Volume 198 - Issue 3
Lost and found: improving ascertainment of refugee-background Australians in population datasets
Authors: Melanie E Gibson-Helm, Andrew A Block and Helena J Teede
Med J Aust 2013; 198 (3): 139-140. || doi: 10.5694/mja12.11742
Published online: 18 February 2013
Published online: 18 February 2013
Information on refugee background and country of birth provides important pointers to possible health needs.
To the Editor: We strongly support Paxton and colleagues in the call for inclusion of year of arrival in routine health datasets to inform improvement in health service provision in Australia.1
We also argue that a consistent and rigorous approach needs to be applied to the use of country of birth (COB) in health research. COB is usually included in routine health data sets and, as an indicator of refugee background, enables research to specifically target populations that for linguistic, cultural or societal reasons may be underrepresented in traditional epidemiological research. How we define source countries of humanitarian entrants, and also group COB by world region, is likely to affect study results.2-4 National immigration data, matched by period to the study dataset, can be used to identify COBs with high proportions of humanitarian entrants.5 The United Nations’ definitions of world regions can be used as a reproducible framework for grouping countries if required.
Using a consistent method to determine probable refugee background, description of which specific countries are represented in a world region and how many participants are from each country allows comparison of results for particular populations with those of other studies. However, it is uncommon for the methods used to determine refugee background to be described in much detail.
An awareness of potential limitations associated with COB is also needed. It is important to note that COB is not sufficient to identify ethnicity. Country borders can change over time, especially with conflict. Matching year of arrival and COB against national immigration profiles could help overcome this problem. Accuracy and consistency in the use of COB, together with year of arrival, and more detailed explanation of population selection methods would improve identification of people with a refugee background who are accessing the health system and also enable comparison of results for resettled refugee populations.
Given that the health care needs of refugees are greater than those of the general population, we also advocate that refugee background be incorporated into health funding models, as occurs with Aboriginal and Torres Strait Islander background. Identification of refugee background, even if by COB and year of arrival, is an essential step in this process.
Competing interests
No relevant disclosures.
References
- Paxton GA, Kay MP, Correa-Velez I. Lost and found: improving ascertainment of refugee-background Australians in population datasets [letter]. Med J Aust 2012; 197: 552-553. 0_BABBIHCA
- Small R, Gagnon A, Gissler M, et al. Somali women and their pregnancy outcomes postmigration: data from six receiving countries. BJOG 2008; 115: 1630-1640. 0_pgfId-2712743
- Lalchandani S, MacQuillan K, Sheil O. Obstetric profiles and pregnancy outcomes of immigrant women with refugee status. Ir Med J 2001; 94: 79-80. 0_pgfId-2712752
- Correa-Velez I, Ryan J. Developing a best practice model of refugee maternity care. Women Birth 2012; 25: 13-22. 0_i1142871
- Correa-Velez I, Sundararajan V, Brown K, Gifford SM. Hospital utilisation among people born in refugee-source countries: an analysis of hospital admissions, Victoria, 1998–2004. Med J Aust 2007; 186: 577-580. 0_i1142875