The Division of Global Migration and Quarantine at the Centers for Disease Control and Prevention (DGMQ/CDC) has issued comprehensive guidelines on health screening for refugees in the U.S. The guidance is detailed and represents the first codification of what should be the basis for “refugee health.” At the same time, by drawing on existing, evidence-based federal recommendations for the general public, they may lack the nuance that is necessary for developing a specific clinical public health screening program and primary care for refugees. These refugee-centered services must also reflect the health needs and the cultural, linguistic, and experiential backgrounds of refugees. Nonetheless, for any state, the CDC guidelines serve as a basis for developing clinical content of a screening program.
States may be challenged by their own public health infrastructure constraints. Systems for health screening need to reflect the state’s clinical capabilities. States with more centralized public health systems may have better success in defining content and completion of public health screenings, while less centralized states may instead need to focus on transitioning refugees into primary care with reliance on dispersed primary care physicians completing aspects of public health screening. In either case, public health screening must be a practical endeavor that reflects not only the core content described by the CDC but also the realities of public health infrastructure.
Public health screening for refugees should be prioritized to focus on core issues that are highly prevalent among most refugees, have simple and cost-effective tests and treatments available, and be reasonably important enough both to the public and the patient to warrant screening. Other issues, particularly the increasingly prevalent chronic diseases, may best be left for the refugee’s primary care physician to investigate. When the screening is being done in primary care settings that are not part of a government-funded screening program, clinical decision-making is likely to depend more on other factors such as the individual concerns and medical history of the refugee patient. In such settings as well, though, the care should still be grounded in the key content outlined by the CDC guidelines.