Health Services for Refugees in the United States: Policies and Recommendations

Some of refugees, who were forced to move out from a home country due to political or religious conflicts, war or natural or manmade disasters, resettle in another country. Resettlement in another country is challenging as refugees suffer from a number of mental and physical health problems. Under the Refugee Act of 1980, the United State (US) governments provide medical assistance as well as financial and immigration legal assistance. Yet, it is still challenging to ensure health and well-being of refugees who have diverse social and health conditions and needs. This study reviewed federal policies and limitations on refugee health in the US, which accepts the largest number of refugee resettlements in the world. The reviewed policies include health insurance policies, health promotion policies, the Survivors of Torture Program, and medical screening. Some refugees still have limited accessibility to services due to difficulties in understanding the healthcare system even when they are eligible for many of the services. While most policies on refugee health mainly focus on the early stage of resettlement and infectious disease screening, follow-up services for chronic conditions are essential to ensure health and well-being of refugees. Because social factors affect health of refugees, it is necessary to provide services that address social and health issues. There are several recommendations to improve policies and services to better serve refugee populations who resettled in the US. First, more comprehensive health promotion and education programs are necessary for refugees to better understand the US healthcare system and healthcare. Second, long-term follow-ups which include chronic health conditions are important to improve health of refugees. Lastly, social and health issues should be integrated with a bidirectional approach which supports both refugees and existing communities. Keywords: refugees, physical and mental health, resettlement, federal policies, United States

Policy and Social Factors Influencing Diabetes among Pima Indians in Arizona, USA

The Pima Indians have the highest rate of type 2 diabetes in the world. While biomedical studies have identified a genetic variable associated with the high prevalence of diabetes among Pima Indians, genetics is only one factor that encompasses an individual’s risk for developing a disease. Information on the social factors relating to the development of type 2 diabetes amongst this population is necessary. The purpose of this analysis is to review policy, social and historical factors associated with diabetes among Pima Indians. Governmental policies have affected this population’s ability to eat a diet native to their culture. For example, the damming of the Gila River in the early 1920s resulted in diet and lifestyle changes, reducing traditional low fat, high fiber intake and physical activity, among the Pima population. U.S. Department of Agriculture (USDA) policies in place in the 1970s and 1980s did not allow Native Americans, the Pima included, to get farm help such as agricultural loans in times of need. These policies led to many Pima finding sedentary jobs, if they could find work at all, and adopting unhealthy lifestyles. While genetic factors have shown to be important predictors of diabetes incidence, the historical and social factors that changed US Pima Indians’ lifestyles are significant factors which have contributed to the high prevalence of diabetes among this group. In order to address the high rates of diabetes among the Pima Indians, it is vital that emphasis be placed upon culturally appropriate interventions. U.S. government agencies, tribal leaders, and community elders would benefit from working together to establish healthier food sources, encourage physical activity, and utilize existing community networks to spread information on diabetes prevention and management practices. Future studies on diabetes among Pima Indians would include more policy, social and historical factors, develop programs with reflection of these factors, and evaluate the programs. Keywords: Pima Indians, type 2 diabetes, Native American policies, social factors, US

Gender Roles and Women’s Health in India

One of the main determinants of the poor health status among women in India is a women’s disadvantaged gender role. This study aims to identify the factors that affect women’s health, and particularly focuses on women’s ability to make decisions in a family concerning health-related issues and education. The data are from the India Human Development Survey-II (IHDS-II), 2011-12 (ICPSR 36151), which includes nationally representative samples across India. Women who have more decision making power within a family had better self-reported health. Women who are more educated have better self-reported health. Self-reported women's health status was dependent on the rank of castes to which the women belonged. Our results suggest that decision-making power and education play a key role in improving the health outcomes for women in India. Health promotion programs for women in India should include a platform for gender roles and decision-making capacity. Keywords: women’s health; gender roles; decision-making power; Indi

Sun Protection Behaviors Associated with Self-Efficacy, Susceptibility, and Awareness among Uninsured Primary Care Patients Utilizing a Free Clinic

Background. Skin cancer is the most commonly diagnosed form of cancer in the United States (US). However, knowledge, behaviors, and attitudes regarding sun protection vary among the general population. The purpose of this study is to examine sun protection behaviors of low-income primary care patients and assess the association between these health behaviors and the self-efficacy, susceptibility, and skin cancer awareness. Methods. Uninsured primary care patients utilizing a free clinic (N=551) completed a self-administered survey in May and June 2015. Results. Using sunscreen was the least common tactic among the participants of this study. Skin cancer awareness and self-efficacy are important to improve sun protection behaviors. Spanish speakers may have lower levels of skin care awareness compared to US born and non-US born English speakers. Male and female participants use different sun protection methods. Conclusion. It is important to increase skin cancer awareness with self-efficacy interventions as well as education on low-cost sun protection methods. Spanish speaking patients would be a target population for promoting awareness. Male and female patients would need separate gender-specific sun protection education. Future studies should implement educational programs and assess the effectiveness of the programs to further promote skin cancer prevention among underserved populations

Perceived Environmental Pollution and Its Impact on Health in China, Japan, and South Korea

Objectives Environmental pollution is a significant global issue. Both objective (scientifically measured) environmental pollution and perceived levels of pollution are important predictors of self-reported health. The purpose of this study was to compare the associations between perceived environmental pollution and health in China, Japan, and South Korea. Methods Data were obtained from the East Asian Social Survey and the Cross-National Survey Data Sets: Health and Society in East Asia, 2010 (n=7938; China, n=3866; Japan, n=2496; South Korea, n=1576). Results South Koreans perceived environmental pollution to be the most severe, while Japanese participants perceived environmental pollution to be the least severe. Although the Japanese did not perceive environmental pollution to be very severe, their self-rated physical health was significantly related to perceived environmental pollution, while the analogous relationships were not significant for the Chinese or Korean participants. Better mental health was related to lower levels of perceived air pollution in China, as well as lower levels of perceived all types of pollution in Japan and lower levels of perceived noise pollution in South Korea. Conclusions Physical and mental health and individual socio-demographic characteristics were associated with levels of perceived environmental pollution, but with different patterns among these three countries

Uninsured free clinic patients’ experiences and perceptions of healthcare services, community resources, and the Patient Protection and Affordable Care Act

Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. There has been a paucity of free clinic research with the few studies employing a quantitative design. The purpose of this study is to conduct an in-depth qualitative exploration of free clinic patients’ experience and perceptions of healthcare services, community resources, and the Patient Protection and Affordable Care Act (ACA). Free clinic adult patients (n=35) participated in four focus groups between June and July 2014 (one Spanish group in June, and two English groups and one Spanish group in July) in a classroom of a free clinic. More than 80% of the participants were non-US born from Mexico, Central/South America, South or East Asia, Pacific Islands, or Western Europe. While participants reported being satisfied overall with free clinic services, they indicated that they desire more specialty services and health education programs. Furthermore, they reported being frustrated by long waiting times- both in the waiting room and when making an appointment, phone communication, and interpreter services. It is necessary to find effective ways to provide information about health education opportunities and the ACA to free clinic patients because participants appeared not to have received sufficient information about available resources. Health education programs for free clinic patients should not only focus on increasing knowledge but also changing behaviors

Perceived concern about the new strain of the influenza and obtaining the vaccine in China, Japan and South Korea

This study compares the factors, which influence individuals from the countries of China, Japan and South Korea to obtain any type of influenza vaccines and their perceived concerns about the new strain of the influenza - pandemic (H1N1) 2009. The data analyzed was from the East Asian Social Survey (EASS), Cross-National Survey Data Sets: Health and Society in East Asia, 2010 (ICPSR 34608) (N = 7938). The results of this study suggest that individuals who are concerned about the new strain of influenza are more likely to have obtained influenza vaccine. In these countries, perceived concerns may be directly related to vaccine-related behaviors. The results of this study also indicate that there are variations within each country regarding as to why individuals do or do not obtain the influenza vaccine. Over all, this project provides new insights about the acquisition of the influenza vaccine within China, Japan and South Korea, which will be useful for medical practice within these countries and future research. Keywords: influenza vaccine, perceptions, social factors, China, Japan, South Kore