Health inequities and social determinants of health in refugee and immigrant communities.

Abstract

This article evaluates and elucidates the intersections across social and economic determinants of health and social structures that maintain current inequities and structural violence with a focus on the impact on imMigrants (immigrants and migrants), refugees, and those who remain invisible (e.g., people without immigration status who reside in the United States) from Black, Indigenous, and People of Color communities. Psychology has a history of treating individuals and families without adequately considering how trauma is cyclically and generationally maintained by structural violence, inequitable resources, and access to services. The field has not fully developed collaboration within an interdisciplinary framework or learning from best practices through international/global partnerships. Psychology has also been inattentive to the impact of structural violence prominent in impoverished communities. This structural harm has taken the form of the criminalization of imMigrants and refugees through detention, incarceration, and asylum citizenship processes. Most recently, the simultaneous occurrence of multiple catastrophic events, such as COVID-19, political polarization and unrest, police violence, and acceleration of climate change, has created a hypercomplex emergency for marginalized and vulnerable groups. We advance a framework that psychologists can use to inform, guide, and integrate their work. The foundation of this framework is select United Nations Sustainable Development Goals to address health inequities.

How psychologists can help achieve equity in health care—advancing innovative partnerships and models of care delivery: Introduction to the special issue.

“…Based on this premise, the Racism Exposure and Trauma Accumulation Perpetuate Pain Inequities—Advocating for Change model illustrates the integration of racism and pain and how this shared contribution of trauma symptoms generates chronic pain for racialized groups in the United States. Rami et al (2023) discuss the role of psychologists in addressing health inequities and social determinants of health in refugee and imMigrants (immigrants and migrant) communities with considerations to exploring how trauma is cyclically and generationally maintained by structural violence and inequitable resources and access to services.…”

What role can (and should) clinical science play in promoting mental health care equity?

“…More broadly, mental health inequities, which is an umbrella term that includes unjust and unfair elevated prevalence rates, diagnostic inaccuracies, poorer treatment response, higher rates of dropout, and differential access to high-quality care in specific groups, have been well documented in historically understudied and underserved populations such as communities of color (Carpenter-Song et al, 2011; Maura & Weisman de Mamani, 2017), sexual and gender minorities (Becerra-Culqui et al, 2018; Rimes et al, 2019), low-income groups (De France & Evans, 2021; McLaughlin et al, 2012), and refugee/immigrant communities (Nickerson et al, 2017; Rami et al, 2023). Indeed, the reality from these and many other studies is that a variety of minoritized groups continue to experience significant inequities in mental health care, in particular, an undisputed and well-supported truth of our current health care picture, particularly in the United States.…”

“…This includes the areas mentioned above around poorer treatment response and higher rates of dropout and also includes widely documented lower rates of engagement in mental health services in specific demographic groups (e.g., Olfson et al, 2023). Several ongoing structural inequalities related to social determinants of health have been identified as underlying causes across these indices of inequitable mental health care, including (but not limited to), language barriers, differential (and lower) financial resources for many historically minoritized groups, immigration complications, and the experience of ongoing racism and discrimination within the health care system (Derr, 2016; Rami et al, 2023). These barriers are in addition to other persisting barriers to mental health care that include stigma toward mental health, a scarcity of treatments that have been tested and validated in minoritized identity groups, and a shortage of culturally responsive treatment providers (Leong & Kalibatseva, 2011; Lu et al, 2021).…”