Optimizing Health for Immigrant Populations: When One Thing Stands, Another Thing Stands Beside It

By Yewande Oladeinde, Ph.D.
National Institute on Minority Health and Health Disparities
Posted June 10, 2024

Most immigrants have frames of reference or ways of knowing based on their immigrant experience that confer certain health advantages in positive and unique ways, often known as the “healthy immigrant effect” or the “immigrant paradox.” To better understand the rationale behind why and how immigrants seek care, we need to know “what are those things that stand and what are the other things that stand beside them," as immigrants try to navigate a fragmented health care system that was not built for them.

The quote referenced above by Nigerian novelist Chinua Achebe refers to the "reality of a cultural multiverse rather than a cultural universe." As public health professionals, we often think about developing and implementing sustainable interventions that will lead to improved health outcomes. As noble as this may sound, many public health professionals design interventions that fail to consider the cultural contexts within which the behaviors and practices they are trying to change are formed and from which they thrive. Failure to do so leads to interventions that are unsustainable at best and, at worst, ineffective.

Dr. Yewande Oladeinde wearing traditional Nigerian gele head wrap made with aso-oke fabric and dress made with ankara fabric.

Highlighting Cultural Assets

Immigrant Heritage Month is about celebrating diversity and one's cultural heritage. It’s also about highlighting the cultural assets people bring to their health that can then be used to develop programs that end disparities while optimizing health for all people.

Take the story of Kemi, for example, a first-generation immigrant woman rooted in the Yoruba culture of Nigeria and an American anchored in the African American experience. Kemi has lived in the United States for over two decades despite spending her formative years in her home country of Nigeria. To remain connected to her Nigerian roots, she and her family are active members of a cultural organization for Nigerians in her community. Even though Kemi has lived in the United States for over two decades, she is very much rooted in her Yoruba culture.

Kemi was experiencing symptoms of extreme fatigue, a feverish feeling, and other flu-like symptoms. At the time when she was experiencing these symptoms, she wanted to see a doctor, but she heard the news of how nobody was allowed to accompany loved ones to the hospital. People were asked to literally drop off their loved ones to an unknown fate and leave them there. Because of this rule, Kemi decided to stay home and have her loved ones care for her.

Kemi called her mother in Nigeria to inform her about her symptoms and to ask for the agbo, a Yoruba term for a medicinal herbal remedy that is commonly used for feverish conditions. Her mother gave her the names of the herbs she needed, the specified quantities, and the preparation instructions. Her husband tried to purchase the medicinal herbs recommended, but many of them were unavailable in the United States. Kemi’s mother shipped the agbo remedy from Nigeria. Kemi drank a 4- to 8-ounce cup of the medicinal herbs each day. After about two weeks, her symptoms abated.

Prior to this incident, Kemi used Western allopathic medicine often. However, when she was in a dire health situation, and some of the allopathic treatments recommended to her were not working, she knew she had to rely on “those other things that seek to stand beside that one thing,” such as traditional cultural practices and values related to healing that sustained prior generations, and reliance on the wisdom and divine power of one’s mother.

When Kemi’s friends spoke to her about possibly seeking care as her symptoms got serious, she stated, ”What is the point of going to the hospital and being subjected to trial-and-error treatment when I can rely on what mothers and grandmothers in my culture have used for several generations that worked for them?” She relied on her cultural identity and the value of what had worked for previous generations. This is one of the reasons why it is important to build and maintain trust with the medical community and between people from other racial and ethnic minority communities, as cultural factors may influence their perceptions of health and uptake of recommended guidelines of care.

As we continue to celebrate our diversity and cultural heritage this month, we must remember to:

• Pay attention to the perceptions that feed people’s beliefs and the broader contexts where these perceptions emerge and from which they thrive. People’s perceptions, be they sociocultural, political, or historical, do not emerge from a vacuum.
• Keep indigenous ways of knowing, which have helped our ancestors thrive. Chinua Achebe's quote speaks to the essence of multiple ways of knowing, which often coexist within an individual and may sometimes complement or oppose more popular views.
• Understand that there is no singular worldview or universal belief that resides within an individual, and trying to silence other narratives or beliefs would be detrimental to addressing pressing health challenges faced by immigrants in the United States.
• Encourage and empower alternate perspectives of people from other cultures, the things they value, and the unique qualities they acknowledge while leveraging their assets for optimal health.

Yewande Oladeinde, Ph.D., is a social and behavioral science administrator in the Division of Clinical and Health Services Research at NIMHD. Her research focuses on understanding the role culture plays in shaping people’s perceptions of health and illness, and how it influences their choices and their behaviors, with a goal of implementing culturally and contextually appropriate interventions. Dr. Oladeinde was born and raised in Lagos, Nigeria, and she is from the Yoruba ethnic group.

Dr. Oladeinde writes periodically for a local Maryland newspaper and aspects of this story were previously published there.