Cultural Competence & Sensitivity Around the African-American Community

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When doing outreach to the African-American community there needs to be a clear degree of cultural sensitivity and competence on the part of those conducting outreach. Given the community is extremely ethnically, socio-economically, and culturally diverse, it’s important to understand the community as a whole but also to thoroughly understand the history, cultural traditions and trends of the local areas with whom you are seeking to connect. The experience of someone of African descent can vary dramatically from state-to-state, city-to-city, or even block-to-block. It’s important to have a clear sense of perspective as to the issues that affect specific populations. Knowing the norms around culture, faith, gender and other socio-political factors is crucial to being effective.

Specific to health coverage, the enrollment process and often any interaction with government programs or entities, there could be a response of extreme receptivity and openness or extreme mistrust and skepticism. The most important rule around engagement with any community is not to assume based on general stereotypes, but to seek first to understand and tailor your message to the individual and/or families with whom you are talking.

The issue of having quality, affordable health coverage is of critical importance for the African-American community. Health disparities between African Americans and other racial and ethnic populations are striking and apparent in areas that could be shifted with access to quality, affordable preventative care options. In 2009, the death rate for African Americans was higher than Whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, and HIV/AIDS.1

Finally, while some think the issue of legal status is one that affects only the Latino and Asian communities; families consisting of foreign-born individuals of African descent also have interest in understanding who qualifies for health coverage and the benefits. Those individuals without protected status are also called “undocumented.”

Income and Education

Income and education are important topics but can be of highly sensitive to African- American consumers.

  • Do: explain that, based on their income, they may be able to get financial assistance to help pay for the cost of coverage.
  • Don’t: take any families’ or individuals’ opposition to share information as a lack of interest. Not everyone is open to discussing their income, occupation or level of education. The reluctance to share such information does not translate to lack of employment, education, or financial stability. Keep in mind that financial stability for one person is different to another. Portions of the African-American community may be less represented when it comes to bank accounts, investments accounts, or saving accounts, but it does not mean they lack access to liquid cash or purchasing power.

Communication

Communicating with individuals in their preferred language is an important practice. Language is a critical component of the African-American community and serves as a mainstay of any culture. Equally important is the manner in which you communicate with consumers you are hoping to help.

  • Do: approach a person to say hello in the language and tone you are comfortable in and equipped to successfully communicate about health insurance. By their response to your “Hello. How are you?” you will be able to gauge their comfort level with the English language and then engage accordingly.
  • Don’t: make assumptions about African/Afro-Caribbean immigrants based on language abilities or preference to use a particular language. Judgments on levels of education, legal status, place of birth, or income levels should not be based on language fluency. Just because a person does not speak English does not mean they are less educated about their health insurance options. Conversely, do not assume that someone who speaks English understands the new coverage options available due to the Affordable Care Act.

Immigrant Population

African/Afro-Caribbean Immigrants’ legal status can be a subject of fear and vulnerability.

  • Do: work to build trust with African/Afro-Caribbean immigrant consumers, to provide as much information as possible around health coverage options and to create a space where they are comfortable communicating without having to share their legal status.
    • Furthermore, it is important to be aware that legal status in the U.S. has many variations. Simply because someone is undocumented does not mean they are not part of a qualifying protected group that might be able to get health coverage through the new health insurance marketplaces – especially children. (A list of qualifying groups is provided in the Engaging African/Afro-Caribbean Immigrants section).
    • If a person does share that they are undocumented or that a family member is undocumented, you must reassure them that although the undocumented family member does not quality for health coverage, there are still resources available via community health centers and other organizations without specific legal restrictions. Make sure you develop a list of these local resources if you are in an area that might have a large population of undocumented people because you will be able to better reach all members of the household. It is also important to encourage their family members to apply for coverage.
  • Don’t: ask if they or someone else in the family is undocumented. Also, do not assume that because a person is an immigrant or speaks another language that they will have a low-wage occupation, or because they don’t care to share their legal status that they are probably undocumented.

Endnotes

1Centers for Disease Control and Prevention, Minority Health, Black or African-American Populations. http://www.cdc.gov/minorityhealth/populations/REMP/black.html

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