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In 2019 more than 7.5 million migrants were living in Australia; 65% of this population group were temporary visa holders (Australian Bureau of Statistics, 2020).  This paper will identify two social determinants of health relevant to the assessment scenario and the impact these have on the health behaviours and health outcomes of temporary migrants.  The Ecological Model has been used to identify and analyse these behaviours and outcomes.  Furthermore, a public health intervention will be proposed to address the barriers faced by migrants regarding access to health services.
“Temporary migration is migration to a country that is not intended to be permanent” (Foulkes, 2015).  Evidence suggests that migrants living in Australia have lower mortality rates and self-reported chronic conditions compared with Australian-born individuals however this pattern appears to decrease after migrants have resided in Australia for several years (Australian Institute of Health and Welfare, 2018).  Migrants from non-English speaking backgrounds have demonstrated poorer mental health and self-assessed health after ten years of living in Australia (Australian Institute of Health and Welfare, 2018).  This understanding is evident in the assessment scenario; after twelve years of working in precarious employment, being separated from his family and the adoption of unhealthy lifestyle behaviours, Jai experienced poorer mental health and suffered a stroke.  A stroke occurs when there is an interruption of blood supply to the brain.  This may result from a blocked artery or from bleeding into the brain tissue (National Heart, Lung and Blood Institute, 2020).  When considering the assessment scenario smoking and drinking are significant risk factors for stroke (National Heart, Lung and Blood Institute, 2020).  People who smoke are twice as likely to have a stroke and twice as likely to die following a stroke compared with non-smokers.  This incidence increases with higher amounts of tobacco usage (Heart and Stroke Foundation of Canada, 2020).  Regular drinking can increase the likelihood of stroke by elevating blood pressure and irregular heart rhythms (atrial fibrillation).  To reduce the risk of stroke no more than two standard alcohol drinks should be consumed per day (Stroke Foundation, 2020).
Social determinants of health are “the conditions in which people are born, grow, live, work and age.  These conditions determine a person’s chances of maintaining good health” (Tasmanian Government Department of Health, n.d).  Two key SDH highlighted in this scenario include poor employment conditions and inadequate access to health services. 
 Temporary migrant workers have been identified as one of the most vulnerable groups to exploitative workplace practices in Australia (Australian Government Attorney-General’s Department, 2019). They are more likely to be employed in precarious jobs, have lower salaries and fewer employment rights when compared with Australian born employees (Moyce & Schenker, 2018).  Employment and income insecurity can deter migrant workers from raising concerns regarding unsafe working conditions in fear of job loss, poverty, and deportation.  These stressors have been linked to poor mental health outcomes for migrant workers (Moyce & Schenker, 2018).   In the assessment scenario Jai decides not to address the issue of unsafe working hours with the business owner and after five years of working in this environment he is burnt out, emotionally drained and uncertain about his future.  When considering the ecological approach to health there are several intrapersonal, interpersonal and community level factors which have influenced Jai’s behaviour and contributed to his poor health outcome.  Intrapersonal factors are characteristics of the individual and include knowledge, attitudes, beliefs, behaviour, and personality traits (UNICEF, n.d).  Jai’s motivation for moving to Australia was to provide his family with a better future.  He persevered through unsafe working conditions with the expectation that he would become a permanent resident and be able to relocate his family to Australia so they could live together.  Jai resorted to tobacco smoking to cope with the stress of his demanding job requirements and the uncertainty of his family’s future. 
Interpersonal factors are social networks and support systems which include family, friends, peers, customs or traditions (UNICEF, n.d).  Many highly skilled individuals from developing countries migrate to more developed countries for improved income and employment opportunities (Piesse, 2014).  As demonstrated in the scenario this often results in loss of support networks and family separation; parents, wives, and children are generally left behind while husbands seek employment across borders or internationally and send remittances back to their families (Lorentzen, 2014, p.176).  Transnational parenting as a result of migration can have emotional and mental health implications for all family members, particularly children (Lorentzen, 2014, p.176).  Studies have shown that successful parenting via long distance is extremely low and children who experience this type of parenting through their early, formative years often experience behavioural problems and issues with confidence and self-efficacy (Lorentzen, 2014, p.178).  This was demonstrated in the scenario and after hearing of his daughters’ behavioural issues Jai felt down, sad, and hopeless; all symptoms of poor mental health (Mayo Clinic, 2019).  The negative outcomes resulting from family separation are often overshadowed by the perceived financial benefits and improved quality of life associated with migrating to more developed countries (Lorentzen, 2014, p.178). 
ing expenses (Castañeda 2013). e negative implications of remittances are
Migrants settling in Australia experience several health care disparities resulting from precarious employment, low-socioeconomic status, and lack of understanding regarding the health care system of the host country (Moyce & Schenker, 2018).  Cost of medical expenses, long working hours, unpaid sick leave, and lack of available migrant friendly health service are significant barriers to health care for this population group (Moyce & Schenker, 2018).  When considering the assessment scenario each of these barriers contributed to Jai’s inability to access health services.  Community level factors involve organisations, institutions and social norms which may impact the health of individuals (UNICEF, n.d.)   In response to increasing media coverage on the exploitation (including being overworked and underpaid) of temporary migrants in Australia the government has implemented federal and state initiatives to address this issue.  These include introduction of the Modern Slavery Act 2018, Fair Work Amendment (Protecting Vulnerable Workers) Act, Introduction of Temporary Skill Shortage Visa, changes to requirements for Working Holiday Makers Program, Labour hire legislation and proposed Wage Theft Law (Queensland) (Stringer & Michailova, 2019).  Migrant health has not received the same level of attention from the Australian Government.  With regards to accessing health care temporary migrant workers are required to obtain private health insurance as they are excluded from the Australian public health system (Medicare).  This often results in ponement of medical treatment and preventative care as demonstrated by Jai (UNSW Human Rights Clinic, 2015).  Lack of government legislation ensuring equitable access to health services for migrant individuals and families is largely responsible for the health care disparities experienced by this population group (International Organization for Migration, 2020).  
Integration refers to the process by which migrants become a part of their new community (Gallagher, 2018).  Evidence suggests that successful integration is associated with economic benefits for the host/destination country, country of origin and individual households (Danzer, 2011).  In the host/destination country, migrants can assist to alleviate increasing demographic pressures by increasing productivity and economic growth; countries of origin may also experience economic growth through remittances and by strengthening local skill sets (Council of Europe Development Bank, 2015); individual households experience improved quality of life indicators such as workplace participation and academic achievements (Gallagher, 2018).  Successful integration addresses every part of the migration process from education to housing, political involvement, and civic engagement (Gallagher, 2018).
The Migrant Centre Organisation (MCO) is a not-for-profit organisation based on the Gold Coast, Queensland which assists in the successful integration of migrants (The Migrant Centre Organisation Inc, 2018).  The MCO aims to;
support and advocate for improved social, cultural and economic opportunities for migrants residing in Australia
facilitate community participation and skill building of migrants
create strategies toward settlement, civic and social inclusion and integration, and sustainable employment
promote an enhance the benefits of multiculturalism and diversity
(The Migrant Centre Organisation Inc, 2018)
Various services have been implemented by the MCO to assist in achieving these objectives.  These include providing access to migrant agents, equitable access to settlement planning programs, services, and aid regardless of cultural or linguistic background, employment training provided through the Skilling Queenslanders for Work program, assistance finding employment, translating services and in-house language resources, family counselling and mediation, community programs to bring new and settled migrants together to share cultures and develop relationship, senior and youth services, and emergency response tools (The Migrant Centre Organisation Inc, 2018).  The MCO employs professionals and volunteers from diverse cultures and backgrounds.  As a result, more than 70 languages are spoken by the staff and associates at MCO enabling them to assist and represent a larger number of cultural groups (The Migrant Centre Organisation Inc, 2018).   
Health professionals have reported significant challenges when working with migrants including language barriers, cost, poor understanding of health service entitlements, health literacy, culturally inappropriate care, and the need for multi-sector involvement to address complex social determinants (Ziersch, Freeman, Javanparast, Mackean, & Baum, 2020).  These challenges were demonstrated in the assessment scenario and the cause of Jai’s poor uptake of health services.  MCO employees are trained in the complex needs of new and settled migrants and provides culturally sensitive services for this population group (The Migrant Centre Organisation Inc, 2018).  By incorporating a government funded medical service into MCO migrants would be able to access all essential services at a facility they are familiar with and have developed trust and relationships with the employees.  This could enable a more successful integration of migrants into the host country. 
This paper highlights the complex issues impacting the integration and health of migrants in Australia. Greater efforts need to be made by the Australian government to ensure policies and interventions are implemented to address the social determinants contributing to poor health behaviours and outcomes of migrants and encourage successful integration of migrants into the country. 
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