The refugees’ health problems are often related to the social determinants of health, including age, gender, literacy, level of education, and socioeconomic factors. Exposure to health risks in the country of origin and during the flight such as violence, oppression, sanitary nuisances, lack of food and clean water, and healthcare can also be contributing factors. Factors related to resettlement in the new country include the risk of poverty, unemployment, social isolation, discrimination, and limited access to health information and healthcare due to language barriers (Wångdahl, 2017; Hempler et al., 2020). Migration is also seen as an independent social determinant for health (Thomas, 2016).
There are thus barriers that limit migrants’ and refugees’ access to healthcare and also limit their participation in health-promoting and disease-preventing activities. This is often due to the challenge of finding and understanding information about health and healthcare, not trusting the healthcare system, and not knowing how to get in contact with it. Communication problems related to both language and cultural issues between refugees and healthcare professionals are also common and can relate to limited health literacy on both an individual and organisational level (Wångdahl & Sørensen, 2020; Wångdahl, 2017).
Refugee women’s health literacy and family health
Among some groups of refugees, it may be relevant to focus on the cultural differences in family structure and gender roles, as these may also have an impact on family health.
Some refugees come from countries where gender inequality is high, where the family structure is often patriarchal, and where women’s educational attainment and employment tends to be low. The women’s fertility rate tends to remain high in the host country, too, which is a key challenge for women’s integration in the new country both in terms of the labour market and health, and not only in relation to their own health but also the health of their family (Liebig & Tronstad, 2018).
A study from Norway on Somali refugee women shows that Somali women’s limited health literacy can have a significant impact on health information exchange and help-seeking for immigrant families. This is because women often play a central caring role in their families and the immediate community. Health planners should therefore pay particular attention to the limited health literacy of refugee women, as this can have significant implications for the health outcomes of migrant families (Gele et al., 2016).
Also, the new host countries’ welfare institutions are designed to serve citizens with a relatively homogeneous cultural background and with a life course normally taking place in the host country. With increasing immigration, this is no longer a sustainable assumption. Immigrants arrive with different linguistic, cultural, and social experiences, norms and knowledge, and welfare institutions must adapt to this new reality if they are to serve their purpose of treating everyone equally (Hempler et al., 2020).
Two studies on participation in cervical cancer screening from Finland (Idehen et al., 2020) and Denmark (Hertzum-Larsen et al., 2019) both indicate that the lowest participation rate is among Somali women compared to other groups of immigrant women and native-born women. Neither of the two studies directly measures health literacy, but they do point out some barriers that might be a contributing factor to why the participation rate is so low among some immigrant women. These barriers relate to health literacy on both an individual and an organisational level. Some individual barriers pertain to low socioeconomic status, unemployment, illiteracy, poor language proficiency, lower awareness of the objective of screening, lower perceived cancer risk, mistrust in healthcare authorities, and cultural/religious beliefs. It may also be that information about the screening is given in the national language only, the invitation comes in a letter, there are no female screeners, the women have limited access to healthcare, and interpretation services are inadequate (Hertzum-Larsen et al., 2019; Idehen et al., 2020) – all of which constitute institutional barriers.
"It is therefore important that the host country focuses on the people who have a disease, not on the disease itself."
It is therefore important that the host country focuses on the people who have a disease, not on the disease itself, and on the possibility of early integration of migrants into a tailored health system. This may also help to determine the long-term health status of the migrant population (Gele et al., 2016; Sodemann, 2020).