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Title page for ETD etd-07172014-213543

Type of Document Dissertation
Author Lunn, Laurel Marie
URN etd-07172014-213543
Title The Social Determinants of Refugee Health: An Integrated Perspective
Degree PhD
Department Community Research and Action
Advisory Committee
Advisor Name Title
Craig Anne Heflinger Committee Chair
Marybeth Shinn Committee Member
Sonya Sterba Committee Member
William Turner Committee Member
  • social determinants
  • refugee
  • stress
  • health disparities
  • cross-cultural health
Date of Defense 2014-04-08
Availability unrestricted
Millions of individuals and families have been permanently resettled in host countries after having fled their homes in order to seek safety from war or persecution. These resettled refugees may experience extreme hardship prior to and during flight, and may continue to experience difficulties upon resettlement, all of which can negatively influence health status. However, many also exhibit strength and resilience. Understanding the myriad social and environmental factors that affect (and are affected by) health status for any population can be difficult in general, and there are many additional contextual factors to consider when working with refugees in particular. This dissertation contributes to knowledge of refugee health status in two ways. The first is to provide an integrated model for the social determinants of health – a tool that can be used to organize what is already either theorized or known, and what is lacked, about the health of a population of interest. This framework is applied to resettled refugees as both an example and as a way of structuring the extant knowledge for this population. The second is to produce evidence about the health status of resettled refugees via three empirical studies. One uses a large existing dataset from the UK, employing latent growth curve modeling to investigate changes in health status over time after resettlement. The other two utilize local data from Nashville, TN collected in partnership with a refugee-serving non-profit organization. One series of research questions focuses on relationships between adjustment to life in the US and health status, drawing on focus groups with Somali residents (n=12). Another series investigates the relationship between life stressors (including traumatic events and chronic stressors) and health status, drawing from survey data collected from Somali residents (n=145). Overall, it is clear that some refugees do quite well upon resettlement, but that there is also great need among others, especially for emotional problems. Approaches to estimating and alleviating the health burdens require attention to cultural issues.
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