The New African Diaspora

8. Acculturation and the Health of Black Immigrants in the United States

8 ACCULTURATION AND THE HEALTH OF BLACK IMMIGRANTS IN THE UNITED STATES Florence M. Margai The health of immigrant populations in the United States is best characterized as an epidemiological enigma that is influenced by a range of factors including migration selectivity, nativity, cultural protective attributes , linguistic proficiency, and health care access. Some researchers have identified a “healthy immigrant effect” that suggests that those who immigrate initially have excellent health outcomes, with low rates of chronic and degenerative diseases and less adverse reproductive outcomes (Perez; McDonald and Kennedy). Others have identified an epidemiological paradox, with immigrants reportedly having better health outcomes than their U.S.-born counterparts, despite the difficulties they face in accessing and utilizing the health care system and other institutional barriers (Markides and Coreil; Scribner and Dwyer; Grady; Margai, “Using Geodata”; Yu et al.). There is also increasing evidence that the superior health status observed among immigrants does not remain in effect forever . Rather, it declines with resettlement and increasing acculturation in the U.S. host society (Lee et al.; Gordon-Larsen et al.). The effects of acculturation on health have been well documented for Latino and Asian American immigrant groups; however, the trends among African-born black immigrants are still sketchy and yet to be fully discerned. Given the volume and rapidity of African immigrant flows to the U.S. in recent years, several researchers have now called for a more detailed assessment of black immigrant families by nativity to uncover any health differentials that might exist between the immigrants and their native-born counterparts (Kamya; Read et al., “Implications”). In concert with these latest efforts, the present study compares the health status of three black subgroups in the United States: U.S-born blacks, African-born black immigrants, and black immigrants from the Caribbean. The study draws on national survey data to investigate whether the relative health advantage observed among Asian and Latino immigrant populations also 164 Acculturation and the Health of Black Immigrants in the United States 165 exists among the African black immigrants; whether this advantage varies by geographical region of nativity; and whether this advantage declines with increasing acculturation in the U.S. society. The research findings are expected to yield important implications for understanding black immigrant health and developing public health strategies that are geared toward racial/ethnic health parity in the United States. The rest of the chapter is divided into four parts. The first section provides an overview of black health geographies in the United States, focusing on the demographic and spatial distributional patterns and the health care challenges. The second section summarizes four models of immigrant health, providing a useful context for conceptualizing and developing the research framework for this study. The third section outlines the research design, data source, and sample profiles. This is followed by a presentation of the results derived from the statistical comparison of chronic health outcomes among the three different black subgroups. An effort will be made to explain these disparate health patterns based on the geographic and socioeconomic factors as well as the varying patterns of health care access. B L A C K G E O G R A P H I E S A N D H E A LT H D I S PA R I T I E S I N T H E U N I T E D S T A T E S As of the 2000 census, black Americans constitute 13 percent of the U.S. population, or roughly 35 million people (U.S. Bureau of the Census). Several articles have articulated the demographic history and settlement geographies of this population, including the emerging patterns and health care challenges facing the group in the twenty-first century (Carter-Pokras; Geronimus; Margai, “Racial and Ethnic Disparities”). The spatial attributes of blacks have been described as predominantly urban and hypersegregated in environmentally and socioeconomically stressed neighborhoods . Historically, blacks have been faced with systemic and structural disadvantages such as residential segregation, racial discrimination, psychosocial conditions of acute and chronic stress, disrupted social support systems, and toxic environmental exposures resulting in deleterious health outcomes (Geronimus; Margai, “Health Risks”; Grady). The health differentials between black Americans and the dominant white majority have been persistent in many health domains and across all age groups (Margai, “Racial and Ethnic Disparities”). A larger proportion of blacks die of chronic health conditions such as heart disease and cancer than their white counterparts. Further, the risks of diabetes, HIV/AIDS, infant mortality, and low...