“There is no Somali word for lead poisoning…”: Role for the public health system in preventing childhood lead poisoning in an African refugee resettlement community

The decline in childhood lead poisoning in recent decades is widely regarded as a public health success story. However, the risk for lead poisoning among refugee children who resettle in the US remains elevated. Following the pediatric fatality of an African refugee child in Manchester, NH from lead poisoning, screening guidelines changed to include mandatory testing of refugee children within three months of arrival. Communication methods implemented by practitioners for preventing lead poisoning in this at-risk population warrant further investigation. We demonstrate childhood lead poisoning as a complex public health problem and illustrate how the understanding of a community's ecology (i.e., social, cultural, economic, and political composition) can be integrated into the local response of public health practitioners to this persistent environmental issue. We utilized semi-structured interviews with key stakeholders (resettlement agencies, social service agencies developed by African refugees and resettled Somali refugees) involved in the refugee resettlement process to 1.) describe an urban community's ecology for Somali refugees and 2.) examine communication methods utilized in reference to childhood lead poisoning. We employed the cultural-experiential model of risk to propose the relevance of a community's ecology when communicating environmental health risks and the importance of developing place-specific and refugee-specific health communication strategies. Communities and neighborhoods are important determinants in health-related problems for resettled refugee populations. A community's ecology and the social context of risk as it pertains to childhood lead poisoning are factors that will influence how a diverse community interprets and responds to educational messages and community capacity building efforts. This presentation describes the importance of a community's ecology in the risk of childhood lead poisoning in a resettled African refugee population and its role in the development of communication strategies. Recommendations are presented for public health practitioners who assist at-risk refugee populations with this complex public health issue.