Health Promotion Needs Assessment for Refugees and Migrants in Victoria Australia

This essay aims to identify the health needs of refugees and migrants in Victoria Australia in the domain of latent tuberculosis infection (LTBI). It discusses the rationale for selecting this population, health disparities in LTBI, past and existing healthcare programs, and recommendations for improvement. The essay emphasizes the importance of planning a sustainable health promotion program for improving health outcomes.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

NURSING
Introduction
Latent tuberculosis infection (LTBI) is a state of body where constant immune
response is generated against the presence of Mycobacterium tuberculosis antigens however,
there are no active clinical manifestations of TB. Someone is said to be suffering from LTBI
if they are infected with TB but is not exhibiting signs and symptoms and are vulnerable
towards developing TB in near future (World Health Organization, 2019). The following
health promotion need assessment essay aims to identify the health needs of the refuges and
the migrants residing in Victoria Australia in the domain of exacerbating LTBI. The essay
will initiate with the rationale of selecting this particular population followed by health
disparity in LTBI. This will be followed by the past and the present LTBI prevention program
followed by pros and cons of such program. At the end, the essay will recommend few
strategies in order to promote comprehensive health promotion in LTBI.
Vulnerable population and rational behind its selection
The vulnerable population of focus in this report is the refugees and migrants of
Victoria, Australia. According to the Australian census data (2016)| published by the Victoria
Government Australia, nearly 28.4% of the Victorian’s population were born overseas. The
survey also states that 49.1% of the Victorian population are either born overseas or have any
one of their parent, born overseas. The majority of the Victorians who are born overseas,
came to Australia as immigrants for seeking better life for them and their family. A large
number of overseas born Victorian migrated to Australia as refugees due to political conflicts
like Second World War in Europe or the Indo-China war. The majority of the migrant
population in Victoria Australia came from Afghanistan, Middle East, Yugoslavia and from
the Horn of Africa.
Page 1 of 11

NURSING
This migrants and the refuge population are selected as the main population of choice
because they are proportionately affected by both chronic and infectious diseases and they are
also poorly represented in the heath research. They are also the victims of the social and the
heath inequalities, mainly the asylum seekers (refugee population) in Victoria Australia
(Renzaho et al., 2016). Moreover, migrant population is increasing constantly in Australia
and thus integrating the requirement of the migrants in the effective development of the
health policy is important to reducing the health inequality in Australia. Moreover, the health
needs of the migrants can be addressed in a comprehensive manner once a clear image of
their actual health condition and other social determinants of health are identified (Renzaho et
al., 2016).
Health disparity
The health disparity of focus in this essay is migrants or refuges of Victoria Australia
with latent tuberculosis and their poor access of specialist clinic for undergoing effective
treatment. Dale et al. (2018) stated that migration is the principal driver of the tuberculosis
(TB) in the low incidence setup with the significant among of TB cases are attributed to re-
activation of the latent TB (LTBI) that are acquired overseas. Thus an increased
understanding about the LTBI vulnerability among the heterogonous migrant population will
aid proper healthcare planning. The percentage of Australian residents with LTBI has
increased from 4.6% in 2006 to 5.1% in 2016. All of the residents who are estimated to have
LTBI during 2016 are born overseas or have migrated to Australia in 2007. The prevalence of
LTBI in Australia is poor however, the increased inflow of migrants in Australia have
increased the incidence LTBI. In Victoria specifically, the incidence of LTBI has increased
since 2000 while the numbers have reached its peak during 2010. Lack of speciality care
Page 2 of 11

NURSING
facilities, lack of proper screening of the refugees in the detention centres have increased the
rate of LBTI occurrence in Victoria Australia (Victoria State Government, 2019).
Past and existing healthcare programs
The Victoria Government had a comprehensive healthcare program in order to
address the prevailing health inequality among the refugee and the asylum seekers (2014 to
2018). This comprehensive health care program provides several mainstream services like
community health service, dental healthcare service, mental health and substance abuse
prevention service, maternity service and acute care service. Additional services include aged
care service, service for fighting against acute diseases and specialised healthcare services.
The healthcare program also provides Refugee Health Program along with trauma
counselling and support. The main partners and sectors supporting this healthcare plan
include Victorian Refugee Health Network, Local refugee health working groups,
Community advisory groups and organisations and CALD and refugee capacity-building
services (Victorian State Government, 2014).
Apart from the comprehensive health promotion program, the Victorian Government
also has a specific program that is directed towards the prevention and the spread of TB
among the Victorian population. The main interventions of these programs include injection
of BCG vaccine (Bacillus Calmette–Guérin vaccine) to the vulnerable group of population,
introduction of the potent anti-TB drugs and hospitalization of the TB patients along with
control of contacts in order to prevent the spread of TB like an epidemic (Victorian State
Government, 2019). The Victorian State Government also conducted a tuberculin skin test in
order to screen the presence of LTBI among the migrants (1996 to 2006) (Australian
Government Department of Health, 2015).
Page 3 of 11

NURSING
What worked well in the past?
Australian Government Department of Health (2015) stated that the tuberculin skin
test helps in highlighting the vulnerable population suffering from LTBI. This group of
populations was offered treatment. Offering of the treatment to the vulnerable group of
migrant population through screening worked as majority of the refuge or the asylum seekers
took part in the screening program. The comprehensive health action plan for the Victorian
refugee helped in reducing the prevailing health disparity.
What does not worked well in the past?
Though the screening program received extreme support from in the domain of
participation however, out of 1,047 persons who were considered for the treatment of LTBI,
12.5% failed to attend the initial appointment and 21.6% attended but were not offered
treatment and 65.9 lost during follow-up (Australian Government Department of Health,
2015). Diacon et al. (2014) stated that the loss of follow-up of the treatment or failing to
complete the anti-biotic dosage of the treatment leads to the development of multidrug
resistant Mycobacterium tuberculosis. This is detrimental as it might lead to epidemic
outbreak of TB. Moreover, failing to provide treatment to the person who has attended the
trail showed that lack of proper supply of BCG vaccine and anti-bacterial drugs. The
comprehensive health action plan undertaken by the Victorian government has no distinct are
plan for the LTBI and thus preventing a comprehensive health promotion for TB.
Recommendations for improvement in past and existing programs
First recommendation will focus on increase in the health literacy among the refuge
and among the migrant population of Victoria to complete the medication course of TB in
order to promote comprehensive prevention of TB development. As per the guidelines of the
WHO (2019), effective drugs are present for the TB treatment and completion of the drug
Page 4 of 11

NURSING
course will help in preventing the chances of TB becoming active. There are no specific
LTBI plan for the people who are immune-compromised like suffering from HVI-AIDS. ()
reported that migrants or the refugee population who are kept in the detention centre have
high rate of occurrence of TB. Thus the government of Australia must come forward with
adequate supply of anti-TB drugs in order to provide a protection to the immune
compromised patient and to reduce the chances of developing multi-drug resistant TB (WHO,
2019)
Importance of planning sustainable health promotion program for improving the health
outcomes
According to the WHO (2018) “Health Promotion: Sustainable Prevention” is defined
as a process of assisting people to increase the control over and to improve their health and
well0being. The five key actions that must be undertaken in order to promote sustainable
health prevention program include development of the healthy public health policy, creation
of supportive environment for comprehensive disease prevention, strengthening the
community based action for the health awareness, development of personal skills or health
literacy and re-orientation of the healthcare service. These five parameters constitute the
Ottawa Charter for the Health Promotion in 1986.
Under the public health policy development the Victorian State Government must
come forward with one specific policy targeted towards the migrants and the refugee
population of Victoria in order to conduct the LTBI screening and medication management.
The creation of the supportive environment can be done by increasing the rural based
healthcare services where screening of LTBI will be undertaken. The strengthening the
community based health awareness program will help in increasing the therapy adherence. In
the personal skill development program education will be given about disease self-
Page 5 of 11

NURSING
management. Here the migrant population will be educated about the mode of disease
transmissions and personal protective measures that they must undertaken for preventing the
spread of disease.
However, Kiazyk and Ball (2017) are of the opinion that the sustainability of the
health promotion mainly depends on the apparent value of the health promotion program and
the support that the organizations and the individuals are willing to undertake for conducting
the ongoing operations. Comprehensive sustainability will be achieved via continued
commitment towards meeting the goals and the mission of the health promotion program, by
increasing the capacity of the local systems and changing the attitudes and knowledge of the
population along with taking ongoing collaboration (Centers for Disease Control and
Prevention. [CDC], 2019). The Victorian state government must seek for active collaboration
from Australian Government Department of Health in order to receive funds for designing
community based health promotion program for screening and health awareness of LTBI and
TB.
Principal and philosophies of health promotion action
According to the WHO (2019), health is defined as a state of complete mental,
physical state and social well-being and can never be defined as the presence or absence of
the disease. In order words, health can be defined as a dynamic state or condition that has
multi-dimension (physical, social, emotional, occupation, intellectual and spiritual). Thus the
health philosophy for comprehensive health promotion includes covering both the aspect of
the emotional and psychological well-being of the people. Yelland et al. (2015) are of the
opinion that the migrants or the refuge population residing in Victoria, Australia suffers for
poor psychological well-being. The reason behind this migrants and the refuge population
resides under adverse condition in the detention centre. Moreover, they also suffer from
Page 6 of 11

NURSING
social exclusion and lack of proper employment. Under this poor mental health condition
they fail to observe healthy lifestyle habits. The lack of proper speciality clinics in the remote
or the very remote areas of Victoria, lack of proper screening of the migrants’ population
leads to increase outbreak of TB as the LTBI that are mainly inherited while overseas remain
unaddressed. Thus following the health promotion philosophy of the WHO, the government
of Australia must come forward with successful mental health promotion and physical health
promotion program. The physical health promotion program will deal with screening of the
migrants at the detention centre in LTBI. Adults, adolescents living with HIV must be
screening for TB must be screened for LTBI. Either tuberculin skin test (TST) or the
interferon gamma release assays (IGRA) must be used for LTBI test (WHO, 2019). The
Victorian Government must also come with direct observation treatment with the help of self-
administered TB medication. The increase in the provision for the self-preventive program
will be help to increase the literacy about the health along with health awareness and thereby
helping to undertaken personal protective for TB prevention in a comprehensive manner
(WHO, 2019).
Conclusion
Thus from the above discussion, it can be concluded that the number of migrants and
the refugee population in Victoria, Australia is increasing and this associated with the
increase in the occurrence of the TB infection. The reason behind the high rate of occurrence
of the TB population among refuge and immigrant population include lack of proper
screening and preventive measures. The previous policies undertaken by the Victorian state
government suffered from decrease in the population in the follow-up session and dearth in
medicines or vaccine to provide proper treatment. In order to promote sustainable health
Page 7 of 11

NURSING
promotion program WHOs five principle of health promotion as discussed by the Ottawa
Charter must be followed.
Page 8 of 11

NURSING
References
Australian Government Department of Health. (2015). Treatment of latent tuberculosis in
migrants to Victoria. Access date: 5th September 2019. Retrieved from:
https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3904b.htm
Centers for Disease Control and Prevention. [CDC]. (2019). Deciding When to Treat Latent
TB Infection. Access date: 5th September 2019. Retrieved from:
https://www.cdc.gov/tb/topic/treatment/decideltbi.htm
Dale, K. D., Trauer, J. M., Dodd, P. J., Houben, R. M., & Denholm, J. T. (2018). Estimating
the prevalence of latent tuberculosis in a low-incidence setting: Australia. European
Respiratory Journal, 52(6), 1801218.
Diacon, A. H., Pym, A., Grobusch, M. P., de los Rios, J. M., Gotuzzo, E., Vasilyeva, I., ... &
Haxaire-Theeuwes, M. (2014). Multidrug-resistant tuberculosis and culture
conversion with bedaquiline. New England Journal of Medicine, 371(8), 723-732.
Kiazyk, S. and Ball, T.B., 2017. Tuberculosis (TB): Latent tuberculosis infection: An
overview. Canada Communicable Disease Report, 43(3-4), p.62.
Renzaho, A., Polonsky, M., Mellor, D., & Cyril, S. (2016). Addressing migration-related
social and health inequalities in Australia: call for research funding priorities to
recognise the needs of migrant populations. Australian Health Review, 40(1), 3-10.
Victoria State Government. (2019). Mycobacterial infections (tuberculosis). Access date: 5th
September 2019. Retrieved
from:https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-
information-advice/tuberculosis
Page 9 of 11

NURSING
Victorian Government Australia. (2019). Discover Victoria's diverse population. Access date:
5th September 2019. Retrieved from: https://www.vic.gov.au/discover-victorias-
diverse-population
Victorian State Government. (2014). The Victorian refugee and asylum seeker health action
plan 2014–2018. Department of Heath Australia.
Victorian State Government. (2019). Mycobacterial infections (tuberculosis). Access date: 5th
September 2019. Retrieved from:
https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-
advice/tuberculosis
World Health Organization. (2019). Latent tuberculosis infection (LTBI). Access date: 5th
September 2019. Retrieved from: https://www.who.int/tb/areas-of-work/preventive-
care/ltbi_faqs/en/
Yelland, J., Riggs, E., Szwarc, J., Casey, S., Dawson, W., Vanpraag, D., ... & Petschel, P.
(2015). Bridging the Gap: using an interrupted time series design to evaluate systems
reform addressing refugee maternal and child health inequalities. Implementation
science, 10(1), 62.
Page 10 of 11