What does the literature have to say about…
This article is part of a series summarizing research conducted in Canada related to refugee health and settlement. This segment is focused on:
BARRIERS TO HEALTH CARE
Research studies have unveiled a number of barriers that stand in the way of refugees having excellent access to health care services. Refugees are not the only group to experience challenges in accessing the Canadian health care system; however, refugees can be considered an especially vulnerable group meaning these barriers take on a new level of urgency (1) . Three components are explored here; Access, Culture, and Challenges for Health Care Providers
Many barriers relate specifically to how refugees are able or unable to access health care. Let’s break down some of what is involved in seeking health care services:
Language barriers are one type of challenge that can be present at each stage noted above. Not speaking or understanding English means that each of these steps becomes increasingly difficult (1–3). Written information about health is also difficult to find in languages that are native to refugee newcomers (4). Language interpreters can help overcome this language challenge; however, interpreters are not always available, and when they are, they usually are only present for Step 3 in the process above (2,3).
In our health care system, hospitals and clinics often rely on the ability to contact patients with additional information after they have completed their visit. This if often achieved through a phone call, however, refugee newcomers may not have access to permanent, reliable phone numbers meaning reaching them via the telephone can be nearly impossible (5). If they are contactable, the language barrier may prevent communication through the phone.
Regardless of whether or not language is a barrier, moving between different care providers such as seeing a specialist or being sent to a different facility for x-ray services is another access barrier. Canada does not have good integration between various sectors and health care providers (6). This is challenging for many people – refugees included.
In cases where a refugee newcomer is able to meet with and understand a health provider, cultural differences can be another type of barrier. Around the world, health is understood differently; Mental health is one example.
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Mental health concerns can be common for individuals, such as refugees who have lived through difficult experiences prior to fleeing their homes. In Canada, we consider mental health to be part of the health care system.
Some countries in the world, however, consider mental health to be a family-centered concern rather than a medical issue, and therefore would not seek out or appreciate intervention from health professionals on this topic.
In addition, Canada largely understands health to be biomedical – meaning health care is focused more on biological factors, rather than considering environmental or social influences. This understanding of health is not necessarily common around the world, and represents another way that culture can influence experiences with health care (3).
Finally, refugee patients have experienced racism in interactions with health care providers.Cases have been documented where individuals have experienced insensitive, ignorant, and inferior health care due to race. This often means, understandably so, that individuals are less likely to visit a doctor when it is required (7).
Challenges for Health Care Providers
Research has also shown that challenges are present for health care providers trying to help refugee patients. Some refugees are covered under a special form of health insurance from the federal government, called the Interim Federal Health Program.
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The way that health care providers receive reimbursement for their services with this plan is complicated, and extra work is required compared to patients under the provincial health insurance plan (8).
Doctors often rely on previous medical records, or a patient ‘chart’ to help them understand health concerns. For refugee newcomers, these patient charts are often unavailable or incomplete (9). Physicians also struggle to communicate with people who speak a different language, and can be dissuaded by this and more complex health concerns that refugees can have (1,7,10).
By Emma Bartel and Craig Carter-Edward, WelcomeHomeTO co-founder.
Understanding the barriers that prevent excellent access to health care for people who arrive in Canada as refugees helps to see where there is room for improvement. Education campaigns could help health care practitioners better understand the unique needs of refugee patients, and the cultural differences that may be present in their visit. Interpretation services could be expanded to ensure that patients have support at each of the 4 steps shown in the diagram above. Patient charts could be better shared across health care providers, and the Interim Federal Health Program could be improved to make things simpler for healthcare providers.
Some innovative solutions are being created and adapted to fill this service gap. As an example, iamsick.ca, a digital healthcare platform that helps Canadians find the care they need when and where they need it, translated their popular healthcare app into Arabic. This tool is helping Syrian refugees better connect with the specialized care they need in their new community.
WelcomeHomeTO is actively mapping out these areas of opportunity and seeking partners with the ability and interest to help fill these gaps. To learn more or to connect with the WHTO team, please reach out to us at firstname.lastname@example.org.
Emma Bartel is a health care and refugee advocate. Emma has research interests in health care systems, program evaluation and social determinants of health. She is currently completing her Master’s degree at the University of Waterloo, focused on how health clinics have organized to support integration and settlement of refugees to Canada.
- McKeary M, Newbold B. Barriers to care: The challenges for Canadian refugees and their health care providers. J Refug Stud. 2010;23(4):523–45.
- Campbell RM, Klei AG, Hodges BD, Fisman D, Kitto S. A comparison of health access between permanent residents, undocumented immigrants and refugee claimants in Toronto, Canada. J Immigr Minor Heal. 2014;16(1):165–76.
- Donnelly TT, Hwang JJ, Este D, Ewashen C, Adair C, Clinton M. If I Was Going to Kill Myself, I Wouldn’t Be Calling You. I am Asking for Help: Challenges Influencing Immigrant and Refugee Women’s Mental Health. Issues Ment Health Nurs. 2011;32:279–90.
- Nicol P, Al-Hanbali A, King N, Slack-Smith L, Cherian S. Informing a culturally appropriate approach to oral health and dental care for pre-school refugee children: a community participatory study. BMC Oral Health [Internet]. 2014;14(1):69. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4061102&tool=pmcentrez&rendertype=abstract
- Merry L, Gagnon A, Kalim N, Bouris S. Refugee claimant women and barriers to health and social services post-birth. Can J Public Heal. 2011;102(4):286–90.
- Joshi C, Russell G, Cheng I-H, Kay M, Pottie K, Alston M, et al. A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination. Int J Equity Health [Internet]. 2013;12(1):88. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3835619&tool=pmcentrez&rendertype=abstract
- Edge S, Newbold B. Discrimination and the Health of Immigrants and Refugees : Exploring Canada’s Evidence Base and Directions for Future Research in Newcomer Receiving Countries. J Immigr Minor Heal. 2012;15:141–8.
- Abdihalim H. Interim Federal Health Program for Refugees : Looking Back and Moving Forward. Univ Ottawa J Med. 2012;1–3.
- Immigration Refugees and Citizenship Canada. Evaluation of the Resettlement Programs ( GAR , PSR , BVOR and RAP ) [Internet]. 2016. Available from: http://www.cic.gc.ca/english/resources/evaluation/resettlement.asp
- Gould G, Viney K, Greenwood M, Kramer J, Corben P. A multidisciplinary primary healthcare clinic for newly arrived humanitarian entrants in regional NSW: model of service delivery and summary of preliminary findings. Aust N Z J Public Health [Internet]. 2010;34(3):326–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20618278