9.13: Immigrant and Refugee Health

after arriving in a new country. Refugees cannot return home due to a well-founded fear of persecution for reasons of race, religion, nationality, political opinion, or membership in a particular social group. Under international law, the United States is obligated to provide refuge to legitimate refuge, just as we would want our citizens to be accepted into refuge elsewhere should our country erupt into civil war. War and civil conflict are the leading causes of refugees feeling their countries. There are sometimes temporary flows of refugees due to natural disasters or climate disasters. Refugees have generally experienced high levels of trauma, and may also present with other health issues or injuries due to the situations they have fled.

The world is experiencing a severe refugee crisis, with an estimated 19.5 million refugees around the globe in 2014. That is not including the people who are "internally displaced," refugees within their own countries, nor even including asylum seekers, who are like refugees but who apply for legal refuge

Asylees (those who receive asylum) also have a well-founded fear of persecution that makes it impossible to return to their home country. Asylees are granted asylum by an immigration court, where they have appealed for asylum after arriving in the U.S. (or other country of refuge).

Immigrants are those who migrate from one country to another seeking permanent or long-term residence and hopefully a better life. Figure 10.9 shows the main sources of immigration to the US in two time periods -- 1960 and 2013. It is much more diverse group of refugees arriving in the US now than in 1960. The total numbers has also risen -- and 21st century immigration is almost as high as early 20th century immigration was, as a percent of the total population (14.7% in 1910). In 2013, immigrants made up about 13% of the US population.

While immigrants and refugees are also members of the racial and ethnic classifications recognized in the US, they have specific health concerns due to their circumstances as refugees or immigrants. While immigrants tend to be healthier than their US-born peers, refugees often arrive with serious health problems such as undernourishment, trauma, or diseases of poverty like parasites. There are organizations dedicated to helping refugees resettle in the US and integrate into life here.

Refugee programs were severely cut back under the Trump Administration and are expected to expand under the Biden Administration. Support for refugees has not always been a partisan issue -- and in fact even now, regardless of political affiliation, those who have direct contact with refugees or refugee support organizations are most likely to support expanding refugee programs in the US, and most Americans, regardless of party, support the ideal of the US as a safe harbor for those in dire need. For more information on US attitudes about immigrants and refugees, you can visit the Pew Trust (OPTIONAL).

Photo Source: Pax Ahimsa Gethen, on Flickr

Health of Diverse Ethnic/Racial Groups in the US

Based on Chapter 10 and the brief summaries for the ethnic and racial groups above, what differences among ethnic/racial groups strike you as important for public health efforts? What similarities do you notice?

If you were starting to work in a new community, how would you want to learn about the cultural health beliefs and practices of the residents? How about their economic, political, educational and social status? What more would you want to know, to understand the community you serve better?

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