Immigrants, Refugees at Higher Risk of Disease

This year, the world watched the emergence of a new strain of influenza virus. Health officials are still closely monitoring the spread of the H1N1 virus and taking steps to protect vulnerable people - especially immigrants and refugees - from the disease.

Immigrants become vulnerable because moving from one country to another - especially under stressful circumstances - can be an emotionally wrenching experience. Research shows that immigration is also a physically exhausting process that leaves immigrants and refugees more vulnerable to disease.

For example, immigrants and refugees tend to have a lower rate of immunization, says Tulane University public health expert Maureen Lichtveld.

"Just the regular immunization… just the stress and irregularity of moving and being part of a new country and a new community brings that with it… the process of moving and the process of acculturation and a new society brings with it unprecedented levels of stress," Lichtveld says. "Also, learning a new language, getting a new job, all things that make you more vulnerable in general."

Lichtveld says these kinds of stressors put refugees and immigrants at higher risk of a disease such as pandemic flu - regardless of the country they're coming from or going to. She says that as a result, they also tend to have a higher rate of infectious diseases.

Lichtveld and a group of public health experts worked together to create recommendations to address the vulnerabilities among refugees and immigrants. They determined the best interventions that should be done by governmental and non-governmental organizations, other measures that can be done by individual health care providers and, finally, actions that can taken at the community level.

"We need to work together to make sure that communities are engaged and understand and will collaborate when we provide the advice - as we did with the recent H1N1 outbreak - to remain at home when you are ill," Lichtveld says.

"We need to be able to make sure that we can indeed implement voluntary isolation and quarantine, that when we advise to take personal protective measures that those indeed are implemented."

Lichtveld and her colleagues also recommended that mental health issues be addressed aggressively during and after an incident such as a disease outbreak. She says, unfortunately, mental health is often an afterthought in the response strategy.

"Mental health is one of the longest and longest lasting adverse impacts of a disaster," Lichtveld says. "And you can look at the pandemic flu, in fact, as a disaster."

She says outbreaks like pandemic flu put added stress on people who are already trying to acculturate to a new area. These pandemics create fear and anxiety in people who already are unsure of their place a new society and often don't know where to turn for help.

Lichtveld says public health leaders have learned from other infectious disease outbreaks. She says they need to apply the lessons learned to all members of their society, even the newest ones.

Her paper is published in the American Journal of Public Health.