Rethinking Health Outreach Methods: Learning from the African Diaspora

by Ahmadou Balde

Since the 1990s, the migration of Africans to the United States has increased. Unfortunately, the majority face overwhelming socioeconomic and psychological challenges due to issues such as: language barriers, skill or educational gaps, and the depletion of economic opportunities. As newly stated by the recent Migrant Policy Institute report on African migration: “The United States, Canada, and Australia disproportionally attract better-educated African migrants than do the United Kingdom, France, and other European countries. Despite higher levels of human capital, high employment rates, and strong English skills, African immigrants’ earnings lag those of the native born."

As an African-born immigrant, the current condition of the African Diaspora fascinated me. Upon my graduation from college in 2013, I took the initiative to understand the roots of the perpetual stagnation of African immigrants. Along this journey, I came across many individuals who were full of hope and fear. They had their own dreams and aspirations. Unfortunately, more often that not, they are trapped in this constant cycle of survival. With the language barrier and the depletion of economic opportunities, I realize that the odds are stuck against them. Additionally, the journey led me to the Refugee and Immigrant Assistance Center known as (RIAC); a community-based, non-profit, that provides comprehensive services to refugees, and immigrants. I was now an Outreach health worker in charge of an educational and awareness program targeted toward African-born men.

I embraced the opportunity of raising health awareness among African immigrants. In addition, I could finally receive an income while working on my initiative. Unfortunately, a few months into my job, I remained unsatisfied; feeling this deep sentiment of failure. I had outreached in different African communities and worked with different local pastors. I spoke to many immigrants and conducted many need assessments surveys of specific communities on each outreach. However, the problem is that the surveys continue to show that there is a negative correlation between activity and results. More people in need are reached but fewer needs are met. The surveys persistently indicated that several of these communities needed some type of help. Many of the participants did not have insurance, have not seen a health care provider for years, and admitted to not feeling well. Even though I clearly indicated that our organization would connect all those in need with health care providers, the majority of the participants never came to ask for support to change their situation. Now, why is that? Do African immigrants just not care about their health or taking care of their health is just not a priority? Or was I simply failing to fulfill my responsibility?

You can make your own judgment, but my experience thus far as a health outreach worker has shown me why the current approach of raising health awareness in immigrant communities is a failing approach. It is a reality that the majority of immigrants who come to the United States come from high context countries, a term popularized by the anthropologist Edward Hall. High context societies tend to be family-oriented, with deeply shared values. Moreover, they come from countries where insurance was not available and preventive care not part of the cultural lexicon. A culture of denial and self-medication is pervasive. They can come from Iraq, Nigeria, Mexico or Somalia but all these immigrants have this in common: they value the importance of building long term and lasting relationships.

Now, the problem is that the current health outreach approach favored by the majority of health outreach organizations that work with immigrants is based on simply outreaching, conducting surveys and raising awareness, and not on building relationships. In reality, the current approach can work in a low-context society like the United States, where people tend to be more individually-oriented, move often, and have many brief relationships. This is not the case, however, among many immigrants, whose societies are tend to be pluralistic. In the U.S., we are opting for outreach methods that ignore the realities of the environment, background and experience of different communities.

I realized that the stress of adapting to new cultural norms, work, and family responsibility prevent many of these immigrants from prioritizing their health. As such, health outreach workers are a necessity. The current condition could help health outreach workers who want to promote preventive care and health equity stop behaving as service driven organizations and to start thinking as community organizers. Acting and behaving as community organizers is not necessarily synonymous to uniting people for the purpose of building power and enacting change. It also helps build credibility and trust within the different immigrant communities, serving as a vehicle through which to identify the leaders and change makers who can improve community health. Through this new approach, new communities values and norms can be created.

Unfortunately, I am also aware that the current approach favored by many health outreach organizations is deeply rooted in our society and is a product of our bureaucracy. The majority of the health outreach workers are mainly running grant programs. Their life, job, and survival depend on the renewal of their respective grant. The goal becomes satisfying the requirements and remaining in this constant cycle of inertia. Sadly, as long as bureaucratic institutions continue to measure the success of a program based simply on the activity level and not necessarily the results, the problem will remain pervasive in our society. In the meantime, health outreach workers will continue to behave as service driven organizations that are blind to the negative correlation between their activity and results.

My journey within the African community has shown me that these people epitomize the old Kenyan theology saying ‘'I am, because we are; and since we are, therefore I am.’ All immigrants from high context societies do too. With the depletion of economic opportunities, and the feeling of personal and family responsibility, these immigrants will not prioritize their health as long as they can walk, talk, and work. As such, health care outreach workers and providers cannot continue to ignore the realities of their environment in order to be effective in their endeavors.

It is possible to have uniquely targeted programs that solve specific needs within specific communities. But more importantly, we cannot ignore the importance of building credible and lasting relationships when dealing with immigrants. Only through the infiltration of these communities can we then change the cultural lexicon. We need first to realize that individuals are the building blocks of any types of community change, and ‘those closest to any change must be involved in the change in order for the change to be effective’ as famously stated by Michael Brown. This new approach requires rethinking our current accountability metrics and an expansion of our time horizon, but it might be the best and most effective approach we have while dealing with immigrants.