Reducing health inequities for asylum seekers with chronic non-communicable diseases: Australian context

Abstract

Asylum seekers are susceptible to chronic non-communicable diseases pre- and post-arrival due to poor living conditions, unhealthy lifestyles and restrictive and poor access to health services. Despite their need for constant and continuous health care access due to poor health, they face healthcare services access restrictions dependent on their visa conditions in Australia. Some visas only allow access to hospital services with restrictions on primary health services access such as GPs and free or discounted pharmaceutical products. In comparison, disadvantaged host populations have access to free/discounted pharmaceutical products and unrestricted access to primary and secondary health care. Ten professionals who constantly engage with asylum seekers in three large asylum seeker centres in Melbourne were interviewed either face-to-face or over the phone. The interviews were essential to understand how health inequities may be addressed for asylum seekers. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic analysis framework. Their recommendations, based mainly on their experience and evaluation of programs, were: (1) cultural competence training; (2) use of interpreters; (3) free access to health services and medications; (4) use of English learning to promote health literacy and community integration; (5) robust chronic non-communicable diseases screening; and (6) health promotion and accessible food programs.

Attitudes and Knowledge of, and Preferences for Learning about Cultural Competence: A Study of Pharmacy Students from One Australian Pharmacy Program

“…Identifying existing knowledge through the survey established baseline knowledge, perspectives and views to inform potential intervention(s) types and to address knowledge gap(s) in the future. The rationale for assessing students' knowledge on diseases prevalence and their views on healthcare entitlements was informed by the previously identified link between empathy, cultural awareness and competence [22,23] and the high disease burden of chronic-non-communicable diseases (CNCDs) such as diabetes and hypertension in this populace [9,10]. Empathy is known to foster cultural sensitivity, which is the building block for cultural competence [21][22][23].…”

“…It is well documented that there is a high disease burden of chronic non communicable diseases (CNCDs) such as diabetes, hypertension and respiratory diseases in asylum seekers [9,10,36,37]. CNCDs disease are often life-long diseases, and some require drastic changes in lifestyle [38], which may be a challenge for healthcare consumers, as they may try to balance their cultural beliefs with the expected healthy lifestyle.…”

“…The diversity of the Australian population has a number of implications in terms of healthcare services provision. The challenges faced by culturally and linguistically diverse (CALD) populations, particularly asylum seekers, in accessing healthcare services are well documented in the literature [7][8][9].…”

“…Cultural competence has been reported as being critically important when dealing with CALD populations to bridge the health inequity gap [9,10]. Cultural competence is recognised as having five domains: (1) cultural awareness-recognition of cultural differences between one's culture and that of others; (2) cultural knowledge-knowing cultures of other ethnic or cultural groups; (3) cultural skills-having skills that enable one to interact with people from diverse cultures; (4) cultural encounters-having been exposed to people of diverse cultural backgrounds; and (5) cultural desires-motivation of wanting to engage with people from diverse cultures to understand their culture [11,12].…”

“…In this study, the focus was on cultural competence, which is a broad concept that incorporates a number of domains: that is, cultural knowledge, awareness, skills, encounters and desires, which are all relevant for emerging healthcare professional students, to address the cultural needs of clients/patients from diverse backgrounds [9][10][11][12]. Cultural safety is creating a safe environment that addresses the inherent power imbalance between a healthcare provider and consumers, and cultural responsiveness focusses on healthcare services that respond to the cultural needs and backgrounds of consumers [25][26][27].…”