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Social Determinant: Social inclusion and Non-discrimination

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Social Determinant: Social inclusion and Non-discrimination

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Social inclusion and non-discrimination are one of the social determinants that affect health outcomes; these are vital non-medical factors that impact the health and well-being of individuals (World Health Organization, 2025). For Iraqi refugees settling in Australia, social inclusion can help them strive towards better health, providing mental stability by reducing anxiety and depression, rebuilding independence and stability through education and employment by using bicultural workers, and community acceptance reduces isolation, developing trust, therefore making it easier to adjust to new health practices (The UN Refugee Agency, 2020). Discrimination has the opposite effects; it breeds distrust, isolation and insecurity about their status in the community, which prolongs access to health care services, worsening health and previous trauma (The UN Refugee Agency, 2020). For instance, using practical actions, such as applying a qualified professional interpreter to ensure proper information and health guidance, respecting religious practices during prayers, avoiding bias and stereotyping, and using NSQHS standards for refugee patients, builds a culturally safe health care environment (Queensland Government, 2022).

State of Queensland (Queensland Health). (2022). Refugee health and wellbeing: Policy and action plan 2022–2027.

https://www.health.qld.gov.au/public-health/groups/multicultural/refugee-services/refugee-health-and-wellbeing-policy-and-action-plan

Shwayli, S. (2017). [Photograph of Iraqi girls studying in a classroom] [Image]. Refugee Research Online https://refugeeresearchonline.org/the-experiences-of-iraqi-refugee-childrens-education-in-australia-mothers-perspectives/

United Nations High Commissioner for Refugees. (2020). Supporting the social inclusion of refugees. UNHCR. https://www.unhcr.org/au/media/supporting-social-inclusion-refugees

World Health Organization. (2025). Social determinants of health [Fact sheet]. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/social-determinants-of-health

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Country of focus: Iraq

Iraq is an Arab country found in Southwestern Asia. Iraqi refugees who fled from their country faced prolonged wars and armed conflict, insecurity, persecution and the loss of basic services and livelihoods (World Health Organization, 2025). Australia's Refugee and Humanitarian Program provides visas for overseas refugees fleeing war and persecution as part of the offshore component (Australian Government, 2024). A common health concerns that is listed in the Australian refugee health practice guide is that refugees are likely to present with mental health issues, specifically post-traumatic stress disorder (PTSD). PTSD is the result of both trauma and stress-related conditions from past experiences of torture, conflict, violence and family separation (Singleton et all., 2025). In a study conducted, 30.8% of Iraqi refugees had probable PTSD (Tomasi et all., 2022). Settlement stress can prolong symptoms, such as financial instability, employment access, and community loss. The recommended treatment option is a specialised torture and trauma services provider, assisting with social support, regular review, lifestyle advice, and counselling (Singleton et all., 2025).

Australian Government Department of Home Affairs. (2024). About the refugee and humanitarian program. Australian Government.https://immi.homeaffairs.gov.au/what-we-do/refugee-and-humanitarian-program/about-the-program/about-the-program

Hart, J. (2014, September 12). Jordan has become the West’s warehouse for Iraqi refugees [Image]. The Conversation. https://theconversation.com/jordan-has-become-the-wests-warehouse-for-iraqi-refugees-31491

Singleton, G., Hocking, D., Gardiner, J., Paxton, G. (2025). Mental Health. Australian Refugee Health Practice Guide. https://refugeehealthguide.org.au/mental-health/

World Health Organization. (2024). WHO contribution in Iraq: Evaluation report (WHO/DGO/EVL/2024.2). World Health Organization.

https://www.who.int/publications/i/item/WHO-DGO-EVL-2024.2

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In Iraqi culture, health belief is deeply structured in religious and cultural practices. Many illnesses are often labelled as spiritual causes, which makes them believe in being possessed by jinn, black magic used and under the curse of the evil eye, which changes how patients seek care (Khoury et all., 2024). Families would first seek help from faith healers to recite the Holy Quran, heal charms, and cupping, rather than consider medical professionals. These practices are trusted by the communities and their people from cultural tradition, accessibility and religion (Khoury et all., 2024). Nevertheless, depending only on these beliefs can delay actions to seek medical attention, prolong symptoms and worsen health outcomes. To provide a culturally safe and respectful practice, it is necessary to be aware of these beliefs to regard the traditional practices while introducing new evidence-informed care and acknowledging the culture. Building trust improves and reduces delayed care, aligning with the code of conduct for nurses (Nursing and Midwifery Board of Australia, 2018).

Aknaf Al Sawary. (2024, June). Iraq culture [Photograph]. Aknaf Al Sawary. https://aknafalsawary.com/iraq-culture/

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Khoury, B., Rafeh, M., & Bou Dargham, Z. (2024). Traditional healing for physical and mental problems in the Arab region: past and current practices. BJPsych international, 21(2), 44–46. https://doi.org/10.1192/bji.2024.3 (Khoury et all., 2024)

Nursing and Midwifery Board of Australia. (2018). Cultural safety: Nurses and midwives leading the way for safer healthcare [Joint statement]. Australian Health Practitioner Regulation Agency. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/position-statements/leading-the-way.aspx

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For me, the most important aspect of competency standard 1.1 was responding sensitively and without assumptions when taking care of patients from migrant and refugee backgrounds.

I have developed my understanding of respecting the cultures, religious beliefs, and traditional practices of the patients who will be under my care.

Having learned about people's backgrounds, I now know that consideration for a person's dignity, safety and collaboration must be considered and come up with a comprehensive treatment plan that would be beneficial to the patient and maximise recovery.

For example, during Ramadan, a patient cannot eat, drink or take medications; therefore, as a nursing student, I must respect the patient's religious beliefs by rescheduling treatments and procedures to another time. This knowledge is essential to me in the workplace because it helps me provide culturally safe and respectful practice and ensure fair and just treatment of patients in my care.

Migrant and Refugee Women’s Health Partnership. (2019). Culturally responsive clinical practice: Working with people from migrant and refugee backgrounds. https://moodleprod.murdoch.edu.au/pluginfile.php/4578910/mod_resource/content/4/Culturally-responsive-clinical-practice-Working-with-people-from-migrant-and-refugee-backgrounds-Jan2019.pdf