Intersecting Structural Barriers and Hypertension Management Among Middle East and North Africa Refugees Resettled in the United States: A Qualitative Study

Hypertension remains one of the leading causes of morbidity and mortality worldwide, affecting more than 1.28 billion people. Refugees have almost twice the risk of cardiovascular disease compared to native populations and other immigrants due to uncontrolled hypertension. Evidence on aspects of structural oppression that impact hypertension management and the experiences of minority populations in managing their hypertension post-resettlement remains lacking especially in the case of refugees whose number is increasing dramatically due to mass displacement. We explored the intersecting structural oppression impacting hypertension management among refugees using in-depth interviews with 54 Syrian and Iraqi refugees who were resettled in California. Structural oppression risk factors that were identified to impact hypertension management were (a) structural barriers (language barriers, lack of health insurance in transit countries), (b) social stigmatization (social isolation, family separation, discrimination), (c) economic inequities (living in poverty, low-pay and high-risk jobs), and (d) discriminatory policies (refugee ban). Our findings highlight that structural oppression affects hypertension management among refugees post-resettlement, highlighting the need for tailored interventions and policy changes that take these factors into account to promote hypertension management in this population to prevent health disparities.