A step towards backyard medicine
Refugee health is an important research field – not only because the patients in this heterogeneous group have health issues that are both quantitatively and qualitatively significant, but also because studying refugees’ health may give insight into underlying mechanisms that influence health and illness in a broader sense. Refugees are in fact just one of several marginal groups in our society for whom marginalisation, stigmatisation and social isolation can impact both health status and the management of illness. In other words, groups for whom structural violence can cause and sustain preventable and treatable health problems, at the same time creating barriers to adequate healthcare.
We can regard these groups – including drug users, the homeless, prison inmates, children from vulnerable families, ethnic minorities, indigenous people – as groups who – in a sense – occupy the backyards of our society. Therefore, we suggest employing the term ‘backyard medicine’ to remind ourselves that there are important, yet less visible, determinants of health – such as mechanisms that link political and economic power and sociocultural norms to health and to the management of health – affecting marginal societal groups like refugees.
A better understanding of refugees’ challenges with regard to health care may have a potential to magnify challenges related to social and structural inequalities, and links between politics, power and health, that we find elsewhere in our society’s ‘backyard’. The anthropologist Heide Castañeda even finds that research on refugee health can ‘observe social inequality by highlighting the body as a site for inscription of politics and legitimacy’ (16).
Moreover, broadening healthcare professionals’ understanding of the above-outlined mechanism underlying health and illness through studying refugee health, may also have a positive impact on how they act in the clinical encounter. Research indicates that doctors are often unaware how we unwittingly use power in the therapeutic relationship (18, 19).
Moreover, diffuse complaints about pain, fatigue or cognitive deficits, or compliance issues, can often cause frustration among healthcare professionals, especially when doctors try to approach such issues with biomedical, scientific logic. Instead, being curious about the patient’s social context and cultural background, and being aware of its relevance for the cause and management of a presented (health) problem, can ease the management of ‘difficult’ patients for the satisfaction of both patient and doctor.