Refugee Health Resources
Research conducted over the past 25 years has shown a strong correlation between language barriers and poor quality health care. Language can affect the accuracy of patient histories, the ability to engage in treatment decision-making, poorer understanding of a medical diagnosis or treatment, under use of primary and preventative services, lower use and misuse of prescription medications, and a decreased level of patient trust.
Linguistically, the majority of the population in the National Network of Libraries of Medicine, MidContinental Region (NN/LM MCR) speaks English as their primary language. Spanish ranks second, German third, and French fourth.Other top languages spoken in the MCR include Arabic, Cambodian, Chinese, Cushite, French, Hindi, Italian, Korean, Laotian, Persian, Polish, Portuguese, Russian, Serbo-Croatian, Swahili, Tagalog, Thai, Urdu, and Vietnamese.1 Although the MCR is primarily composed of Caucasians, it is growing in diversity with an increasing number of refugees resettled in the region. Persons seeking refugee status do so because of persecution based on race, religion, nationality, political opinion, or affiliation with a social group.
In 2010, over 73,000 refugees were resettled in the United States.2 Nationally Iraq, Burma, Bhutan, Somalia and Cuba have the highest representation out of 83 countries. The MCR had nearly 5,500 refugees resettled in Colorado, Kansas, Missouri, Nebraska and Utah3 – Wyoming does not officially participate in the resettlement program. The countries represented match very closely to what is seen nationally, with the addition of the Democratic Republic of Congo.
Due to this influx, medical providers may interact with patients and family members from different cultural and linguistic backgrounds. Refugee populations have been shown to have a high prevalence of mental disorders, including post-traumatic stress disorder (PTSD), depression, substance abuse, somatization disorder (a long-term condition in which a person has physical symptoms that are caused by psychological problems), and traumatic brain injuries.4 So while the refugee populations are small, they can require substantial medical care.
Access to culturally and linguistically appropriate resources and training has the potential to improve the quality of care and health outcomes, and assist patients and consumers to make informed decisions about their health. However, there are barriers to accessing appropriate resources. A 2008 report exploring refugee populations identified three key issues in providing culturally and linguistically appropriate health information:5
- Lack of existing materials in appropriate language
- Expense of buying or producing materials in appropriate languages
- Finding qualified interpreters and translators
Organizations such as the Office of Refugee Resettlement (ORR) have mechanisms in place to identify minority communities and translate health information pertinent to those groups. The ORR provides people in need with critical resources to assist them in becoming integrated members of American society.
Access to these critical resources is made possible through partnerships with federal and state agencies, mutual assistance associations, and voluntary organizations. At the state level, the MCR works with two key personnel: Refugee Health Coordinators (RHC) and State Refugee Coordinators (SRC). The role of the RHC is to administer the refugee health programs and services within their jurisdiction. The role of the SRC is to administer the resettlement program within a state. Both the health programs and resettlement programs develop language resources that can assist health care providers to provide authoritative information. MCR Coordinators encourage developers of these language resources to share through submission to open access databases, such as RHIN (Refugee Health Information Network).
Identifying and tracking population shifts in a community can also be problematic when determining what language needs might exist. The Flewelling report noted that health agencies depend on state agencies for health information materials, while health agencies employ resettlement agencies for cultural orientation.6 The flow of refugee information touches many agencies and follows a very specific process. For instance, the State Department notifies resettlement agencies and public health officials about the incoming populations. The Office of Refugee Resettlement contracts with VOLAGs (volunteer agencies working with the Federal Government) and participating states to provide services to refugees. The Centers for Disease Control and VOLAGs communicate with state and local public health agencies when specific individuals arrive. Finally, local health agencies or contracted clinics conduct initial health screenings.
Below are free online resources for health information, linguistic services, and population profile data:
Patient and Consumer Health Information Resources:
- EthnoMed – 10 languages. Strong in Southeast Asian and East African languages. Primarily print. http://ethnomed.org/patient-education.
- Health Information Translations – 19 languages, including American Sign Language. Formats include print, audio and video. http://www.healthinfotranslations.org/
- Healthy Roads Media – 21 languages. Formats include handouts, audio, multimedia, web-video, iPod video. http://www.healthyroadsmedia.org/
- MedlinePlus – Spanish and 48 additional languages. Formats include video, tutorials, patient handouts, and current news. http://www.medlineplus.gov
- New Americans Health Information Portal – 20 languages. Formats include audio, multimedia, podcast, video. http://palantir.lib.uic.edu/nahip/
- RHIN (Refugee Health Information Network) – 89 languages. Formats include print, audio, and video. http://rhin.org/
- Refugee Health Technical Assistance Center – provides tools, resources and support for health providers. http://www.refugeehealthta.org/
- SPIRAL: Selected Patient Information Resources in Asian Languages – 7 languages. http://www.library.tufts.edu/hsl/spiral//
- Language Services Resource Guide for Health Care Providers – interpreter and translator associations and agencies, training programs, assessment tools. http://www.healthlaw.org/images/stories/issues/ResourceGuideFinal.pdf
- “I Speak” Language Identification Card – short phrases written in over 30 languages that a user can check to indicate the language they speak. http://www.justice.gov/crt/about/cor/Pubs/ISpeakCards.pdf
- American Translators Association http://www.atanet.org/
- National Council on Interpreting in Health Care http://www.ncihc.org
- International Medical Interpreters Association http://www.imiaweb.org/corporate/find.asp
- Video Interpreting http://www.imiaweb.org/basic/videointerpreting.asp
State Level Population Profile Data:
- Office of Refugee Resettlement – arrivals by state and country of origin http://www.acf.hhs.gov/programs/orr/data/fy2010RA.html
- U.S. Census Bureau – languages spoken at home (release date April 2010) http://www.census.gov/hhes/socdemo/language/ (click on “Detailed Tables”)
- American Community Survey – languages spoken at home http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml
County Level Population Profile Data:
- County Health Rankings – select “Additional Measures” tab for LEP information http://www.countyhealthrankings.org/
- MLA Language Map Data Center – number, ages, and percentage of speakers of each language in a particular geographic region http://www.mla.org/map_data
- National Center for Education Statistics – percentage of adults with low literacy by state and county http://nces.ed.gov/naal/estimates/StateEstimates.aspx
- Dana Abbey, Colorado/Health Information Literacy Coordinator
1U.S. Census Bureau. The 2010 Statistical Abstract. Population: Language Spoken at Home by State: 2008 [cited 2012 February 6]. Available from http://www.census.gov/compendia/statab/cats/population/ancestry_language_spoken_at_home.html.
2Fiscal year 2010 refugee arrivals [Internet]. Washington: Administration for Children and Families – Office of Refugee Resettlement [cited 2012 February 6]. Available from: http://www.acf.hhs.gov/programs/orr/data/fy2010RA.htm.Ibid.
4Savin D, Seymour D, Littleford L, Bettridge J, Giese A. Findings from mental health screening of newly arrived refugees in Colorado [Internet]. Bethesda: PubMed Central [cited 2012 February 6]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497730/pdf/16134561.pdf.
5Flewelling K. Addressing the need for culturally and linguistically appropriate health information for newly arriving refugee populations: project report [Internet]. Bethesda: PubMed Central; p 13-14[cited 2012 February 6]. Available from: http://tinyurl.com/7nekeme.
6Flewelling, pg. 18