GLOBAL HEALTH
SAEM PULSE | NOVEMBER-DECEMBER 2024
The Broader Differential: How Immigrant and Refugee Health is Reshaping Emergency Care for a More Equitable Future
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By Nikkole Turgeon, MD and Felisha Gonzalez, MD on behalf of the SAEM Global Emergency Medicine Academy As global displacement continues to rise due to war, political instability, and climate change, the United States has seen an increase in immigrant and refugee populations. The U.S. is the world’s top migrant destination, accounting for 5 percent of the global population while attracting 18 percent of all migrants. This demographic shift will change the disease burden seen in emergency departments (EDs) nationwide. These changes demand that emergency clinicians adapt
their practices — not only in terms of cultural sensitivity but also by expanding their clinical differentials to account for diseases not commonly encountered in the U.S. Urban centers within sanctuary states, such as Boston, Massachusetts, have historically resettled many immigrant and refugee populations. Essential hospitals, like Boston Medical Center (BMC), provide care for largely uninsured patient populations or
those on Medicaid or Medicare, which often results in these hospitals caring for many immigrant and refugee patients. Consequently, BMC’s ED sees a higher incidence of diseases that are typically rare in the U.S. but more common in low- and middle-income countries. Providers must be well-versed in conditions such as tuberculosis (TB), malaria, leishmaniasis, and intestinal parasites, which can have severe consequences if not recognized early. For example, among 223 cases