Vulnerable Populations

• What are vulnerable groups?

  Groups of people who are not usually well provided for by healthcare services, and have poorer access, experiences & health outcomes
• Define international migrants.

  Individuals born outside their country of residence including asylum seekers, refugees as well as documented and undocumented economic migrants
• Define refugee.


  People outside their countries of origin who are in need of international protection because of feared persecution, or a serious threat to their life, physical integrity or freedom in their country due to persecution, armed conflict, violence or serious public disorder
• Define economic migrant.


  Persons who leave their countries purely for economic reasons, unrelated to the refugeedefinition, or in order to seek material improvements in their livelihood
• Define a person seeking asylum.

  Person whose request for sanctuary has yet to be processed
• Define an internally displaced person (IDP).

  A person who has been forced or obliged to flee from their home or place of habitual residence due to or to avoid the effects of armed conflicts, situations of generalised violence, violation of human rights or disasters (natural/human), who has not crossed an internationally recognised border
• What is the difference between asylum seekers & refugees?

  Asylum seeker

  • flees their home, arrives in other country, makes themselves known to authorities, submits asylum application, has legal right to stay in country while waiting a decision

  Refugee

  • has proven they'd be at risk of returned to their home country, has claim for asylum accepted by government, has permission to stay in country (either long-term or indefinitely), as a right under UK & international law to bring immediate family members to join
• Asylum seekers in UK

  Do not have the right to work, rely on state support (£6.43 per day)

  Housing is provided, but have no choice where & often 'hard to let'
• Migration is a social determinant of health.
• Asylum seekers, refugees and migrants face barriers in accessing appropriate levels of healthcare, which are detrimental to health and result in health inequalities
• What are some of the health inequalities for asylum seekers, refugees & migrants?


  Increased levels of PTSD, depression, anxiety & suicidal thoughts

  Increased risk of infectious diseases (process of migration, overcrowding, poor living conditions)

  Increased risk of childhood preventable diseases (no vaccinations)

  Risk of inadequate nutrition (risk of non-communicable diseases)

  Inequalities in prevention (cancer screening)

  Poorer oral health outcomes

  Inequalities in sexual & reproductive health
• What are the barriers to accessing healthcare in asylum seekers, refugees & migrants?


  Language & low levels of health literacy

  Difficulty navigating the health system

  Confusion about entitlement to care

  Cost of transport to appointment

  Fear of unknown consequences (e.g. deportation)

  Cultural differences, lack of culturally appropriate services

  Different health beliefs & practices

  Communication with health-care providers

  Trust in HCPs

  Experiences of discrimination
• What is trauma-informed care?


  An approach that recognises & responds to the widespread impact of trauma on individuals & aims to create an environment that promotes healing & minimises re-traumatization
• What are the key principles of trauma-informed care?

  Safety (physical environment, clear communication)

  Trustworthiness & transparency (build trust)

  Peer support

  Collaboration (shared decision-making)

  Empowerment

  Cultural, history & gender sensitivity
• What is cultural competency?


  Set of aligned and transparent skills, attitudes and principles that acknowledge, respect and work together as a system towards optimal interactions between individuals and the various cultural and ethnic groups within a community.
• How can you develop effective communication with diverse pts?

  Avoid assumptions based on ethnicity

  Use professional interpreters when needed (do NOT rely on family members)

  Ask open-ended questions to explore pts perspective on their health

  Be mindful of non-verbal communication differences
• Which of the following is a potential consequence of a health workforce lacking cultural competency in working with refugees and migrants?

  
  

  A - improved communication & trust between healthcare providers & pts

  B - increased uptake of preventive health services by refugees & migrants

  C - misdiagnosis & inappropriate treatment on health conditions

  D - reduced burden on healthcare resources

  C
• How can we build on cultural compectency?

  Self awareness

  Knowledge

  Communication skills

  Attitudes
• Which of the following is an essential component of cultural competency for healthcare providers working with refugees and migrants?

  A - having a basic knowledge of the healthcare system in the refugees' and migrants' countries of origin

  B - understanding the cultural & religious beliefs of the refugees & migrants

  C - provided healthcare services exclusively in the refugees' & migrants' native languages

  D - avoiding discussions of cultural differences to prevent misunderstandings

  Not sure
• Which of the following social determinants of health can have a significant impact on the health outcomes of refugees and migrants?

  A - access to healthcare resources

  B - level of education

  C - occupational status

  D - social support networks

  A?