Minnesota Department of Health
The Refugee Act of 1980
“The Refugee Act of 1980 created The Federal Refugee
Resettlement Program [Office of Refugee Resettlement at
Dept of Human and Health Services] to provide for the
effective resettlement of refugees and to assist them to
achieve economic self-sufficiency as quickly as possible
after arrival in the United States.”
 Availed funds for medical screening and initial
medical treatment under subsection (b)(5), (ii) for
services for refugees under subsection (c)(1)…
Infectious Disease Epidemiology, Prevention and Control
Refugee and International Health
Program Staff
• International Health
Coordinator
• LEP Communications
Planner
• International Health
Planner
Student Workers
(x3)
Interns (x2)
• Refugee Health
Coordinator
• Refugee Health Nurse
Consultant
• Refugee Health Systems
Coordinator (MSW)
• Refugee Health
Epidemiologist
Refugee and International
Health Program Vision
Optimal health for refugees and immigrants
achieved through innovative leadership and
strong partnerships
Mission Statements
Refugee Health
Program
Promote and enhance
the health and wellbeing of refugees
International Health
Program
Advance effective
community health
practices with refugees,
immigrants, and LEP
persons
Refugee and International Health
Program Guiding Principles
• Community Engagement: Working collaboratively with our communities
on issues affecting their well-being
• Empowering Partnerships: Strengthening and maintaining relationships
with key partners over time through mutually beneficial capacity-building
• Data-informed Action: Analyzing and acting on health surveillance data
and data gathered from our communities to effect positive change for the
people we serve
• Cultural and Linguistic Best Practices: Ensuring that our messaging
and programming are culturally reflective and linguistically appropriate
• Health Equity: Achieving the conditions in which all people have the
opportunity to attain their highest possible level of health
Minnesota Refugee & International Health
Program Functions

Coordinate health screenings for refugees

Analyze data, summarize and share results
•
Research studies

Identify health disparities

Develop health education programs & materials

Train health professionals

Strengthen partnerships
U.S. Government Definitions
U.S.A.
Non-Citizen (Foreign-born)
U.S. Citizen
Non-Immigrant
Immigrant
LPR
LTR
authorized
employment
undocumented
individual
student
Persons fleeing from persecution
refugee
asylee
Parolee/
entrant
Refugee Health Program, Minnesota Department of Health
victim of
trafficking
visitor on
business
tourist
Refugee Admissions Ceilings for FY2015
Europe and
Central Asia,
1,000
Latin
America/Cari
bbean, 4,000
Unallocated,
2,000
Near
East/South
Asia, 33,000
East Asia,
13,000
Africa,
17,000
Ceiling: 70,000
Source: US Department of State
YEAR
REFUGEE
ADMISSIONS
CEILING
FY TOTAL
ADMITTED
INTO U.S.
2002
36,500
27,119
2003
70,000
28,423
2004
70,000
52,873
2005
70,000
53,813
2006
70,000
41,279
2007
70,000
48,282
2008
80,000
60,191
2009
80,000
74,654
2010
80,000
73,311
2011
80,000
56,424
2012
76,000
58,236
2013
70,000
69,930
2014
70,000
69,987
2015
70,000
51,530
Top U.S. States for Refugee*
Resettlement FY 2014
1. Texas
2. California
3. New York
4. Michigan
5. Florida
6. Arizona
7. Ohio
8. Pennsylvania
9. Georgia
10. Illinois
13. Minnesota
Total admitted
7,210
6,111
4,079
4,006
3,519
2,964
2,811
2,743
2,694
2,578
2,232
69,987
* Numbers include Amerasian, Asylees (Derivatives), Entrants/Parolees and Primary Refugee arrivals
Source: Refugee Processing Center/WRAPS
Refugee Arrivals to MN by Region of World
1979-2014
8000
7000
Number of arrivals
6000
5000
4000
3000
2000
Southeast Asia
FSU
Sub-Saharan Africa
Middle East/North Africa
Refugee Health Program, Minnesota Department of Health
Eastern Europe
Other
2013
2011
2009
2007
2005
2003
2001
1999
1997
1995
1993
1991
1989
1987
1985
1983
1981
0
1979
1000
Types of Medical Exams
Overseas Visa Medical Examination
United States Public Health Service
Domestic Refugee Health
Minnesota Department
Assessment
of Health
Adjustment of Status Medical Examination
 from temporary to permanent resident
 needed to obtain a green card
 Immigration and Naturalization Services
Refugee Health Program, Minnesota Department of Health
Refugee Benefits

Health screening exam within 90 days of arrival

Almost all newly arrived refugees are eligible for “Refugee
Medical Assistance”

Mandated 3 months of casework through assigned
resettlement agency; each family has a case manager

Time-limited public cash benefits distributed through the
resettlement agency; must comply with work participation
expectations
Refugee Health Program, Minnesota Department of Health
Refugee Health Partners
County
Services
VOLAGs
MDH
Health Care
Provider
Local Health
Dept.
5/2010
Outline of Exam Components
•
•
•
•
•
•
•
•
•
Health History
Physical Exam
Immunization review and update
TB screening
Hep B screening
Screening for Intestinal Parasites
CBC with differential
Lead Screening
STI risk assessment and screening
– per provider discretion
• Assessment for Dental, Vision, WIC etc.
Refugee Health Assessment
Information Flow
Quarantine Station/CDC/EDN
Local Health Dept.
Screens
Forwards to
primary provider
Primary provider
screens
Screening form
completed & returned
Refugee Health Program, Minnesota Department of Health
What is eSHARE?
web-based application developed for
collecting demographic and domestic
health screening results to conduct
disease surveillance.
- secure, remote data entry
- summary reporting tool
Minnesota Refugee
Health Data and
Statistics
2014
Refugee Arrivals to MN by Region of World
1979-2014
8000
7000
Number of arrivals
6000
5000
4000
3000
2000
Southeast Asia
FSU
Refugee Health Program, Minnesota Department of Health
Sub-Saharan Africa
Middle East/North Africa
Eastern Europe
Other
2013
2011
2009
2007
2005
2003
2001
1999
1997
1995
1993
1991
1989
1987
1985
1983
1981
0
1979
1000
Primary Refugee Arrivals, Minnesota
2014
Ethiopia, 70
(3%)
Bhutan, 77
(3%)
Iraq, 191 (8%)
Burma, 838
(34%)
All Others*,
172 (7%)
N=2,475
Somalia, 1127
(45%)
“Other” includes Afghanistan, Belarus, Cambodia, Cameroon, Cuba, DR Congo, Ecuador, El Salvador, Eritrea, the
Gambia, Honduras, Iran, Kenya, Liberia, Moldova, Nepal, Russia, Rwanda, Sierra Leone, Sri Lanka, Sudan,
Tanzania, Ukraine, and West Bank
Refugee Health Program, Minnesota Department of Health
Kittson
2014 Primary Refugee Arrival To
Minnesota (N=2,475)
Lake
of the
Woods
Roseau
Koochiching
Marshall
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Lake
Itasca
Mahnomen
Norman
Hubbard
Cass
Becker
Clay
Aitkin
Wadena
Crow Wing
Number of Refugees Arrival By
Initial County Of Resettlement
Carlton
Otter Tail
Wilkin
Pine
Todd
Grant
Douglas
Stevens
Pope
Mille
Lacs
Kanabec
0
Morrison
Benton
Traverse
Stearns
Sherburne
Swift
Anoka
71
Wright
Chippewa
Hennepin
Hennepin
Lac Qui Parle
Yellow Medicine
Lyon
McLeod
Renville
11 - 30
Chisago
Kandiyohi
Meeker
Lincoln
1- 10
Isanti
Big Stone
31 - 100
WashingRam-ton
sey
101 - 250
Carver
Scott
251 – 500
Dakota
Sibley
Redwood
Le
Sueur
Nicollet
Rice
501 – 1,500
Goodhue
Wabasha
Brown
Pipestone
Murray
Rock
Nobles
Cottonwood
Jackson
Watonwan
Martin
Blue Earth
Faribault
Waseca
Steele
Freeborn
Dodge
Mower
Olmsted
Winona
Fillmore
Houston
Top MN Counties of Primary Refugee
Resettlement – 2014
1.
2.
3.
4.
5.
6.
Ramsey
Hennepin
Stearns
Anoka
Olmsted
All Others
Total
Refugee Health Program, Minnesota Department of Health
1,277
455
275
155
136
177
2,475
Country of Origin by County of Resettlement, 2014
400
900
800
300
700
Burma
600
Somalia
Iraq
Bhutan
Ethiopia
Other
Somalia
500
Bhutan
400
200
Iraq
300
Ethiopia
200
Other
100
100
0
0
Ramsey
Hennepin
N=1,277
N=455
100
250
80
200
150
Somalia
100
Iraq
Kenya
Iraq
Somalia
Afghanistan
Other
60
40
20
50
0
Stearns
N=275
Refugee Health Program, Minnesota Department of Health
0
Anoka
N=155
Primary Refugee Arrivals Screened
Minnesota, 2003-2014*
8000
7351
7009
6801
Number of Arrivals
7000
6000
5355
5326
4893
5108
4990
4710
5000
97%
4000
3000
98%
2403
2242
2118
98%
2000
1000
2867
2740
2697
98%
94%
2320
2241 1893
2220 1845
1830
1265
1205
1167 1200
1152 1169
99%
97%
2008
2009
99%
99%
2010
2011
2259 2141
2475
2200
2109
24282410
2172 2082
99%
99%
2012
2013
99%*
0
2003
2004
2005
2006
2007
2014*
Arrivals
Eligible for Screening
Screened
*Ineligible if moved out of state or to an unknown destination, unable to locate or died before screening
Refugee Health Program, Minnesota Department of Health
*2014 data are preliminary
Primary Refugees Reasons for No Screening,
Minnesota, 2014
Contact Failed,
7%
Screened
Elsewhere, No
Results, 2%
Pending, 2%
Refused
Screening, 5%
Unable to
Locate,
Incorrect
Address*, 50%
N=56
Moved Out of
State*, 34%
*Ineligible for the refugee health assessment
Refugee Health Program, Minnesota Department of Health
*Counted as ineligible for screening
Refugee Screening Rates by Exam Type
Minnesota, 2014*
99%
Health Screening
Rate
Tuberculosis (TB)
2,419/2,428
96%
Hepatitis B
2,332/2,419
98%
Intestinal Parasites
2,378/2,419
91%
Lead (<17 yrs old)
STIs**
Malaria
9%
0%
2,212/2,419
97%
1,000/1,036
98%
2,363/2,419
206/2,419
20%
40%
60%
80%
100%
*Some screening results pending
Refugee Health Program, Minnesota Department of Health
**Screened for at least one type of STI
Health Status of New Refugees, Minnesota
2014*
Health status upon
arrival
No of refugees
screened
No (%) with
infection
TB infection**
2,332 (96%)
484 (21%)
Hepatitis B infection***
2,378 (98%)
123 (5%)
Parasitic Infection****
2,212 (91%)
331 (15%)
Sexually Transmitted
Infections (STIs)*****
2,363 (98%)
19 (1%)
Malaria Infection
206 (9%)
0 (0%)
Lead******
1,000 (97%)
71 (7%)
Hemoglobin
2,354 (98%)
502 (21%)
*Total screened: N=2,419 (>99% of 2,428 eligible refugees); data are preliminary
** Persons with LTBI (>= 10mm induration or IGRA+, normal CXR) or suspect/active TB disease
*** Positive for Hepatitis B surface antigen (HBsAg)
**** Positive for at least one intestinal parasite infection
***** Positive for at least one STI (tested for syphilis, HIV, chlamydia or gonorrhea)
****** Children <17 years old (N=1,036 screened); lead level ≥5 µg/dL
Refugee Health Program, Minnesota Department of Health
2014*
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
Overseas
Domestic
2003
100
90
80
70
60
50
40
30
20
10
0
2002
% with Evidence of
Immunizations
Health Status of New Refugees, Minnesota
Immunization Status, 2002 – 2014*
Year
Refugee Health Program, Minnesota Department of Health
Refugee Health Program, Minnesota Department of Health
*2014 data are preliminary
Primary Refugee Arrivals, Minnesota
Jan – June 2015
Ukraine,
Afghanistan, 19 (2%)
23 (3%)
Ethiopia,
28 (3%)
All Others*,
82 (8%)
N=990
Iraq, 52
(5%)
Burma, 310
(31%)
Somalia,
476 (48%)
“Other” includes Belarus, Bhutan, Congo, DR Congo, Eritrea, Ethiopia, Iran, Liberia, Mexico, Moldova, Russia,
Sudan, Syria, and Vietnam
Refugee Health Program, Minnesota Department of Health
Kittson
Jan-June 2015 Primary Refugee
Arrival To Minnesota (N=990)
Lake
of the
Woods
Roseau
Koochiching
Marshall
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Lake
Itasca
Mahnomen
Norman
Hubbard
Cass
Becker
Clay
Aitkin
Wadena
Crow Wing
Number of Refugees Arrival By
Initial County Of Resettlement
Carlton
Otter Tail
Wilkin
Pine
Todd
Grant
Douglas
Stevens
Pope
Mille
Lacs
Kanabec
0
Morrison
Benton
Traverse
Stearns
Sherburne
Swift
Anoka
71
Wright
Chippewa
Hennepin
Hennepin
Lac Qui Parle
Yellow Medicine
Lyon
McLeod
Renville
11 - 20
Chisago
Kandiyohi
Meeker
Lincoln
1- 10
Isanti
Big Stone
31 - 40
WashingRam-ton
sey
41 - 100
Carver
Scott
101 – 300
Dakota
Sibley
Redwood
Le
Sueur
Nicollet
Rice
301 – 500
Goodhue
Wabasha
Brown
Pipestone
Murray
Rock
Nobles
Cottonwood
Jackson
Watonwan
Martin
Blue Earth
Faribault
Waseca
Steele
Freeborn
Dodge
Mower
Olmsted
Winona
Fillmore
Houston
Languages* Used by Primary Refugee Arrivals
to Minnesota, January 2004-June 2013
N=24,344
*Language used during the domestic refugee health assessment, which generally occurs within 90 days of US arrival. Language is only available for refugees wh
a refugee health assessment and used an interpreter.
**Other includes Acholi, Afar, Anuak, Bali, Bari, Bassan, Bhutanese, Burmese, Chin, Chinese, Dinka, Farsi, French, Fula, Ghanaian, Gio, Gola, Haitian Creole, I
Italian, Karenni, Kayah, Khmer, Kono, Krahn, Kuranko, Kurdish, Liberian, Madi, Mandinka, Mandino, Mano, Mende, Moldova, Mon, Nepali, Nuer, Oromo, Pashto
Russian, Sarpo, Sign Language, Spanish, Sudanese, Swahili, Thai, Tibetan, Tigre, Tigrigna, Togolese, Ukrainian, and Vietnemese
Secondary Refugees
2014 – 2015*
*Secondary notifications through June 30, 2015. 2015 data are preliminary
Secondary Refugees
•
Who is a secondary refugee?
Secondary refugees are individuals who initially settle in a state
other than Minnesota but soon migrate to live in Minnesota. This
migration can occur within days, weeks, months or a year of a
refugee’s arrival to the U.S.
•
Who notifies MDH of the arrival of a secondary refugee?
MDH is most often notified of a secondary refugee’s arrival into
Minnesota from Local Public Health or a clinic. However, in
some instances, the primary state may notify MDH that the
refugee has moved to Minnesota.
Secondary Refugee Work Flow
LPH or Clinic Notified of
Secondary Refugee Arrival
Fax Notification Form to MDH
Refugee Health Program (RHP)
MDH RHP Requests Overseas
Records and Screening History
from Primary State
Secondary refugee
eligible for screening
MDH RHP Forwards
Overseas Records and
Screening History to LPH
• Refugee Health Assessment Completed
• LPH Faxes/Mails Pink Form to MDH RHP
Secondary refugee
ineligible for screening
No further assistance
required
Secondary Refugee Arrival
Notifications to Minnesota, 2014
Iraq, 26 (3%)
Burma, 13
(1%)
All Others, 13
(2%)
N=841
Somalia, 789
(94%)
Kittson
2014 Secondary Refugee Arrival
Notifications To Minnesota
(N=841)
Lake
of the
Woods
Roseau
Koochiching
Marshall
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Lake
Itasca
Mahnomen
Norman
Hubbard
Cass
Becker
Clay
Aitkin
Wadena
Crow Wing
Number of Refugees Arrival By
Initial County Of Resettlement
Carlton
Otter Tail
Wilkin
Pine
Todd
Grant
Douglas
Stevens
Pope
Mille
Lacs
Kanabec
0
Morrison
Benton
Traverse
Stearns
Sherburne
Swift
Anoka
71
Wright
Chippewa
Hennepin
Hennepin
Lac Qui Parle
Yellow Medicine
Lyon
McLeod
Renville
11 - 20
Chisago
Kandiyohi
Meeker
Lincoln
1- 10
Isanti
Big Stone
21 - 40
WashingRam-ton
sey
41 - 100
Carver
Scott
101 – 300
Dakota
Sibley
Redwood
Le
Sueur
Nicollet
Rice
>301
Goodhue
Wabasha
Brown
Pipestone
Murray
Rock
Nobles
Cottonwood
Jackson
Watonwan
Martin
Blue Earth
Faribault
Waseca
Steele
Freeborn
Dodge
Mower
Olmsted
Winona
Fillmore
Houston
Secondary Refugee Arrivals to
Minnesota
2014
Total notifications: 841
Outcome
Eligible and Screened
in MN
No. (%)
332 (39%)
Completed screening in 320 (38%)
primary state
Completed screening in 8 (2%)
primary state, needs
LTBI f/u
Not screened/Pending
Refugee Health Program, Minnesota Department of Health
181 (22%)
Secondary Refugee Notifications to MDH by
Initial State of Resettlement, 2014
1. Texas
81 (10%)
2. Georgia
73 (9%)
3. New York
71 (8%)
4. Arizona
56 (7%)
5. Connecticut
56 (7%)
6. Missouri
53 (6%)
7. Massachusetts
46 (5%)
8. North Carolina
42 (5%)
9. Colorado
40 (5%)
10. Pennsylvania
35 (4%)
11. All Others
288 (34%)
12. Total
841 (100%)
Refugee Health Program, Minnesota Department of Health
Secondary Refugee Arrival
Notifications to Minnesota,
January to June 2015
Burma, 33
(6%)
All Others, 18
(3%)
N=581
Somalia, 530
(91%)
Kittson
Jan – June 2015 Secondary
Refugee Arrival Notifications To
Minnesota (N=581)
Lake
of the
Woods
Roseau
Koochiching
Marshall
St. Louis
Beltrami
Pennington
Polk
Cook
Clear
Water
Red Lake
Lake
Itasca
Mahnomen
Norman
Hubbard
Cass
Becker
Clay
Aitkin
Wadena
Crow Wing
Number of Refugees Arrival By
Initial County Of Resettlement
Carlton
Otter Tail
Wilkin
Pine
Todd
Grant
Douglas
Stevens
Pope
Mille
Lacs
Kanabec
0
Morrison
Benton
Traverse
Stearns
Sherburne
Swift
Anoka
71
Wright
Chippewa
Hennepin
Hennepin
Lac Qui Parle
Yellow Medicine
Lyon
McLeod
Renville
11 - 20
Chisago
Kandiyohi
Meeker
Lincoln
1- 10
Isanti
Big Stone
21 - 40
WashingRam-ton
sey
41 - 100
Carver
Scott
101 – 200
Dakota
Sibley
Redwood
Le
Sueur
Nicollet
Rice
>201
Goodhue
Wabasha
Brown
Pipestone
Murray
Rock
Nobles
Cottonwood
Jackson
Watonwan
Martin
Blue Earth
Faribault
Waseca
Steele
Freeborn
Dodge
Mower
Olmsted
Winona
Fillmore
Houston
Medically Complex Cases
• Increased number of medically complex cases
arriving nationally and in MN
•
•
•
•
HTN
DM
Pregnancy
Mental Health
•
•
•
•
Asthma
Physical Disability
Seizure disorder
Developmental Delay
• Resettlement workers are not familiar with
medical terminology or impact of disease
• Social Work position housed at MDH assists all resettlement
agencies with complex cases
• Program implications
• Implementing mental health component to routine screening
• Expanding resources/partners
Complex Cases by Health Condition, 2014
Condition
N
%
Cardiology/HTN
102
24%
Blind/Vision
37
9%
Mental Health
37
9%
Pregnancy
35
8%
Asthma
27
6%
Diabetes
19
5%
Orthopedics
18
4%
Deaf/Hearing
17
4%
Physical Disability
16
4%
Developmental Delay
14
3%
Gastroenterology
10
2%
Other†
90
21%
Total‡
422
100%
Includes Infectious disease, kidney, thyroid, hematology, ENT, immunology, pulmonary, migraines,
malnutrition, seizure disorder, COPD, OB/GYN
‡Sum of health conditions > total, due to multiple conditions per case (34% of cases had more than
one condition; N=100/293)
†
CURRENT PROJECTS
Health Education: Refugees
Community Health Education (CHE) Project
• Partner with refugee- and immigrant-led community organizations
• Activities include radio and TV shows, presentations, fairs, etc.
• Variety of topics covered: HIV, hepatitis B, nutrition, flu, etc.
Refugee Health Orientation
• Standardize messages: resettlement agencies,
clinics, community organizations
Other Health Education Activities
• Health curriculum for English language learners
• Community events: health and resource fairs
Karen Organization of Minnesota
Hmong Health Care Professionals
Coalition
Southside Center Adult Education
Diverse Media & Health Promotion
• RIH works with over 20 diverse
media vendors – Print, Radio,
and Online
• Vendors often publish an
accompanying health article for
free when an ad is purchased
Diverse Media Example: Autism
• Goal: Reach Somali
audiences to increase
awareness of signs of
Autism and why to act
early
• Included:
– Programs on Somali TV
– Online ads with video
links
– Print ads with article on
Autism
Other Projects
• Mental Health Screening
– Piloting addition of screening questions in key clinics
– Normalize mental health as being part of general
health
• Emergency Network to Reach LEP Populations
– Building a more robust network of key people
connected to LEP communities across MN
• CDC Projects
Other Projects (cont.)
• LEP Communications Project
– Building capacity within and externally
– Language Data Workgroup
– MDH LEP Communications Website
• In Planning phase
• Will be getting input from a variety of stakeholders
Resources: LEP data, Cultural Profiles, Diverse
Media examples, Spotlight on Partners
• What could help your work?
Ayurvedic Medicine Project
• Several recent cases of lead
poisoning in South Asian
children residing in MN
• Sources found to be Ayurvedic
medicines/remedies that were
either purchased in India or sent
from there
• RIH partnering with:
Huthasani – for eczema
– MDH Lead/Healthy Homes
– South Asian CBOs including AshaUSA
and SEWA-AIFW
– Several Ayurvedic Practitioners
• Created informational brochure
in English and 5 major South
Asian Languages
Gripe Water
Ayurvedic Medicine Project (cont.)
• Partnered with AshaUSA to survey the South Asian
community for better understanding of use in MN
• Interviewing and planned messaging for providers
• Surveyed and discussed Ayurvedic medicine at India
Fest, 8/15/2015
Interpreter Registry Project
Tasked by MN legislature to:
• carry out extensive informationgathering with all stakeholders
• Create report and proposed
legislation
Other Initiatives
• Publications
– www.health.state.mn.us/refugee
– Directories, Provider and Partner
Information, Material for Refugee
Education
• Annual Forum
• Metro Refugee Health Task Force
• Workgroups, collaborations and coalitions
• Quarterly newsletter
For More Information
 Website:
www.health.state.mn.us/refugee
 Phone: 651-201-5414 or
1-877-676-5414