Lessons Learned About Safety Nets for Refugee Arrivals and Health Outcomes

We live in a complex world with political instability, war, and climate change-induced natural disasters, with a staggering 117.3 million¹  displaced people reported over the past year. Of these forcibly displaced individuals, 68.3 million are internally displaced, leaving 49 million who must leave their home countries in search of safety, opportunity, and hope for themselves and future generations.¹  However, few countries with advanced economies²  accept a proportionally appropriate number of refugee arrivals per capita,³  and fewer provide adequate support and a streamlined pathway to citizenship,^4–6  so that refugees can fully participate in the society of their adoptive country.

Denmark is one industrial country²  that has welcomed a small proportion of refugee arrivals. Once resettled, refugees in Denmark are provided with what, to the US observer, is an enviable mix of guaranteed access to basic needs, including health care, housing, education, and food security, as well as other health indicators, including strict gun laws and associated low gun deaths,^7,8  guaranteed paid parental leave of up to 13 months⁹  per parent, and an infant mortality rate of 3 per 1000,¹⁰  compared with a US rate of 5 per 1000¹⁰  (ranking 8^th and 33^rd in the world, respectively¹⁰ ).

Under this backdrop, in Neighborhood Disadvantage and Birth Outcomes among Refugees,¹¹  Foverskov et al retrospectively evaluated nearly 8000 refugee women resettled to Denmark over a 12-year period and asked the following question: if resettled to an area of high disadvantage, defined, in Danish terms, as a municipality with residents of lower income, education, and employment and higher welfare assistance needs, how likely were these newly resettled refugee women to have adverse birth outcomes, defined as infants who were small for gestational age, low birth weight, or preterm?

The authors found that women who resettled to areas with higher disadvantage, by Danish standards, had a higher rate of adverse birth outcomes. However, when taking into account supports in place for Danish refugee populations, including the provision of Danish language classes, preventive health interventions, and other social services (and the aforementioned guaranteed additional Danish supports), the risk of these birth complications was significantly attenuated.

Foverskov et al concluded that it is important to have governmental policies in place to provide adequate support for refugee populations, including areas of resettlement with others from the same country, as well as with people with higher incomes, educational levels, and employment statuses and less need of welfare assistance. In the case of Denmark, the basic needs of housing, health care, education, and food, among others, are already covered. We agree with the need for consistent governmental policies to provide the necessary support for newly arriving refugee populations, as well as the benefit of resettling refugee families with the intentionality needed to preserve social and family connections and provide language and cultural support and needed economic opportunities, including identifying jobs that match the skills of the people who arrive. In fact, US refugee arrivals have demonstrated clear patterns of secondary migration, which may reflect on-the-ground decision-making to pursue more robust economic opportunities and social networks.¹²  Based on this observation, we believe that it is of utmost importance for refugee resettlement policies to include the wisdom and recommendations of individuals who have directly experienced and participated in the resettlement process.

In addition, all countries with advanced economies²  should aspire to provide systems, services, and safety nets to the entire populace. Without these systems in place, the health and well-being of minoritized populations are clearly at risk, including new refugee arrivals. It is also time for all countries with advanced economies to look at their refugee resettlement policies with open eyes to the realities of the world, including the part they play in contributing to climate change, political unrest, vast economic disparities, and directly associated forced migration, and to allow an appropriate proportion of refugee arrivals per capita to live and thrive within their borders, with a streamlined pathway to citizenship and the full rights and associated security and respect that every human being deserves.