Research conducted over the past 25 years has shown a strong correlation between language barriers and poor quality health care. Language can affect the accuracy of patient histories, the ability to engage in treatment decision-making, poorer understanding of a medical diagnosis or treatment, underuse of primary and preventative services, lower use and misuse of prescription medications, and a decreased level of patient trust.
In 2010, over 73,000 refugees were resettled in the United States. Nationally Iraq, Burma, Bhutan, Somalia and Cuba have the highest representation out of 83 countries. Nearly 5,500 refugees resettled in Colorado, Kansas, Missouri, Nebraska and Utah - Wyoming does not officially participate in the resettlement program. The countries represented match very closely to what is seen nationally, with the addition of the Democratic Republic of Congo.
Due to this influx, medical providers may interact with patients and family members from different cultural and linguistic backgrounds. Refugee populations have been shown to have a high prevalence of several mental disorders, including post-traumatic stress disorder (PTSD), depression, substance abuse, somatization disorder (a long-term condition in which a person has physical symptoms that are caused by psychological problems), and traumatic brain injuries. The prevalence of psychiatric symptoms is high in non-clinical as well as clinical refugee populations. So while the refugee populations are small, they can require substantial medical care.
Access to culturally and linguistically appropriate resources and training has the potential to improve the quality of care and health outcomes, and assist patients and consumers to make informed decisions about their health. However, there are barriers to accessing appropriate resources. A 2008 report exploring refugee populations identified three key issues in providing culturally and linguistically appropriate health information:
Identifying and tracking population shifts in a community can be problematic when determining what language needs might exist. The Flewelling report noted that health agencies depend on state agencies for health information materials, while health agencies employ resettlement agencies for cultural orientation.
The flow of refugee information touches many agencies and follows a very specific process. For instance, the State Department notifies resettlement agencies and public health officials about the incoming populations. The Office of Refugee Resettlement contracts with VOLAGs (volunteer agencies working with the Federal Government) and participating states to provide services to refugees. The Centers for Disease Control and VOLAGs communicate with state and local public health agencies when specific individuals arrive. Finally, local health agencies or contracted clinics conduct initial health screenings.