lack of health care providers from culturally and linguistically diverse groups further limits the incorporation of cultural understandings into available health care.
Hurdle three: language difficulties
Provision of translated materials and translating services are fundamental to responsive health service delivery.5,7,8,11,12,14 Data from the Adult Migrant English Program (AMEP) suggest that over 70% of entrants with the Humanitarian Program and almost 60% of entrants in the Family Migration Program have few or no English skills on arrival in Australia.15
Communication skills affect knowledge of disease, compliance and satisfaction with health treatment, and access to health care.11,12,16,17 Accessing trained interpreters with appropriate language skills is key, although this is not always adequately funded, particularly for emerging communities.18
Hurdle four: an under-trained workforce
Training of health personnel in issues specific to refugee health has been recognised as a priority in refugee health care.7,8,14 Factors that have been identified as important for an adequately equipped workforce include an awareness of: health and welfare needs of refugees; available interpreting services; other resources available to assist refugees such as Migrant Resource Centres; and opportunities for interagency work so that holistic care is achieved.5,7,19-22 These are key to ensure the expectations of patients are met and trust is established. Establishing trust requires providers to be equipped to deal with issues of trauma, torture, and persecution, which by definition humanitarian entrants have suffered before arrival. …