I don't think general practice should be the front line: Experiences of general practitioners working with refugees in South Australia

Introduction Many refugees arrive in Australia with complex health needs. In South Australia (SA), providing initial health care to refugees is the responsibility of General Practitioners (GPs) in private practice. Their capacity to perform this work effectively for current newly arrived refugees is uncertain. The aim of this study was to document the challenges faced by GPs in private practice in SA when providing initial care to refugees and to discuss the implications of this for policy relating to optimising health care services for refugees. Methods Semi-structured interviews with twelve GPs in private practice and three Medical Directors of Divisions of General Practice. Using a template analysis approach the interviews were coded and analysed thematically. Results Multiple challenges providing care to refugees were found including those related to: (1) refugee health issues; (2) the GP-refugee interaction; and (3) the structure of general practice. The Divisions also reported challenges assisting GPs to provide effective care related to a lack of funding and awareness of which GPs required support. Although respondents suggested a number of ways that GPs could be assisted to provide better initial care to refugees, strong support was voiced for the initial care of refugees to be provided via a specialist refugee health service. Conclusion GPs in this study were under-resourced, at both an individual GP level as well as a structural level, to provide effective initial care for refugees. In SA, there are likely to be a number of challenges attempting to increase the capacity of GPs in private practice to provide initial care. An alternative model is for refugees with multiple and complex health care needs as well as those with significant resettlement challenges to receive initial health care via the existing specialist refugee health service in Adelaide.David R Johnson, Anna M Ziersch, Teresa Burges

Neoliberal anti-racism: Responding to ‘everywhere but different’ racism

© 2016, © The Author(s) 2016. Racism cannot be treated as a spatially homogeneous phenomenon. This review reports on the merits of a localized approach to anti-racism, and delivers a frank assessment of the challenges faced when developing local responses to racism in a neoliberal era. Under neoliberalism, local actors are responsibilized, and for anti-racism this means action can potentially be closely aligned to local inflexions of racism. But localized responses to racism under neoliberalism are associated with deracialized and depoliticized policies on interethnic community relations. Neoliberal anti-racism promotes competition among local agencies rather than coalition building, and is associated with spatially uneven and non-strategic action

A six-year descriptive analysis of hospitalisations for ambulatory care sensitive conditions among people born in refugee-source countries

Background: Hospitalisation for ambulatory care sensitive conditions (ACSHs) has become a recognised tool to measure access to primary care. Timely and effective outpatient care is highly relevant to refugee populations given the past exposure to torture and trauma, and poor access to adequate health care in their countries of origin and during flight. Little is known about ACSHs among resettled refugee populations. With the aim of examining the hypothesis that people from refugee backgrounds have higher ACSHs than people born in the country of hospitalisation, this study analysed a six-year state-wide hospital discharge dataset to estimate ACSH rates for residents born in refugee-source countries and compared them with the Australia-born population. Methods: Hospital discharge data between 1 July 1998 and 30 June 2004 from the Victorian Admitted Episodes Dataset were used to assess ACSH rates among residents born in eight refugee-source countries, and compare them with the Australia-born average. Rate ratios and 95% confidence levels were used to illustrate these comparisons. Four categories of ambulatory care sensitive conditions were measured: total, acute, chronic and vaccine-preventable. Country of birth was used as a proxy indicator of refugee status. Results: When compared with the Australia-born population, hospitalisations for total and acute ambulatory care sensitive conditions were lower among refugee-born persons over the six-year period. Chronic and vaccine-preventable ACSHs were largely similar between the two population groups. Conclusion: Contrary to our hypothesis, preventable hospitalisation rates among people born in refugee-source countries were no higher than Australia-born population averages. More research is needed to elucidate whether low rates of preventable hospitalisation indicate better health status, appropriate health habits, timely and effective care-seeking behaviour and outpatient care, or overall low levels of health care-seeking due to other more pressing needs during the initial period of resettlement. It is important to unpack dimensions of health status and health care access in refugee populations through ad-hoc surveys as the refugee population is not a homogenous group despite sharing a common experience of forced displacement and violence-related trauma

Cancer screening among migrants in an Australian cohort; cross-sectional analyses from the 45 and Up Study

<p>Abstract</p> <p>Background</p> <p>Limited evidence suggests that people from non-English speaking backgrounds in Australia have lower than average rates of participation in cancer screening programs. The objective of this study was to examine the distribution of bowel, breast and prostate cancer test use by place of birth and years since migration in a large population-based cohort study in Australia.</p> <p>Methods</p> <p>In 2006, screening status, country of birth and other demographic and health related factors were ascertained by self-completed questionnaire among 31,401 (16,126 women and 15,275 men) participants aged 50 or over from the 45 and Up Study in New South Wales.</p> <p>Results</p> <p>35% of women and 39% of men reported having a bowel cancer test and 57% of men reported having a prostate specific antigen (PSA) test, in the previous 5 years. 72% of women reported having screening mammography in the previous 2 years. Compared to Australian-born women, women from East Asia, Southeast Asia, Continental Western Europe, and North Africa/Middle East had significantly lower rates of bowel testing, with odds ratios (OR; 95%CI) ranging from 0.5 (0.4–0.7) to 0.7 (0.6–0.9); migrants from East Asia (0.5, 0.3–0.7) and North Africa/Middle East (0.5, 0.3–0.9) had significantly lower rates of mammography. Compared to Australian-born men, bowel cancer testing was significantly lower among men from all regions of Asia (OR, 95%CI ranging from 0.4, 0.3–0.6 to 0.6, 0.5–0.9) and Continental Europe (OR, 95%CI ranging from 0.4, 0.3–0.7 to 0.7, 0.6–0.9). Only men from East Asia had significantly lower PSA testing rates than Australian-born men (0.4, 0.3–0.6). As the number of years lived in Australia increased, cancer test use among migrants approached Australian-born rates.</p> <p>Conclusion</p> <p>Certain migrant groups within the population may require targeted intervention to improve their uptake of cancer screening, particularly screening for bowel cancer.</p

'Language Background Other Than English': a problem NAPLaN test category for Australian students of refugee background

Since 2008 Australia has held the National Assessment Program: Literacy and Numeracy (known as NAPLAN) for all students in years 3, 5, 7 and 9. Despite the multilingual character of the Australian population, these standardized literacy and numeracy tests are built on an assumption of English as a first language competency. The capacity for monitoring the performance of students who speak languages other than English is achieved through the disaggregation of test data using a category labelled Language Background Other than English (LBOTE). A student is classified as LBOTE if they or their parents speak a language other than English at home. The category definition is so broad that the disaggregated national data suggest that LBOTE students are outperforming English speaking students, on most test domains, though the LBOTE category shows greater variance of results. Drawing on Foucault’s theory of governmentality, this article explores the possible implications of LBOTE categorisation for English as a Second Language (ESL) students of refugee background. The article uses a quantitative research project, carried out in Queensland, Australia, to demonstrate the potential inequities resultant from such a poorly constructed data category

Longitudinal Survey of Immigrants to Australia: Phase 1

The aim of Longitudinal Survey of Immigrants to Australia was to collect information on recently arrived migrants, to measure how they settle in Australia, and to provide reliable data for Commonwealth and other agencies to monitor and evaluate immigration and settlement policies, programs and services. Three waves were collected from the Phase 1 sample; Wave 1 was collected around six months after arrival, Wave 2 a year later and Wave 3 two years later. The Primary, or Principal Applicant (PA) and their Migrating Unit Spouse (MU) were interviewed, and information was collected about other household members (OH) at each wave. Variables for the PA and MU surveys include: attitudes to their former country, and Australia; reasons for immigrating; sources of information about Australia and its States/Territories and why their chose the state they settled in; experience of and attitudes to different sources of information, support and assistance received before and after arrival, in areas including employment, education, accommodation, health and government assistance; education in and attainment of english language; future migration, citizenship and sponsorship plans; and indicators of happiness and satisfaction. Background variables for the PA's and MU's include country and date of birth, gender, marital status, languages spoken, occupation and employment, income and expenses, accomodation, visa and citizenship status. Background variables for the OH's include country and date of birth, gender, marital status, employment, visa and citizenship status, and income