Contributor – Frances Okpaluba

Approximately one in ten Black individuals in the United States is an immigrant (Pew Research Center, n.d). Between 2000 and 2019, the population of Black African immigrants (AI) from Sub-Saharan Africa increased by 246%, from approximately 600,000 to 2 million. Consequently, individuals of Sub-Saharan African descent now represent 42% of the nation’s foreign-born Black population, a substantial rise from 23% in 2000 (Omenka et al., 2020). Despite this significant demographic shift, AI remains underrepresented in research, a challenge exacerbated by the current defunding of studies that include Diversity, Equity, and Inclusion (DEI) clauses.

Existing literature highlights that African Americans face disproportionately higher mortality rates related to stroke, diabetes, and cardiovascular disease. Notably, the stroke mortality ratio between African Americans and Caucasians is consistently higher in southern states, with the average ratio ranging from 6% to 21% higher in southern states compared to their non-southern counterparts (Howard et al., 2007). This disparity underscores the urgent need to examine the unique health challenges faced by African immigrants, whose experiences are often overlooked in health research.

Social determinants of health (SDOH) are the conditions in which individuals are born, live, learn, work, play, worship, and age. They significantly shape health outcomes (U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, n.d.). These factors deeply influence individuals’ health behaviors and outcomes. While efforts to address health disparities in immigrant populations have been ongoing, African immigrants have largely been excluded from research, primarily for two reasons. First, funding for immigrant health research is disproportionately directed toward Hispanic and Asian populations, which represent 50% and 28% of the U.S. immigrant population, respectively, while African immigrants account for only 5.1%. Second, African immigrants are often grouped with African Americans in research studies (Omenka et al., 2020; Malika et al., 2023). This conflation fails to account for these groups’ distinct cultural norms and values despite their phenotypic similarities.

Research conducted by Malika et al. (2023) utilized cross-sectional survey data from 569 Black adult male participants in a prostate cancer health study to compare the health profiles of African immigrants (AI) with African Americans (AA). The study revealed that African immigrants face unique health challenges compared to African Americans and Caribbean Americans (CA), including lower rates of substance use but higher rates of hypertension and diabetes. Moreover, African immigrants reported experiencing significant everyday discrimination, which adversely affects both their physical and mental health. Despite generally having access to healthcare and insurance, a strong sense of medical mistrust and reliance on complementary and alternative medicine (CAM) were prevalent, which may delay their healthcare utilization.

Omenka et al. (2020) conducted a scoping review of existing literature to explore African immigrant health in the U.S. and identify critical gaps in knowledge. This review identified two significant themes: the influence of culture and spirituality on health perceptions and negative experiences with the U.S. healthcare system. Cultural factors, including traditional beliefs and religiosity, shape health behaviors. Simultaneously, stigma within African immigrant communities and linguistic barriers further complicate access to healthcare. These immigrants often face challenges such as a lack of culturally competent healthcare providers, the complexity of the U.S. healthcare system, high healthcare costs, biased provider attitudes, and a profound mistrust of the healthcare system.

Roberts et al. (2021) conducted a qualitative study to explore barriers to preventive healthcare participation among African immigrant communities in King County, WA. The study identified individual, interpersonal, organizational, and policy-related barriers to healthcare access. Individual barriers included low health literacy and limited knowledge about preventive healthcare. Interpersonal barriers involve cultural differences, language challenges, and trust issues with healthcare providers. Organizational and policy barriers included the high cost of care, lack of insurance, and structural racism. The study also suggested that community-based outreach and culturally competent care could effectively address these challenges.

In an increasingly interconnected world, healthcare professionals will likely care for a diverse patient population, making cultural competence an essential component of nursing practice. Globally, approximately 281 million individuals reside outside their country of birth, and an estimated 285 million people travel internationally every three months. In 2023, the United States had an estimated 47.8 million foreign-born residents, accounting for 14.3% of the total population (USAFacts. 2024, June 6). Transcultural Nursing Theory, developed by Madeleine Leininger in the 1950s, emphasizes that nursing care encompasses universal elements common across cultures and culture-specific components unique to individual communities. This framework advocates for culturally responsive care, acknowledging patients’ values, beliefs, and practices, thus promoting holistic and person-centered care. It also supports patient involvement in healthcare decisions, like the informed consent process. It encourages the integration of traditional practices such as dietary customs, spiritual beliefs, or the inclusion of faith healers into care plans (Ellenbecker, 2023). As nursing and medical practices are grounded in evidence-based research, medical and nursing research must reflect and include diverse populations, especially crucial for underrepresented groups, such as African immigrants, whose unique cultural contexts are often overlooked. Providing culturally congruent care is a professional responsibility and a fundamental human right.

The United States must pay attention to the health challenges facing African immigrants. African immigrants now make up a larger population segment yet continue to be underrepresented in health-related research, which receives most of its funding support from Hispanic and Asian immigrant communities. AI individuals face specific health disparities, including higher hypertension and diabetes rates, as well as discrimination, which become more serious due to barriers in culture, language, and healthcare access. This group faces barriers that prevent effective healthcare use and lead to worse health results.

Immediate action must come from policymakers, researchers, and healthcare providers to address these disparities. The health needs and behaviors of African immigrants require dedicated research separate from studies that include all African American communities. Research efforts should prioritize understanding the cultural distinctions and healthcare journeys of AI individuals along with their unique health profiles and obstacles to accessing care. Protecting funding for diversity, equity, and inclusion (DEI) research is essential to prevent African immigrants from being excluded from essential health studies.

Healthcare providers need cultural competence training to address AI individuals’ specific challenges, like medical mistrust and the demand for accessible culturally relevant care. Healthcare policies need to be developed to enhance preventive care access while simultaneously cutting healthcare expenses and dismantling structural obstacles that disproportionately impact AI communities.

National health agendas must incorporate African immigrant health needs so their perspectives shape research and healthcare delivery through policymaking. Immediate action is crucial to eliminate health inequalities while enhancing the well-being of African immigrants in the U.S. and ensuring they receive deserved care and support.

References

Ellenbecker, C. (2023). Transcultural nursing theory: Bridging gaps and promoting cultural competence. Research & Reviews: Journal of Nursing and Health Sciences, 9(4), Article 96. https://doi.org/10.4172/JNHS.2023.9.4.96

Howard, G., Labarthe, D. R., Hu, J., Yoon, S., & Howard, V. J. (2007). Regional Differences in African Americans’ High Risk for Stroke: The Remarkable Burden of Stroke for Southern African Americans. Annals of Epidemiology, 17(9), 689. https://doi.org/10.1016/j.annepidem.2007.03.019

Malika, N., Roberts, L. R., Casiano, C. A., & Montgomery, S. (2023). A Health Profile of African Immigrant Men in the United States. Journal of migration and health, 8, 100202. https://doi.org/10.1016/j.jmh.2023.100202

Omenka, O. I., Watson, D. P., & Hendrie, H. C. (2020). Understanding the healthcare experiences and needs of African immigrants in the United States: A scoping review. BMC Public Health, 20. https://doi.org/10.1186/s12889-019-8127-9

Pew Research Center. (n.d.). Key findings about Black immigrants in the U.S. Retrieved July 26, 2024, from https://www.pewresearch.org/key-findings-about-black-immigrants-in-the-us/

Roberts, D. A., Abera, S., Basualdo, G., Kerani, R. P., Mohamed, F., Schwartz, R., Gebreselassie, B., Ali, A., & Patel, R. (2021). Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants. PLoS ONE, 16(5). https://doi.org/10.1371/journal.pone.0250800

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (n.d.). Social determinants of health. Healthy People 2030. Retrieved April 22, 2025, from https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health

USAFacts. (2024, June 6). How many immigrants are in the United States? https://usafacts.org/answers/how-many-immigrants-are-in-the-us/country/united-states/

About Frances Okpaluba

My name is Frances Okpaluba, I was born in Nigeria West Africa. I began my career as a registered nurse in my early twenties. From a young age, I was drawn to the caring professions, with a deep-rooted desire to care for others. As a child, I took it upon myself to check on sick family members, especially at night, to ensure their well-being. This innate sense of responsibility and compassion ultimately guided me toward a career in nursing.

Over the past eight years, I have transitioned from providing direct patient care to serving as an advanced practice provider (APP) in critical care. In my current role, I have witnessed firsthand the complex challenges our patients face, including high hospital readmission rates and the rapid decline in health outcomes. It is particularly concerning that, despite being one of the most developed nations, the United States lags behind peer countries in healthcare outcomes. Improving access to care has been identified as a key strategy to address these disparities.

I am pursuing a Doctor of Philosophy in nursing science at Texas Woman’s University. My research focuses on exploring the concept of professional autonomy among intensive care unit (ICU) nurses. The literature suggests that nurses often have limited involvement in healthcare policy development and that other professional groups frequently shape their practice. My research aims to better understand how ICU nurses perceive their autonomy and how this perception influences their engagement in policy-making processes.

Beyond my professional pursuits, I have been married to my amazing husband for 22 years and am the proud mother of three teenage boys, two of whom are in college, and the youngest is a high school junior. Outside of my role as a nurse practitioner, I sincerely enjoy motherhood, particularly watching my sons grow and thrive. I enjoy cooking, exercising, outdoor activities, and traveling with my children.

I am an active member of several professional organizations, including the American Nurses Association (ANA), the Texas Nurses Association (TNA), the American Association of Critical-Care Nurses (AACN), and the Society of Critical Care Medicine (SCCM), a multidisciplinary organization dedicated to the care of critically ill patients. Additionally, I participate in local politics, church, and charitable organizations, where I frequently hear firsthand accounts of patients’ struggles. I am passionate about encouraging nurses to become more involved in political advocacy and healthcare policy to elevate the voice of the nursing profession and drive systemic change.