Europe can now see itself as a casualty of the self-proclaimed Islamic state. Terrorized families are being fired at them like ammunition. Europeans are suffering the personal, social, economic, political, spiritual, religious, moral, financial, public health and healthcare stresses of finding hundreds of thousands of individuals and families on their door steps. The situation would be challenging even if these were happy families on holiday. But the arrivals are in crisis, terrorized, grieving, sick, hungry destitute and desperate.— and they are not going home. To further complicate matters, likely lurking among them are smugglers, criminals, terrorists, and recruiters of new terrorists ready to take advantage of disruption and vulnerability.
Europe's health systems will be hard hit, especially mental health services. The children have been exposed daily to ACEs- Adverse Childhood Experiences - that will have lifelong effects. Adults have lost everything that tells them who they are and how to be- their countries, towns, schools, places of worship, neighbors, friends, family, jobs, credentials, status, their whole range of resources and solutions. Their coping capacity was likely used up before they arrived. The conditions for recovery — safety, quiet, comfort, privacy — do not exist. Then there are the language barriers and cultural and religious tensions.
What would happen if the 250, 000 refugees and immigrants who flooded into Greece this year arrived instead on the shores of Alabama? The state is roughly the same size as Greece, but has half the population. Like Greece, Alabama has high rates of poverty and xenophobia, and limited healthcare resources. Would we see the famous southern hospitality, or a wall?
How does a health literate organization, community, or state respond to such a barrage of challenges?
Can we even think about health literacy in such a crisis. Should we?
More than ever. As a matter of social justice. As a matter of public health. My research suggests priority needs to be on basic essentials; because adequate housing and food and are pre-requisite to learning a new language and recovering enough from trauma and ordeal to think about obtaining and using information and services to regain health. Next, scale up adult and family literacy programs that integrate health education. Hospitals should lead this effort; it will make everything else they do easier, more efficient and effective. Scale up training of health educators, medical translators, public health nurses. Scale up cultural competence training for all health and social services providers.
Looking through a health literacy lens at Europe's responses to the refugee crisis, we might learn some strategies for healthcare systems facing new levels of diversity and xenophobia, socio-economic and health disparities, and unprecedented numbers of poor, inexperienced patients with language barriers and a backlog of medical needs. If we can understand and act on what we learn, we could get closer to our vision of a health literate society in which no one dies for lack of information and the support to use it.