Policies must recognize diversity of city’s black population
Boston’s long-diverse black population is becoming increasingly so as the number of foreign-born rises. This growing heterogeneity has some experts saying it is time policies and services caught up with the reality and faced the fact that members of the black community have varied needs.
“There is a presumption that the black community is a monolithic one,” said James Jennings, professor emeritus at Tufts University.
In particular, some scholars say, new healthcare approaches and greater offering of immigrant services are needed.
In 2014, Boston’s population was more than one-quarter foreign-born, according to the Boston Redevelopment Authority. The most-represented ethnic group was Dominican, with Haitian coming in as third-most prominent. A recent report — co-authored by Jennings — recorded that in Massachusetts, 32.8 percent of the black population is foreign-born. The most common first ancestries of blacks in the state are Haitian, Cape Verdean and Jamaican, followed by Nigerian, Ethiopian, Kenyan, Trinidadian and Tobagonian, Barbadian and Ghanaian.
No typical patient
Jennings said health care professionals have often acted as if there is one typical black patient with a standard set of needs — a mistake that may become increasingly apparent as the community continues to diversify.
One example: while medical studies long have reported that African Americans tend to have high blood pressure, Jennings said recent studies found that Jamaican Americans buck the trend.
“[For] Jamaicans who have been here a long time, a few studies are finding their blood pressure rates are much lower than African Americans who’ve been here a long time,” he said.
Health care professionals not only need to assess what kinds of care they emphasize but also how they deliver it. Patients from different cultures bring varied expectation for what healthcare should look like, including the role of the doctor, medication and where and how care is sought, said Linda Sprague Martinez, assistant professor at Boston University.
On the web
She cited the example of a young Dominican man, who told her he was surprised by how American doctors practiced. Compared to doctors in his native country, the Americans acted in what he felt was a rushed, impersonal style of patient treatment. They seemed eager to hook patients up to machines and run tests, but not to talk or listen to them, he had said.
These kinds of cultural disconnects can make it challenging for health care providers to build trust with patients, Sprague Martinez said. “Providers need to be more cognizant to meet people where they’re at [culturally].”
Community health centers traditionally have had more success meeting patients where they are culturally. In part, this is because the centers are embedded in neighborhoods, which affords them comprehension of local context; they also tend to hire staff who reflect the community and allocate more time for each patient. Although some larger hospitals now are making efforts to gather and incorporate patient feedback into their programs, most are not well-attuned to the needs of the community, Sprague Martinez said.
Jennings said patient outreach is an area that needs to go further.
“We have very little consumer-client evaluation of the human services delivered in black or Latino communities,” he said. The more hospitals gather responses, the more they may move away from a one-size-fits all template for treating blacks, he said.
Taking on immigrant causes
As the number of foreign-born rises, offering services to immigrants and championing their causes in the political sector will become increasingly important in the black community.
“There’s still may be pockets in the black community that see immigration as a non-black issue,” Jennings said. [“But] immigration, bilingual education — all of a sudden those issues are not the other group’s issues. Those are our issues.”
Traditionally, new immigrants are focused on establishing economic stability for themselves and their families: acquiring jobs, housing and child care, and getting children into good schools. They may need community assistance to reach these goals, said Rachel Bernard, an independent consultant.
“It will be up to the academic, community health centers and other civic organizations to really reach out and get to know people in their communities that are newcomers,” she said.
Among the most crucial of immigrant needs is expanding access to English-language learning resources and opportunities, Bernard said. This means providing English language classes at schools, community-based organizations and workplaces. Similarly, schools, like hospitals, need to be aware of the cultures they serve in order to ensure their programs and services cater to all members’ needs and are well-received.
One black community, mostly
Although it may take time for new arrivals to integrate, Jennings said that for the most part, members of Boston’s black population have not divided into communities along ethnic lines, but rather identified as part of a larger black community.
“At end of day I think people see themselves as part of the black community. It’s not like ‘us’ and ‘them’ in the black community,” he said.
One factor influencing this is that new arrivals land in the midst of power structures and dialogue that often group people along lines of black, white, Latino or Asian. There is less of a focus on subgroups within those broader categories, Jennings said.
“They’re responding to a context of, ‘You’re still a person of color.’”
He said media and the research community often have regarded the black community as homogenous and not distinguished further.
Likewise, many in the Latino and black communities come together over shared concerns such as housing and health causes, Jennings said.
City Councilor Tito Jackson said that the diversity of the black and Latino communities has been a source of strength, providing new insight and perspectives on causes faced by the community as a whole.
“[It] brings a powerful perspective and ability to bring solutions to the table from their respective countries and cultures, and that is a wonderful thing to happen,” he said.