Social Determinants Of Health Essay

1.0 Introduction
Beside genetic and life style, that are individual determinants of health, there are many other factors -known as social determinants of health- which are varying even for the people who are living in the same society. They are defined as “social, cultural, environmental, and political factors that can affect the health of individuals” (Rumbold & Dickson-Swift, 2012, p. 40). This assignment will discuss the influence of one of the social determents of health, accessing to health services on the health condition of a specific target group; refugees population in Australia. The Refugee Convention 1951 defines refugees as ‘‘persons outside their country of origin who are unable or unwilling to return because of a well-founded fear of persecution for reasons of race, religion, nationality,

membership of a particular social, or political opinion’’ (Grove & Zwi, 2006, p.1931). From 1945, around 700,000 refugees have migrated to Australia and around 12,000 persons arrive each year (Clark, Gilbert, Rao & Ker, 2014; Murry & skull, 2005). Beside their physical health problems, this population are more vulnerable to psychological disorders as a result of their experiences both in their country of origin and their destination country where they faced many difficulties in accessing to health services such as financial problems as well as cultural and language barriers (Murray & Skull, 2005).
2.0 Accessing to health services as a social determinant of health for Australian Refugees
Among countries with large migrant population, health has been recognised as one of the most critical human rights and the governments are aware of the importance of providing the access to health services for a diverse population with different cultural and ethnicity background (Vasey & Manderson, 2012).

Based on World Health Organisation (WHO) report, difficulties in accessing to the health services are the most important factors of inequity in health (Clark et al., 2014). Although most countries are aware of the impact of these factors and try to decrease the gap between health statuses of different groups in their society, the inequity still exists (Rumbold & Dickson-Swift, 2012). Data from a cross-sectional study on African refugee’s health in Melbourne, Australia, indicates that 50% of participations had difficulties in accessing to health services with mentioning communication as the most important one (Neale, Ngeow, Skull & Biggs, 2007). There are also some evidence that proves the differences in health outcome for refugees and migrant population as a case in point, refugee workers in Australia are more likely to be hurt at work (Shaw, Dorling & Smith,

2006).
3.0 Barriers of Accessing to health services by Refugees in Australia
In regards of Refugees’ health needs, there are three main points that should be discussed. First, they have high physical health needs as a result of conditions such as poverty and abuse that may existed in their origin country or the difficulties they face during their journey from their home country. They are at risk of ill health and need special health care when they reach to their destination country and through resettlement (Lawrence & Kearns, 2005). On the other hand, as they may be carry contagious disease, they should be screened and quarantined prior to resettlement to guarantee the health of host population (Grove & Zwi, 2006). Moreover, it has proved by many studies that mental health problems are their main health concern. Most of them experienced violence, war, and torture in their home country before migration while they were struggling to survive. They also experience high level of stress and anxiety during resettlement (Lawrence & Kearns, 2005). Second, they face many barriers in accessing to the health services in the host country. In this regard, language is introduced as the main barrier. Other difficulties are financial cost of the health care as well as differences in health-seeking behaviours and culture. The third point worth mentioning is the challenges that health professionals face while working with refugees which language and cultural differences are the most important ones (Lawrence & Kearns, 2005).

3.1 Financial Barriers
Most commonly, refugees’ skills and agency would be neglected in the host countries. They consider as needy and helpless people who are just using the resources and not having a productive effect. This attitude leads to the othering process, which means mainstream population sees them as “others”. This limits their participation in helping to improve the future of the country as well as seeking their rights in health and other domains (Grove & Zwi, 2006). As a result, refugees are mostly unemployment or having low-paid casual jobs. Migrants are also more likely to attend dangerous jobs (Murray & Skull, 2005). It worth mentioning that all of the above factors put refugees in poorer socio-economic status, which is another important social determinant of health, that can lead to social exclusion and social gradient in health (Rumbold & Dickson-Swift, 2012). Not having enough income decreases their willingness to take a day off to see a doctor or spend the money on health services. Moreover, many of them don’t have sufficient information about bulk-billing and other free services (Murray & Skull, 2005).

3.2 Language Barrier
The data analysis from a study done by Clark and her colleges on refugee women in South Australia showed that language barrier is the most important factor that prevents refugees from accessing to health services. They don’t make appointment with GP when they need to seek help from a health professional, as they don’t have sufficient English knowledge to be able to communicate with him/her (Clark et al., 2014). On the other hand, if they do not get the opportunity to communicate via their native language while they can’t speak English, it may cause psychological problems such as loneliness, depression, boredom, anxiety, embarrassment and disconnection. Moreover, using a foreign language, even when they know it well, may be really stressful as it is difficult to interact effectively with native speakers and as it’s well known, stress can leads to many acute and chronic health conditions. Some refugees reported that they believe the key factor to be adapted in the society is to learn English and be able to use it sufficiently (Fanany, Kasem & Fanany, 2013).

3.3 Cultural Differences
Since health and illness are social concepts, individual’s definition of health and illness may depend on their culture, ethnicity and beliefs. Different cultures have different beliefs about the health and illness, the causing factors of illness and how it can be cured (Rumbold & Dickson-Swift, 2012). Cultural differences affect how and when refugees seek help and what they expect as a cure for each disease. Some of them may not be familiar with health system of the host country such as referral process or bulk billing (Lawrence & Kearns, 2005). Another point worth mentioning is that among refugees, health behaviour and therefor health outcomes is affected by their family, peers, community and friends in both accessing to health services and accepting the prescribed medicine or food regime (Bellamy, Remo, Ostini, Martini & Kairuz, 2015).

4.0 Mental Health problems
As mentioned above, mantel and psychological disorders are the most important concerns in the refugee’s health domain and while lack of sufficient access to health services and its involved barriers affect their both physical and mental health, it has more negative impact on their mental health as they have poorer level of mental health even before arriving to Australia as a consequence of their experience of psychological trauma (Harris & Zwar, 2005). Refugees left their home country for many reasons such as war and political or social discrimination. They may have experienced the death of a family member or friend, separation from them, torture, physical and psychological abuse (Harris & Zwar, 2005). Before resettlement they may experience living in refugee’s camp and facing problems such as poverty, overwhelming and violence, which can lead to anxiety, depression or even passivity. After arriving to Australia, they have to deal with adjusting in new culture and country. As a result of all of these factors, many of them suffer from mental problems such as post-traumatic stress disorder (PTSD), anxiety, poor sleep, nightmares, memory loss, and poor concentration (Harris & Zwar, 2005).
Moreover in the host country, people sees them as others, divided from the mainstream population and uninvited guests, in other word they would be socially excluded and it can affect their ability to access health services (Grove & Zwi, 2006). In addition, the difficulties in accesing to health services such as language barrirs and poorer SES not only prevent them from seeking mental health aids, but also make the situation even worse by pointing towards social discrimination (Grove & Zwi, 2006). Social exclusion separates groups based on different factors such as ethnicity and makes one group more eligible to access services and resources compared to other group. The negative impact of social exclusion on health is that it restricts the excluded groups to access equal health services as much as the mainstream population and leads to inequity in health (Reidpath, Chan, Gifford & Allotey, 2005).
5.0 Conclusion
Refugees leave their home country to seek better future in developed countries and experience many difficulties both before and after arriving to their destination country. They may leave their friends, family and loved ones in their home country and when they arrive in the host country, they have to cope with high level of stress associated with new living condition and being socially excluded. This special situation makes them more vulnerable to physical and mainly mental health disorders so they need special care but unfortunately, they are not able to access to health services sufficiently as they can not afford the cost of it or they may not be able to communicate effectively in the foreign language or simply just because they do not see the health and illness from western prospective