Refugee Status and Health

Refugee Status and Health

Michigan is home to about 40,040 refugees who have resettled in the state since 2008 (1), mainly originating from Iraq, Syria, and Democratic Republic of Congo (2). Substantial refugee populations reside in major city centers of Michigan, especially in metro-Detroit (3), Dearborn (3), and Lansing (4). Refugees face unique health challenges due to pre- and post-migration stressors (Fig. 1), such as violence that prompted migration and language barriers upon arrival3. These challenges influence both mental and physical health outcomes.

A social and political climate hostile to refugees and immigrants can exacerbate such stressors. National policy decisions, most notably various iterations of the “Muslim Ban” (Executive Orders 13769 and 13780) (5), increased enforcement actions from border patrol and Immigrations and Custom Enforcement (ICE) (6), and stricter limits to the number of refugees the U.S. will accept (7) have already begun to shape Michigan’s refugee population at the state level.

While Michigan welcomed the 4th most refugees of all U.S. states in 2016, it now ranks 13th for number of refugee resettlements. Refugee resettlements, or transfers of refugees to the United States for permanent residence, are at their lowest levels in Michigan since 2006 (1). Demographically, numbers of refugees from Middle Eastern countries such as Iraq and Syria have dramatically decreased (1,5) and higher proportions of resettled refugees in the last three years originate from the Democratic Republic of the Congo. While Congolese refugees do not have the same level of establishment in Michigan as Middle Eastern refugees, Congolese communities in Grand Rapids and Lansing are growing (7).

Though refugees are not subject to deportation by ICE or border patrol, the increase in enforcement activities can be a stressor that contributes to poor health outcomes for the wider community, especially since such activities are often conducted on the basis of racial profiling (8,9) rather than evidence. Even singular raids can be associated with lower self-rated health and higher immigration enforcement stress at the local level (8) and low birth weight for both immigrant and U.S.-born Latina mothers at the state level (9) according to studies surveying Latino populations. The entirety of Michigan lies within the “100-mile border zone” that falls under border patrol jurisdiction (10) making it easier to carry out raids and other enforcement activities. The latest reports suggest Michigan has the second highest rate of ICE arrests of immigrants (6).

Figure 1. Model for the various ways in which refugee status impacts health.

The Michigan Department of Health & Human Services (MDHHS) offers the Refugee Assistance program to help those admitted into the United States as refugees that meet a certain eligibility become self-sufficient post-arrival. Among their services they promote healthcare through the Kent County Health Department, the Ingham County Health Department, and the Arab-American and Chaldean Council (ACC). The MDHHS also offers health screenings in geographic areas of major resettlement through the ACC, the Calhoun County Health Department, the Ingham County Health Department, the Kent County Health Department, and the Jewish Family Services of Washtenaw County. (11) Currently, refugee services in Michigan that receive the most support focus on the English language and translation while refugee services that receive the least support are in healthcare. This lack of healthcare access to refugee communities is mainly due to an inequitable program allocation and geographical distribution of resources across the state, availability of funding, and a shortage of staff that are qualified to meet the needs of these communities. Healthcare in the United States is largely “family-based” which presents additional challenges to refugees such as adults that have yet to be naturalized with U.S.-born children, or those having some children born in the U.S. and others born in another country.

Call to Action

Healthcare workers can improve accessibility to healthcare for local refugee communities by being specific in target funding, collaborating with diverse perspectives (e.g. grant writers, leaders in the community, and service providers), develop priority services within specific geographical regions, collaborate between service organizations, and lead advocacy efforts at a local, state, and national level. To limit a lack of access, it is also essential for healthcare workers to know to what capacity aid organizations can fulfill locally as the quality and types of services available differ drastically from institution to institution. Health professionals in Michigan can aid in advocacy work by partnering with local organizations that support immigrant and refugee populations - especially those that face high socioeconomic disparities. Some current examples include the Michigan Immigrants Rights Center, the Arab Community Center for Economic and Social Services (ACCESS), the Children's Hospital of Michigan Hamtramck School-Based Health Center (HSBHC), the Office of Global Michigan, Global Detroit, and Welcoming Michigan.

References

*Augmented text for the example boxes in Fig. 1.

Figure 1 References