On March 19-20, 2016, AAN Program Manager Adoubou Traore and AAN Research Intern Natalie Cox participated in the first annual Northwest Regional Conference on African Immigrant Health at the University of Washington in Seattle. Entitled â€œAddressing the Social Determinants of African Immigrant Health,â€ the African-led conference highlighted core competencies in healthcare service delivery as well as served as a forum for promoting best practices to build on African immigrant communitiesâ€™ strengths.
The conference offered educational and training opportunities for public health professionals, doctors, nurses, mental health professionals, community members, community health workers, students, civic leaders and researchers. The conference presentation topics ranged from mental health, chronic disease prevention, community health worker development, cultural competency, infectious disease, nutrition, sickle cell disease, womenâ€™s health, research in African immigrant communities, and traditional medicine usage in African immigrant communities. In all, there were 29 different break-out presentations, 4 plenary sessions, 1 poster session and 1 panel.
Natalie presented some of the data and lessons learned from an African immigrant community health assessment project she administered with the African Immigrant and Refugee Resource Center (AIRRC) from 2007-2009. The project was called â€œAkili Ni Mali,â€ meaning â€œKnowledge is Wealthâ€ in Swahili. Her 30-minute co-presentation with Adoubou discussed not only the findings and outcomes of the study, but updates on AAN clientsâ€™ access to healthcare in the current context of the Affordable Care Act (Covered California), the USCIS Asylum application backlog, and the Bay Area housing crisis. Natalie also reviewed the benefits and challenges of utilizing a community-based participatory research (CPBR) paradigm and mixed methods (qualitative and quantitative) research among African immigrant communities.
The purpose of Akili Ni Mali was to assess the unmet health needs of local African immigrant communities and to identify any linguistic or sociocultural barriers to health services. They also wanted to learn how to best refer immigrants of varying documentation statuses to appropriate health services. The project took place in collaboration with local African immigrant community leaders, healthcare professionals, AIRRC interns and staff, and academic researchers. The research team facilitated 143 non-exclusive multiple-choice surveys, conducted 12 individual semi-structured interviews, and organized one focus group among immigrants from 13 different African nations.
The nationalities represented in the data were Ethiopia, Eritrea, Cote dâ€™Ivoire, Togo, Cameroon, Ghana, Nigeria, Senegal, Democratic Republic of Congo, Liberia, Uganda, the Central Republic of Africa, and Burkina Faso. The majority of participants came from Ethiopia, Eritrea, and Cote dâ€™Ivoire. However, the population included in the research was due to community access and collaboration and did not necessarily represent an accurate population breakdown of Bay Area African immigrant demographics.
Slightly more men than women filled out the survey, at 52.3% to 47.7%, respectively (although 13 people did not state their gender). Very few of these men and women are young adults, as the average age of survey respondents was 39 years old. Out of the 143 surveys collected and entered, the majority (37.8%) were completed in English, followed very closely by those completed in the French language (at 34.3%). 15.4% of the remaining surveys were completed in Amharic, and 12.6% in Tigrinya. Only 11 respondents reported using the assistance of an interpreter.
The average income for survey was $45,000 annually among the 91 respondents who answered this question. However, this number changes significantly dependent upon family size; people with children in the study appeared to actually make less money. 70 people reported having dependent children living with them, and the average family size was 3.2 persons. The average annual income was $42,409. Thus, according to the federal poverty index of the U.S. Department of Health and Human Services, the average African immigrant family in the study lived at about 250% of the federal poverty line. This would put many of the survey respondents in the middle to lower middle class (U.S. Department of Health and Human Services 2008, 3971). The average amount of time survey respondents reported living in the Bay Area was 8 years, but it is important to note that 35 of the participants were relative newcomers, having lived here 3 years or less. Overall, the survey data and interviews demonstrated that Africans living in the Bay Area were well educated (high school and above), employed (often in multiple occupations), and financially independent people. Only 14 out of 143 people reported that they received public benefits, and 52% of them reported that they had health insurance. 78% of them said they received care at Western biomedical facilities such as hospitals and clinics (rather than from traditional medical practitioners or self-care).
The top health 3 concerns for African survey respondents and their families were diabetes, hypertension, and asthma, and 75% of the overall survey population said they took prescription medicines. The top 3 barriers to healthcare access were (1) lack of insurance (2) lack of money (3) language or communication barriers. It is important to note that those who reported having no health insurance were much more likely to report health problems (61% versus 47% of the insured), more likely to report communication problems at the hospital (50% versus 23% of the insured), less likely to have college degree (39% versus 64% of the insured) and made much less money that the insured (average income was $25k compared to $62k)
There were also notable gender disparities in healthcare access. First, regardless of country of origin, whether married or unmarried, all women in the survey who reported their economic status had much lower annual incomes. They averaged $30,800 per year, while men earned nearly $50,000. The survey demonstrates how income can correlate with levels of education. Many male respondents wrote that they had college degrees and the majority held at least the equivalent of a high school diploma. By contrast, few women reported that they had completed more than a high school education
The lack of education may in turn relate to limited English proficiency. Female survey respondents were much more likely to report communication barriers than men. In fact, nearly 50% of all female survey respondents said that they often experienced communication problems in the healthcare setting, and more than a quarter of them used medical translators or interpreters. The majority of men, on the other hand, said that they did not experience barriers to communication.
Overall, the data revealed that the those research participants who did face significant obstacles to healthcare access did so because of lack of or inadequate health insurance, poverty, communication and language barriers, and most of all, difficulty navigating and comprehending American healthcare systems. At the time of the study (2009), culturally competent healthcare providers and/or healthcare workers of African descent (who may have both cultural and linguistic capacities to better serve members of their own community) were in short supply. Neither clinics nor resource programs existed to address the language and cultural needs of African immigrants, refugees, or asylees. This contrasted sharply to the fact that the Latino and Asian immigrant communities (in San Francisco) were served by their own culture and language-specific health clinics and wellness programs.
Akili Ni Mali demonstrated that while the slight majority of African immigrants in the Bay Area did have access to preventative health, the people who need help most often did not know how and where to get help. This was particularly relevant for those without insurance, low income families and individuals, and those with unstable or unauthorized documentation status. There was lack of publicly available, well-advertised, linguistically-appropriate information explaining how and where underserved Africans could receive safe and affordable services.