Session

Promoting Refugee, Immigrant, and Migrant Community Health and Global Health

Katherine Goscilo, MPH, Biological Sciences Division, UChicago, Chicago, IL

APHA 2022 Annual Meeting and Expo

Abstract

Factors associated with avoiding public places and gatherings among crisis affected populations in Bangladesh

Min-Hee Heo1, Jin-Won Noh2, Kyoung-Beom Kim3, Huiwon Jeon4 (1)Department of Health Administration, Yonsei University Graduate School, South Korea, (2)Division of Health Administration, College of Software and Digital Health care Convergence, Yonsei University, South Korea, (3)Public Health Science, Graduate School, Dankook University, South Korea, (4)Department of Healthcare Management, College of Health Sciences, Youngsan University, South Korea

APHA 2022 Annual Meeting and Expo

Since August 2017, more than 860,000 of Rohingya refugees fled to Cox’s Bazar, Bangladesh have been reported. They rely heavily on humanitarian aid to meet their essential needs. And their settlement was hilly, formerly forested regions where landslides and flash floods were frequently reported during the monsoon season. These refugee communities were associated with significant increasing environmental degradation, rising prices, inducing additional pressures on communities where public services and infrastructure were limited. Since March 2020, COVID-19 pandemic and COVID-19 preventive measures have caused additional difficulties on livelihoods, accessing goods, and social services among host communities, and increased their essential needs. The developing countries like Bangladesh are needed effective actions due to their fragile economic, educational and health status resulting in the COVID-19 overwhelming impact. However, in the context of high population density and lower-middle-income countries like Bangladesh preventive measures such as implementing social distancing are challenging strategy.
This study analyzed 1,053(Refugee=836, Host=217) crisis-affected households from the 2020 Bangladesh Multi-Cluster Needs Assessment survey data. Between March to December 2020, household survey was conducted by the REACH Initiative to provide comprehensive evidence base of the diverse multi-sectoral needs among refugee populations and host communities. The independent variable was acceptance of COVID-19 preventive measures (avoiding public places and gatherings) The independent variables included demographic variables (gender and age of household head, education level of household members, number of family members), health related variables (disability in household members, access to healthcare facility by walking), household vulnerability variables (information accessibility: Food assistance, Health services). We performed sampling weighted multivariable binary logistic regression analysis using Stata/MP version 16.1.
In refugee, household with 30~59 min to reach the healthcare facility by walking were more likely to accept avoiding public places and gatherings than household with less than 15 min (OR=1.763, p=0.032). In host, household who were female headed household (OR=0.281, p=0.042) showed lower acceptance of preventive measures to avoid public places and gatherings. However, household who were elderly household head (OR=1.036, p=0.032), disabled household members (OR=3.033, p=0.001), were significantly higher acceptance of preventive measures to avoid public places and gatherings. Households with the highest educational attainment in high school were less likely to accept preventive measures to avoid public places and gatherings (OR=0.093, p=0.006).
This finding showed the characteristics and vulnerabilities of crisis-affected households who have difficulties to accept COVID-19 preventive measures avoiding public places and gatherings during the COVID-19 pandemic.

Abstract

Elevating Refugee and Immigrant Needs during COVID-19: A model for partnership among grassroots organizations, community advocates and the local public health department.

Yeri Shon, MPH, MSW, KCCEB

APHA 2022 Annual Meeting and Expo

Problem
Alameda County's population is over 1.67 million; it’s the 4th most diverse county in the nation with over 43% of residents speaking a non-English language at home.
During the pandemic, many limited English proficient (LEP) refugee and immigrant (RIM) populations have been struggling with access to in-language information on COVID-19 relief programs, testing, and vaccines. Vaccine and testing sign-ups weren’t initially available in diverse languages, making it difficult for these communities to access them in a timely manner.

Method
KCCEB created a coalition of 7 local community-based organizations that have long histories of serving their respective RIM communities to: 1) Provide COVID-19 outreach and vaccine support in 14 languages; 2) Understand COVID-related community challenges through community advocates; 3) Work with the local health department to advocate for improving public health resources for RIM communities.
We used MAP-IT framework, an evidence-based program planning model, to plan and implement this project:

Mobilize organizations: KCCEB recruited organizations that have built trust with LEP communities they serve and share the goal of increasing communities’ access to COVID-19 resources - especially testing and vaccinations.
Assess the areas of need: The coalition conducted a survey assessing how communities receive information about vaccines and reasons for getting vaccinated. We also reviewed the local public health department (PHD) website to assess the availability of COVID-related information in diverse languages.
Plan: We developed strategies for effective COVID-related outreach and engagement, centering partner organizations’ expertise in reaching the communities they serve. We engaged the local PHD to share LEP challenges and seek meaningful changes for equitable access to information and resources.
Implementation with action steps: 1) Translate crucial information that lack translations to distribute within the communities; 2) Address communities’ vaccine-related concerns in a culturally responsive manner; 3) Provide vaccine clinics at local hotspots identified by county PHD; 4) Collect and analyze survey data; 5) Train community advocates on how to advocate for their communities to stakeholders using data and experiences from the field; 5) Build relationships with PHD to learn up-to-date COVID-19 data, learn effective advocacy strategies, and be invited into spaces to share our lessons learned.
Track progress: Monthly partner convenings, reports, and check-ins with county PHD.

Conclusions
We share best practices from our experience on building an effective and supportive coalition, providing outreach, education, and direct services tailored to community needs, and advocating for sustainable changes at local PHD to advance health equity for RIM communities.

Abstract

Building Capacity and Partnership with our Refugee, Immigrant, and Migrant Communities

Lilliana Cardenas Maricopa County Dept. of Public Health / AZ Public Health Association

APHA 2022 Annual Meeting and Expo

During the peak of the COVID-19 pandemic, reaching our refugee, immigrant, and migrant communities to address safety and minimize disease transmission became exceptionally difficult in Maricopa County. Arizona is one of the top states for resettling refugees fleeing persecution and armed conflict in countries worldwide. Estimates show that close to 15% of the population in Maricopa County is foreign-born, and almost 27% of the total population speak another language other than English at home. In addition, Arizona is the third-largest producer of vegetables and citrus in the USA. According to the Human Rights Watch, Arizona is considered a base state that holds a significant resident farmworker population and a large migrant flow of seasonal workers from other parts of the country and Mexico. Many migrant farmworkers live in communities outside of major cities and towns, creating accessibility issues to health and healthcare. In consultation with the Arizona Dept. of Economic Security, local refugee resettlement agencies, and many community partners, significant gaps were revealed in culturally and linguistically appropriate COVID-19 specific outreach, including general education, case investigations, and contact tracing (CICT), infection control recommendations, testing, and vaccine opportunities to persons who resettled in Maricopa County as refugees, immigrant groups, and migrant workers. To address the need, MCDPH developed the Refugee Outreach Unit and the Diverse Community Vaccine Access Unit, which were tasked with creating culturally and linguistically appropriate education and outreach plans to ensure equitable and accessible testing and vaccine sites throughout Maricopa County. The success of these COVID-19 response units led to the permanent creation of the Refugee, Immigrant, and Outreach (RIM) Team within the Office of Community Empowerment. This team will serve as a direct link in the community with partners and agencies serving our RIM communities, will work to build trust to increase representative data collection efforts, and ensure decision-makers are aware and accountable to the needs of our diverse communities. The RIM team is comprised of three Clinical Health Navigators who are former refugees and a manager who is first generation in the USA and whose parents were migrant farm workers. This direct link to lived experience gives our team the capacity to truly understand the communities they are serving through empathy, first-hand experience, and the combined ability to speak ten different languages.