Calls for National Refugee Health Strategy

Dr Smith's editorial prefaces a range of research articles in the MJA which have identified significant health needs in recently arrived refugees, including under-immunisation, nutritional deficiencies, and hepatitis B.

This is despite the fact that refugees migrating to Australia undergo health examinations and testing before coming here.

"The principles of prevention and early intervention, our existing knowledge about refugee health care needs, and the additional evidence from the articles in this issue of the journal, justify a call for nationally coordinated, comprehensive health assessments to be offered to all newly arrived refugees," Dr Smith said.

"Currently, each state and territory has a different model and varying coverage for post-arrival checks. Despite a new Medicare item number being available since May, there remain limitations to GPs being able to perform comprehensive assessments, including time constraints, the challenges of using an interpreter over the phone, and the need for specialised knowledge.

"A system of 'accredited practices' could be envisaged, with key GPs linked into, and supported by, clinicians and public health staff experienced in refugee health," he said, adding that publicly funded clinics offer a number of advantages including centralised knowledge and strong links with key refugee agencies.

Malaria and hepatitis B checks should be routine for all arrivals from high prevalence countries, Dr Smith suggested, along with screening for conditions such as anaemia, vitamin D deficiency and schistosomiasis, a tropical disease caused by blood flukes.

"Health assessments must not only focus on infectious diseases, but should take into account the refugee trauma experiences of families and individuals, and assess physical, psychological and psychosocial needs," Dr Smith said.

"Sufficient attention needs to be given to oral health, nutrition and under-managed chronic conditions, and the impacts of violence."

Dr Smith said that a national refugee health strategy would provide greater direction and coordination across the country, and improved data collection and monitoring of disease rates.

Co-author of a research article on refugee health, Associate Professor Donna Mak, public health physician of the Communicable Disease Control Directorate (Western Australia) and the University of Notre Dame, Fremantle, said individual and population health would be protected through routine health checks for refugees.

"Our study demonstrates the need to monitor the prevalence of diseases of public and personal health significance in refugees entering Australia to provide cost-effective services that protect the health of both individual refugees and the wider community," Assoc Prof Mak said.

Assoc Prof Mak and Dr Jennifer Martin, Resident Medical Officer at Perth's Migrant Health Unit, reviewed infectious disease screening of refugees by the Migrant Health Unit. They found a high prevalence of infectious diseases of public health significance in sub-Saharan Africans.

" supports the need for comprehensive post-arrival medical assessments and appropriate follow-up health care for refugees and humanitarian entrants from countries with high rates of disease," they said.

"It also highlights the need for health professionals in both migrant and mainstream health services to be aware of the conditions prevalent in refugee groups."

Another study in the same issue of the MJA confirmed that African refugees settling in Australia have considerable health care needs.

Associate Professor Beverley-Ann Biggs, an infectious diseases specialist at the Victorian Infectious Diseases Service and Department of Medicine, University of Melbourne, Royal Melbourne Hospital, and colleagues found refugees recently arrived in Melbourne from Africa, and attending general practice clinics, suffered from conditions including tuberculosis, nutritional deficiencies, schistosomiasis, and various infections.

"Inadequate vaccination was the most common problem identified by GPs," Assoc Prof Biggs said.

"GPs need to be aware of these health problems and need support in conducting comprehensive health assessments during the early settlement period," she said.

GPs are the first point of contact in the Australian health system for most refugees, Professor of paediatrics and child health, C Raina MacIntyre and Nicholas Wood, Clinical Fellow, said in a related article in the MJA.

Prof MacIntyre, of the University of Sydney and the Sydney-based National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, and colleagues examined the barriers to accessing health care experienced by recent refugees from sub-Saharan Africa.

"We have identified lack of language skills, poor access to health information, misconceptions about infectious diseases, lack of transport, and unemployment as potential barriers to health care use," she said.

Despite the difficulties they encountered in accessing health care, most families studied had already made contact with a GP.

"The role of GPs in understanding the specific health and social issues of refugees is crucial," Prof MacIntyre said.

Australian citizens' understanding of the health risks posed to the community by refugees also should be addressed, said Dr Julie Leask, a senior lecturer at the University of Sydney and research fellow at the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases.

Dr Leask and colleagues investigated community perceptions of the disease risk posed by recent immigrants.

"Multiculturalism was considered to bring new diseases through travel across our borders, through unvaccinated children, through cultural practices that spread disease, and through innate aspects of ethnicity that were believed to increase infection risk," she said.

Children were seen by the focus groups to be more vulnerable to disease, because of international travel and immigration, unvaccinated children and cultural practices - such as spitting - of people from overseas.

However, Dr Leask and colleagues said the community is at little health risk from refugees.

"A substantial body of research indicates that refugees pose a low risk of infection to the general community," she said.

These articles can be accessed in full at www.mja.com.au

The Medical Journal of Australia is a publication of the Australian Medical Association.