Special Public Health Services for the Elderly, Prisoners and Refugees
Dr. Ebun Ebunlomo
Associate Professor, Public Health, American Military University
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In the field of public health, we seek to prevent disease and promote health for all people. However, we ought to also consider sub-populations, or special populations, that may be more vulnerable than others to health issues. The word “special” has different connotations. Within this context, older adults, prisoners, and refugees are considered special given the unique elements of their health and well-being.
It’s not news that the U.S. population is aging; there are not as many new births to match our aging population. By 2020, the number of people age 65 or older will outnumber children under five.
According to a report in Healthy People.gov, in 2014, 14.5% (46.3 million people) of the U.S. population was 65 or older. Moreover, this number is projected to reach 23.5% (98 million) by 2060.This trend is due to various reasons such as higher life expectancy, lower fertility rates and the epidemiological shift from infectious to chronic diseases.
Although life expectancy is higher than in previous generations, it is important to note that older adults often face diverse health challenges such as dementia and physical disabilities. In addition, they are more prone to diseases such as the flu. Also, new data show a higher risk of HIV among older adults: Almost half the people in the United States living with diagnosed HIV are 50 years old or older, according to the Centers for Disease Control and Prevention.
Given these statistics, the U.S. Department of Health and Human Services has specified Healthy People 2020 objectives targeting older adults. For example, the CDC is supporting health departments and community-based organizations to deliver effective prevention interventions.
Prisoners tend to have poorer physical, mental and social health than the population at large, due to factors such as limited access to quality healthcare services. The United Nations Basic Principles for the Treatment of Prisoners mandates that all prisoners are entitled to the highest attainable standard of health care: Principle Nine says, “Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation.”
However, often this is not the case, particularly in for-profit prisons. The popular Netflix series, “Orange Is the New Black” has promulgated a public dialogue on this issue because its characters showcase the different healthcare challenges prisoners face. For example, “Crazy Eyes” has a mental health issue; Daya needs prenatal care; Miss Claudette is dealing with untreated PTSD; Pennsatucky needs dental services; counselor Sam Healy is incompetent because he lacks training and experience.
Finally, refugees too are a special public health population. According to the 1951 United Nations Refugee Convention, a refugee is defined as someone 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, unwilling to avail himself of the protection of that country….”
We see illustrations of refugees transitioning into their destination-countries in movies such as “The Good Lie,” about a group of Sudanese refugees resettling in Kansas City, Missouri. An encounter with an employment agency counselor changes their lives forever.
Why is this population special? It is important to note that refugees must complete a pre-departure medical screening and a post-arrival medical screening to ascertain their health status. However, mental health issues are common within this population due to the trauma they may have experienced. Therefore, while they may not be carriers of any physical diseases or ailments, this population should be given priority treatment in the area of mental health. Services should be tailored to integrate them into their host-country’s health care system so their health status can be continually monitored and evaluated.
As we deal with more time-sensitive public health emergencies, it is important not to lose sight of these special populations given their unique health challenges and how easy it is for us to ignore or undermine their peculiar needs. There are several non-profit organizations and governmental agencies that focus on these special populations; feel free to check with your local community to see how you can contribute your time and perhaps resources to ensure that these special populations are not forgotten and that their health care needs are met.
About the Author
Dr. Ebun Ebunlomo, MPH, MCHES, is a trained scholar in health promotion and health education, with over 10 years of experience developing, implementing and evaluating public health programs in clinical, community and work-site settings. She previously was an evaluation fellow at the Centers for Disease Control and Prevention in Atlanta. She received her Ph.D. in Health Promotion and Behavioral Sciences, with minors in Epidemiology and Leadership/Management from the University of Texas School of Public Health.
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