Impact of social exclusion on health in Sudanese refugee communities in Australia

¶ … social exclusion on the health of the Sudanese refugee community in Australia?

In this paper, we investigate the concept of social exclusion and its effect on the provision of health care services the Sudanese refugee community in Australia. Our specific focus is on the assessment of the impact of social exclusion on the health of the Sudanese community and to investigate how social exclusion of the Sudanese refugees affects them. A recommendation then follows on how the situation can be mitigated in order to provide the Sudanese refugees with equal health services.

The existence of social exclusion against refugees in different parts of the world is a fact which demands thorough investigation. Several scholars have dedicated their work in creating an understanding as to why this takes place in our society. Several other studies have also been dedicated to the creation of an in-depth understanding of the mitigating actions that are necessary to reduce and even eliminate this terrible behavior that is against the basic human rights. In our study however, we dedicate our efforts in the study of how social exclusion affects the level of dispensation of health care to the Sudanese refugee community in Australia. We therefore begin with a brief introduction of the key terms.

Social exclusion

Social exclusion, which is defined by Social Exclusion Unit (SEU) as 'a shorthand label for what can happen when individuals or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown' (SEU,1997).

Refugees

The United Nations Convention took place in 1951 came up with the definition of a refugee. The definition was used for the determination of the eligibility of an individual for entrance into Australia as well as other nations as pointed out by Jupp (2003).The definition that is provided by the United Nations High Commissioner for Refugees is;

'A person who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country...' (UNHCR, 2004)

Rationale

The Sudanese refugees in Australia arrived there via various programs that are aimed at their resettlement. These programs are run and monitored by the Australian government. It is however good to note that these programs come with their specific bottlenecks that are heavily underpinned by the extensive trauma caused by conflicts. There is therefore a need for an elaborate settlement support. There have been various organizations as well as the government who came up with intensive programs that were aimed at the identification and the supporting of the refugee's strength in order to enable them to establish as well as to rebuilt their lives in a dignified fashion (Pittaway et al.,2006).The Sudanese refugees are however discriminated on racial and cultural grounds by the Australian healthcare providers. They also get excluded from the mainstream social networks which are integral in the process of job searching -- an important factor in the attainment of financial stability for the purpose of enabling the refugees to meet their basic needs. The resulting lack of resources subsequently leads to poor health among them. Health in this context is used to refer to the physical fitness which is made up of physical, emotional, mental, spiritual, environmental and societal dimensions. The 2005 DIMIA report indicated that about 11,000 refugees from Sudan were absorbed into Australia in 1996.Of this lot, about 8,000 were lucky to be granted visas in 2003 and 2004.

The concept of social exclusion can be effectively traced back to Weber who positively identified that exclusion is among the social closures that are present in our society (Weber, 2000).He attributed it to the attempt of one particular group to come up with a way of securing itself a certain privileged position. A move which they take at the expense of another group via a process of subordination. An extreme example is that of the Australian community that has access to high quality health care services as coupled with top notch security in order to prevent outsiders such as the Sudanese refugee community from deriving benefit from the same services.

Not much literature has been dedicated to the concept of social exclusion among refugees in terms of health care. Therefore the literature searched is mainly concerned with 'social exclusion' and 'poverty' among the refugees. These factors can be conceptualized in many ways since it has been proven that there is a correlation between poverty and poor state of health. For this purpose, it can positively be cited that poverty is a key factors that results as a result of social exclusion. The idea of poverty has several undertones such as low income, too much expenditure, unemployment and lack of income support. It is therefore necessary to ensure that we discuss all the aspects of social inclusion that faces the Sudanese refugee community in Australia. The social exclusion witnessed in Australia as a result of a program referred to as 'border protection'. Some refugees who are in the process of seeking asylum have been removed forcefully (physically) as they approached Australia. Yet again others have been detained for years in designated detention centers waiting processing for deportation. The argument given by the Federal Government is that the persons who are being excluded are never legitimate. It is worth noting that certain aspect of the said social exclusion which is faced by the refugees is never experienced by the rest of the refugee community.

Models of social exclusion

The main models of social exclusion in relation to the referees as well as the asylum seekers in the UL and Australia are the Burchardt's model of the dimensions of social exclusion. This model involves consumption materials such as social security, health, housing as well as settlement support. The next is production which includes employment, education, training and job skills. The other factors included in this model are political engagement as well as social interaction-these include family reunion, language barriers, victimization, travel and geography as well as cultural barriers.

The aim and objectives

The aim and objectives of this paper is to find out the effect of social exclusion the health of the Sudanese refugee community in Australia. The general objective however is to assess the impact of social exclusion on the health of the Sudanese refugee community and also to find out how social exclusion of the target group affects the refugee community at large. This research aims at the assessment of how the health of Sudanese refugee community is directly or indirectly affected by social exclusion in Australia.

The social determinants of health

Before we proceed with the paper, it is important to note that there are certain social factors that affect the health of an individual. These factors, also known as the social determinants of health (SDH) are used to refer to the various conditions in which an individual is born, nurtured, work and even age.These conditions can on be used in the making of informed action.It has also been noted that the main themes that underlie the concept SDH are health equity as well as the right to health: Issues that can best be addressed within the established health system and by the primary health care (PHC) providers.

It has been suggested that social exclusion of the Sudanese refugee community in Australian renders them unemployed. This state of unemployment according to Burnett and Peel (2001) affects their mental health. As an illustration, it has been widely acknowledged that a very tiny percentage of the Sudanese refugee community actually manages to get jobs in the Australian job market as compared to the general population who are otherwise unemployed. This inability to acquire employment subsequently leads to a significant level of poverty for the Sudanese community which leads to poor health.

Literature review

Extant literature has been dedicated to the study of social exclusion of refugees and its effects. Colic (2005) investigates the effects of visible difference on discrimination of refugees and its effects of employment. This study which was carried in Western part of Australia revealed that there is:

A high level of employment among refugees who are skilled

A huge loss in terms of the occupational status among the refugees who are skilled

A high level of persistence of the Australian segmented labor market which results to the culturally and racially visible refugees being allocated jobs that are unattractive despite their skill levels.

The social exclusion leads to a loss in human capital since some of the refugees who are professionals (doctors and engineers) end up doing inappropriate jobs such as driving of taxis.

The significance of Colic's (2005) work is that it helps to illustrate the fact that social exclusion of the Sudanese refugee community in Australia leads to renting of poor houses while having a low level of living standard which subsequently results to poor physical and emotional health amongst them. Colic's (2005) argument is that there is a very strong correlation between porr housing and an individual's physical ill health. He goes further to point out that six out of every ten homeless individuals do suffer from a certain form of mental distress. About 20% of this lot have severe mental illness. In a nutshell, social exclusion gives rise to a direct form of social and economic consequences that include poor housing and limited financial resources.

Dunn (1999) studied the link between social exclusion and mental health. His concluded that the correlation was rather strong and was in congruence with what other authors have documented. It has been acknowledged that unemployment affects persons who have long-term mental disorders in a way that is far greater as compared to the other persons with disability. A total of only 13% are employed as opposed to the more than a third of individuals with disability in general terms (ONS, 1998).The lack of ability to gain employment culminates to a significant level of poverty amongst persons who are having problems associated with mental problems ( FMH,2001).The effect of the inequality falls in a way that is disproportionate on certain groups of persons who use mental health services as compared to others. There is also an element of gender inequality in terms of income as well as wealth both of which when combined with the role of women as mothers as well as carers make the refugees very susceptible to poverty. The poverty itself is also associated with physical illness as well as mental illness. The existence of social exclusion amongst the refugees contributes to a significant impact on both their physical and mental health. A study involving Iraqi asylum seekers revealed that depression had a more close correlation with social support in a manner that is greater that with the history of the torture in that country (Gorst-Unsworth and Goldenberg, 1998)

Burnett and Peel (2001) identified that there is a strong link between an individual's well being and the support that they get from their communities. This is because it aids them in the development of their friendships and links with the host community in order to promote their health as well as their well being.

Dunn (1999) further shows that persons who are of older age who suffers from mental health problems and face other inappropriate acts of discrimination, negative stereotyping, low income and isolation are at a higher risk (more vulnerable) to an elevated vulnerability in terms of their poor physical health (HEA, 1997, Roberts, Seymour and Robinson,2002 and McCulloch,2002)

Galabuzi (2006)'s calls for attention to the eincreasing gap that exists between the rich and the poor amongst the Canadian society. The book makes a challenge to certain common myths that are usually employed in order to deflect the concern of the public as well as for the purpose of masking the various escalating level of social crisis. Galabuzi goes ahead to point out the various roles of the historical patterns of the mainly historical pattern in the prevailing systemic kind of discrimination which then is essential for the succinct understanding of the level of over-representation of the groups that are racialize in the various low paying companies

The link between poverty and health

Several studies have categorically shown that health status is measure via:

Mortality chronic conditions

Emotional stability

General life satisfaction

Physical functioning.

The socio-economic status is however noted via the following measure:

Current income level

Recent income change,

Poverty flags,

Current earnings,

Multi-period averaged incomes,

Relative position in the income distribution

Number of spells of poverty.

Various studies have indicated that the measures of income are significantly linked to the health outcomes (Mullahy, Stephanie and Barbara, 2001). Mullahy and colleagues concludes that several empirical studies as well as reviews have demonstrated that there is a strong association between an individual's income and morbidity by means of various measures derived from both income and health from a diverse layout of samples at various moments (Mullahy, Robert and Wolfe, 2001)

More analysis from literature suggests that:

There is a relationship that exists between the income of an individual and their health. This relationship is however non-linear. This is to means that low-income persons do suffer a greater amount of negative health consequences as compared to the high-income individuals who stand to reap various health benefits.

The long-terms measures that are used for average income do have a higher association with an individual's health as compared to the measures of current income which is regarded to be highly volatile.

Hypothesis

The Sudanese refugee community in Australia to a large extent is affected negatively on health matters because they are socially excluded from the other communities. They are not being given attention or health care by the Australians' healthcare providers like the rest, thus they suffer a lot as they are excluded.

H1: Over 75% of Sudanese refugee Community in Australia gets poor health services due to social exclusion

H2: Less that 75% of Sudanese refugee Community in Australia gets poor health services due to social exclusion

Methodology

The methodology to be utilized in this research is meant to de-colonize the various research experiences to the largest extent in order to adhere to the objectives that are outline in the research questions as pointed out by (Smith, 2006). This is done by drawing on the various experiences of the participants since the methodology gives enough room for the encapsulation of the voice of the Sudanese refugees, their experiences as well as opinions regarding the phenomenon of poor health as a result of social exclusion. The various dimensions of the concept of social exclusion that is experienced by the Sudanese refugees in Australia is investigated via a first target group by means of semi-structured interviews that solicits the opinions and vies of the refugees themselves and the community health workers (second target group) who are integral for helping them in the path to social inclusion. The advantages of interviewing both the first and the second target groups is to ensure that one obtains an in-depth understanding of how the process of social inclusion actually affects the level and manner in which poor health of the Sudanese refugees comes about. The views obtained from the refugees are then contrasted against the ones obtained from the community workers.