Part 1
This story is drawn from my experience as a volunteer counsellor for African, Atlantic and Indian Ocean islands-born immigrants in USA. The W-curve only begins to synthesize the experiences of adjusting. But, it is an individual experience: honeymoon/exhilaration once one is here; culture shock and reality of the many adjustments one has to undergo; initial adjustment/creating a new routine; mental isolation/ balancing resolve to make a home at a given address as well as having a discombobulating vacillation; and acceptance/integration/ where by one gets more involved in day to day life and begin to establish good relationships (Hoffenburger, K., Mosier, R., & Stokes, B. 1999). This calls for great perseverance and strength. The immigrant’s story is one that is structured along: I-94, grant letter, status, order of immigration, social security card, form AR-11, RCA, Medicaid, GA, GR, housing, I-9, I-485, I-693, I-730 (Forms) and whatsitsname……..and more than $5,000 dedicated as an initial fee for: legal fees, medicals & green card.
Different people have different needs. The citizens or lawful residents may have different views of America from the one who is just grappling with documentation. Dissatisfaction with government, the economy and immigration are perceived differently. There are many important issues in USA today and they are part of what we hear or read: guns, terrorism, climate change, labor, immigration, globalization, infrastructure, defense, investment, taxation, research, health care, and education (Anna North, 2016).
Health seeking practices are influenced by one’s status. The visa one holds in turn impacts one’s eligibility for federal, state and county services. Eligibility for Marketplace coverage or a health plan is important (10 things immigrant families need to know about the Marketplace). Knowledge that one can get low-cost health care at a nearby community health center makes a difference. Community health centers provide primary health care services to all residents, including immigrant families, in the health center’s service area (How to find low-cost health care in your community).
Refugees and immigrants especially, are faced with many barriers such as: need to speak English. Try getting a job, making friends, or even completing basic tasks like buying food or filling out forms. English influences abilities too. Prescriptions for being Americanized, may be at odds with their own culture are demanded individually. Finding a job, and slowly moving up the ladder, is incredibly difficult for some. Employers typically prefer work experience within the US, and certifications outside of the US usually don’t transfer. Discrimination and exploitation in the workplace is common when one is vulnerable. Some employers recognize the sense of urgency and desperation among these groups to keep their jobs, so they will have them take the less desirable and even dangerous roles. Undocumented immigrants have an especially difficult time accessing services, largely because they are afraid of being deported. Consequently, people will avoid seeing the doctor or reaching out for services like legal guidance when they’re badly needed (Christina Nuñez, 2014).
There are abilities, enhancement and self-improvement skills one has to learn/acquire immediately. These range from civics: where the county, state or Federal seats are; how a bill is formulated; the US balance of powers, congress, senate and the basics of the electoral process; to familiarity with roads, destinations and signage ( David Mikkelson, 2011).
Part 2
This section is divided into:
Background
The five key Social Characteristics and Reflexive Typology
The Healthy People 2020 Action matrix
Importance of applying tenets of Healthy People 2020 to US African Immigrant Populations
US Population Race and Origin
Conclusion
Background:
People, who come from Africa, need an orientation and acculturation input as they learn to live in USA. To an American most of the services, decor, way of life, etiquette and habits are normalized. The literacy and numeracy levels are at such a level that most Americans can go on normally in life independently. It is no wonder that most services are 'prescriptive, do-it-yourself' kind. For an immigrant, there is need for an 'instructive-guiding-descriptive' approach that will not be taken to be condescending but empowering. In order to engage in healthy living practices, the immigrant needs someone who will reach out to them, walk half a mile towards them as they too walk to the service provider. If this is not the case false beliefs about health will abound, risky lifestyles will be the norm and hence morbidity and mortality.
The Healthy People 2020, National Partnership for Action to End Health Disparities, National Prevention and Health Promotion Strategy, The Office of Disease Prevention and Health Promotion, different institutions and community-based organizations are opportunities to continue the task of create social and physical environments that promote good health for all.
According to Healthy 2020, health starts in our homes, schools, workplaces, neighborhoods, and communities. We know that taking care of ourselves by eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor when we are sick all influence our health. Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships. The conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be.
It is possible to contribute towards health equity through action on the social determinants of health among immigrants. Knowledge of how they socialize, acculturate, identify and work towards an independent autonomy is crucial for any public health practitioner. This knowledge helps one to empower immigrants to own skills with which to improve on their life, engage in healthy living and contribute to the wellbeing of their families and communities.
The five key Social Characteristics and Reflexive Typology:
The five key areas (determinants) in which immigrants contribute to their communities include:
Economic Stability
Education
Social and Community Context
Health and Health Care
Neighborhood and Built Environment
Each of these five determinant areas reflects a number of critical components/key issues that make up the underlying factors in the arena of determinants:
Economic Stability:
Poverty
Employment
Food Security
Housing Stability
Education:
High School Graduation
Enrollment in Higher Education
Language and Literacy
Early Childhood Education and Development
Business & Management
Creative Arts & Media
Health & Psychology
History
Languages & Cultures
Law
Literature
Nature & Environment
Online & Digital
Politics & the Modern World
Science, Maths & Technology
Sport & Leisure
Teaching & Studying
Social and Community Context:
Social Cohesion
Civic Participation
Discrimination
Incarceration
Health and Health Care:
Access to Health Care
Access to Primary Care
Health Literacy
Neighborhood and Built Environment:
Access to Healthy Foods
Quality of Housing
Crime and Violence
Environmental Conditions
The Healthy People 2020 Action Matrix:
The Healthy 2020 vision calls on all of us to create social and physical environments that promote good health for all. All Americans deserve an equal opportunity to make the choices that lead to good health. But to ensure that all Americans have that opportunity, advances are needed not only in health care but also in fields such as education, childcare, housing, business, law, media, community planning, transportation, and agriculture. Making these advances involves working together to:
1. Explore how programs, practices, and policies in these areas affect the health of individuals, families, and communities.
2. Establish common goals, complementary roles, and ongoing constructive relationships between the health sector and these areas.
3. Maximize opportunities for collaboration among Federal-, state-, and local-level partners related to social determinants of health.
Understanding the relationship between how population groups experience “place” and the impact of “place” on health is fundamental to the social determinants of health—including both social and physical determinants.
Examples of social determinants according to Healthy People 2020 include:
Availability of resources to meet daily needs (e.g., safe housing and local food markets)
Access to educational, economic, and job opportunities
Access to health care services
Quality of education and job training
Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities
Transportation options
Public safety
Social support
Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)
Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)
Residential segregation
Language/Literacy
Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media)
Culture
Examples of physical determinants include:
Natural environment, such as green space (e.g., trees and grass) or weather (e.g., climate change)
Built environment, such as buildings, sidewalks, bike lanes, and roads
Worksites, schools, and recreational settings
Housing and community design
Exposure to toxic substances and other physical hazards
Physical barriers, especially for people with disabilities
Aesthetic elements (e.g., good lighting, trees, and benches)
By working to establish policies that positively influence social and economic conditions and those that support changes in individual behavior, we can improve health for large numbers of people in ways that can be sustained over time. Improving the conditions in which we live, learn, work, and play and the quality of our relationships will create a healthier population, society, and workforce.
Importance of applying tenets of Healthy People 2020 to US African Immigrant Populations:
They have homes and are part of thriving US communities. Empowering them to participate in activities of their “places” positively influences social and economic conditions and those that support changes in individual behavior. Improving the conditions of living, learning, working, and play and the quality of relationships will create a healthier population, society, and workforce.
The number of African immigrants in the United States grew from 881,300 in 2000 to 1.6 million in 2010.
The number of male African immigrants increased from 484,790 to 845,237 between 2000 and 2010, while the number of females increased from 396,510 to 761,677.
The African-share of foreign born Americans is 4%. As of 2010, more than one-fifth (21.8%) of African immigrants spoke only English, while just under half (49.1%) reported speaking it fluently. Nearly three-quarters of immigrants from Africa are black, while one-fifth are white. As of 2010, 74.3% of African immigrants were black, while 20% were white and 2.7% Asian.
The largest numbers of African immigrants are found in California, New York, Texas, Maryland, and Virginia. As of 2010, the largest African foreign-born populations were in California (158,953), New York (158,878), Texas (136,112), Maryland (125,470), and Virginia (89,290). The number of African immigrants in the United States are estimated to be 1,400,000 (2015) and 3,000,000 (2020). Going by the US Population census 2014 Age and Sex statistical formulae and using the population estimates of 2015:
US African Immigrant Population Specific Estimates/Data:
Persons under 0-4 years (6.2% of the population) are estimated at: 86,800
Persons 5-18 years (23.1% of the population) are estimated at: 323,400
Female persons (50.8% of the population) are estimated at: 711,200
Male persons (48.2% of the population) are estimated at: 678,800
Female persons 6-18 years (50.8% of the 323,400) are estimated at: 164,287
Male persons 6-18 years (48.2% of the 323,400) are estimated at: 155,879
Persons 19-65 years (14.5% of the population) are estimated at: 203,000
Female persons 19-65 years (14.5% of 711,200) are estimated at: 103,124
Male persons 19-65 years (14.5% of 678,800) are estimated at: 9,976
NB. Data on Non black, White and Asians who emigrate from Africa is captured under different categories. It should be noted that some people who moved from Africa have different races they may identify with once they come to USA.
The Ugandan-Americans:
Imagine the contribution of Ugandan-Americans in various areas ranging from improving use of information as a resource; operationalizing US policy on Africa; contributing to strategic planning; contributing to defense; contributing to industry; contributing to hospitality; contributing to hygiene. There has to be readiness to embrace such pillars like: Strengthening democratic institutions; supporting African economic growth and development; advancing peace and security; promoting opportunity and development as embodied in the US Strategy Towards Sub-Saharan Africa. Or it could be working with the Defense department leadership as they become leaders in technology innovation and keep the world’s best military force moving into the future. But to get there we need to have a minimum understanding of the composition.
The Ugandan population in America is between 20,000-25,000 with big communities living in California, Texas, Atlanta GA, Baltimore MD, Washington DC, Waltham MA, Boston MA, Detroit MI, Chicago IL, and St. Paul MN.
Taking a baseline of 20,000:
8,000 have eligible documentation to enable them access full range of social support services at federal, state and county levels in USA e.g., Lifeline or the US Dept. of Education Discretionary Grants
There are 9,000 females:11,000 males
University undergraduates 450
University level educators 20
PhD and postdoctoral level holders 10
Master level holders 70
High school level students 150
Technical/ Vocational level trainees 40
Licensed to drive a motor vehicle 4,000
Owning a car 3,000
Having a permanent place to stay 20,000
Owning a place to stay 5,000
Earning USD 1,000 and above every 2 weeks 1,200
Taxi-cab operators 200
Nursing care/home health aides 800
Employed in hospitality/janitorial/security occupations 1,000
Returned to Uganda in past 12 years (between 2015-2016) 6,000
Earning USD 30,000 and above per year 5,000
Below 40 years 13,000
Fluent in basic English language 20,000
Good command of business/corporate and social intuitive English 13,000.
Ugandan-Americans below 40 years 13,000:
With computer skills 5,000
Fluent in basic English language 13,000
Good command of business/corporate and social intuitive English 9,000
Licensed to drive 7,000
Own a car 700
Earning USD 1,000 and above every two weeks 4,000
Owning a house/ place to stay 2,000.
US Population Race and Origin:
Black or African American alone, percent, July 1, 2014, (V2014) is 13.2% of total population.
White alone, percent July 1, 2014, (V2014) is 77.4% of total population.
White alone, percent, April 1, 2010 is 72.4%
Black or African American alone, percent, July 1, 2014, (V2014) is 13.2%
Black or African American alone, percent, April 1, 2010 is 12.6%
American Indian and Alaska Native alone, percent, July 1, 2014, (V2014) is 1.2%
American Indian and Alaska Native alone, percent, April 1, 2010 is 0.9%
Asian alone, percent, July 1, 2014, (V2014) is 5.4%
Asian alone, percent, April 1, 2010 is 4.8%
Native Hawaiian and Other Pacific Islander alone, percent, July 1, 2014, (V2014) is 0.2%
Native Hawaiian and Other Pacific Islander alone, percent, April 1, 2010 is 0.2%
Two or More Races, percent, July 1, 2014, (V201) is 2.5%
Two or More Races, percent, April 1, 2010 is 2.9%
Hispanic or Latino, percent, July 1, 2014, (V2014) is 17.4%
Hispanic or Latino, percent, April 1, 2010 is 16.3%
White alone, not Hispanic or Latino, percent, July 1, 2014, (V2014) is 62.1%
White alone, not Hispanic or Latino, percent, April 1, 2010 is 63.7%
Age and Sex:
Persons under 5 years, percent, July 1, 2014, (V2014) 6.2%
Persons under 5 years, percent, April 1, 2010 6.5%
Persons under 18 years, percent, July 1, 2014, (V2014) 23.1%
Persons under 18 years, percent, April 1, 2010 24.0%
Persons 65 years and over, percent, July 1, 2014, (V2014) 14.5%
Persons 65 years and over, percent, April 1, 2010 13.0%
Female persons, percent, July 1, 2014, (V2014) 50.8%
Female persons, percent, April 1, 2010 50.8%
US Population Transportation Data:
Mean travel time to work (minutes), workers age 16 years+, 2010-2014, is 25.7 minutes.
US Population Business Data:
Total employer establishments, 2014 is 7,563,085
Total employment, 2014 is 121,079,879
Total annual payroll, 2014 is 5,940,442,637
Total employment, percent change, 2013-2014 is 2.4%
Total non-employer establishments, 2013 is 23,005,620
All firms, 2012 is 27,626,360
Men-owned firms, 2012 is 14,844,597
Women-owned firms, 2012 is 9,878,397
Minority-owned firms, 2012 is 7,952,386
Non-minority-owned firms, 2012 is 18,987,918
Veteran-owned firms, 2012 is 2,521,682
Non veteran-owned firms, 2012 is 24,070,685
US Population Economy Data:
Population in civilian labor force, total, percent of population age 16 years+, 2010-2014 is 63.5%
Population in civilian labor force, female, percent of population age 16 years+, 2010-2014 is 58.7%
Total accommodation and food services sales, 2012 ($1,000) is at 708,138,598
Total health care and social assistance receipts/revenue, 2012 ($1,000) is at 2,040,441,203
Total manufacturers’ shipments, 2012 ($1,000) are at 5,696,729,632
Total merchant wholesaler sales, 2012 ($1,000) are 5,208,023,478
Total retail sales, 2012 ($1,000) are at 4,219,821,871
Total retail sales per capita, 2012 are at $13,443
Conclusion:
The Black, African, Atlantic and Indian Ocean Islander Immigrants to USA can be mobilized, organized into socially Cohesive entities and through them be empowered to participate in activities that improve individual skills, attitude, identity, autonomy and continued desire to lead a healthy happy life in USA. You are welcome to use this tool to empower immigrants in USA.
Sources:
For more on the US Population see:
https://www.census.gov/quickfacts/table/PST045215/00.
For more on Heathy People 2020:
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health.
For more on US State Department see:
http://www.state.gov/p/af/index.htm.
For more on US Department of Defense see:
http://www.defense.gov/News/Special-Reports/0715_science-tech.
For more on Information as a resource see:
http://capita.wustl.edu/me567_informatics/concepts/infores.html.
For more on Ugandan Diaspora see:
http://www.ugandandiaspora.com/ugandan-diaspora-website-vision-and-objectives.
For more on US Department of Education Grants see:
http://www2.ed.gov/programs/triostudsupp/index.html.
For more the Federal Lifeline Program see:
http://www.lifelinesupport.org/ls/.
Anna North. 2016. The Biggest Challenges of 2016. Retrieved from: http://takingnote.blogs.nytimes.com/2016/01/06/the-biggest-challenges-of-2016/?_r=0. Retrieved on July 25th 2016.
Christina Nuñez. 2014. The 7 biggest challenges facing refugees and immigrants in the US. Retrieved from: https://www.globalcitizen.org/en/content/the-7-biggest-challenges-facing-refugees-and-immig/. Retrieved on July 25th 2016.
David Mikkelson. 2011. The High(way) Sign. Retrieved from: http://www.snopes.com/autos/law/highways.asp. Retrieved on July 25th 2016.
Forms. Retrieved from: https://www.official Website of the Department of Homeland Security/. Retrieved on July 25th 2016.
Hoffenburger, K., Mosier, R., & Stokes, B. (1999). Transition experience. In J.H. Schuh (Ed.), Educational programming and student learning in college and university residence halls. Columbus, OH: ACUHO-I.
How to find low-cost health care in your community. Retrieved from: https://www.healthcare.gov/community-health-centers/. Retrieved on July 25th 2016.
10 things immigrant families need to know about the Marketplace. Retrieved from: https://www.healthcare.gov/blog/10-things-immigrant-families-need-to-know-about-the-marketplace/. Retrieved on July 25th 2016.
