SSA Immigrants in California: Educated and Insured but Still Facing Deep Gaps

In a pioneering study led by researchers from the RAND Corporation, the University of Buffalo, Yale Center for Interdisciplinary Research on AIDS, and UCLA Center for Health Policy Research and Management, the health and socioeconomic realities of Sub-Saharan African (SSA) immigrants in California have been brought to light with exceptional clarity. Using data from the 2021–2022 California Health Interview Survey (CHIS), the nation’s largest state health survey, the research focuses on 304 SSA immigrants, comparing them to 2,246 non-immigrant Black/African Americans. As SSA immigrants represent one of the fastest-growing yet most understudied immigrant groups in the U.S., this study breaks important ground in understanding their health outcomes, access to care, and the broader social determinants that shape their lives.

Highly Educated, Yet Economically Vulnerable

The SSA immigrant population in California is notably well-educated, with 57% holding a college degree or higher. This figure exceeds both national averages and that of non-immigrant Black/African Americans in the same dataset. Employment rates are also relatively strong, with 66% working full-time. However, this educational and employment success does not fully shield them from economic insecurity. Nearly 16% live below the federal poverty line, exceeding both national statistics and the Healthy People 2030 benchmark of 8%. Food insecurity is another significant concern: 16% reported not having enough to eat, while others reported skipping meals or reducing their intake due to financial strain.

This contradiction, educational achievement alongside economic instability, is sometimes referred to as the “African immigrant paradox.” Contributing factors include the under-recognition of foreign credentials, racial discrimination in the labor market, high costs of living in urban California, and the burden of sending remittances to families in their countries of origin. Housing data reflect these pressures too, with only 41% of SSA immigrants owning homes, well below California’s state average, while 56% rent or live in non-traditional arrangements. Despite their educational capital, these immigrants face significant financial hurdles in achieving the American Dream.

Good Coverage, Uneven Access to Healthcare

One of the most striking findings from the study is that 96% of SSA immigrants have health insurance, surpassing the Healthy People 2030 target of 92.4%. Most reported having a regular source of care, and 79% visited a doctor in the past year. Yet, access to quality healthcare is uneven. Around 18% delayed or didn’t receive necessary healthcare, and 15% postponed filling prescriptions, rates much higher than national targets. Common reasons included appointment availability, lack of time, and out-of-pocket costs, even among those with insurance.

Preventive care remains underutilized: while more than half of respondents had been tested for HIV, only 31% of adults aged 45 and above had received colon cancer screenings, compared to the national goal of 72.8%. Meanwhile, experiences of racial discrimination in healthcare were alarmingly common. Nearly one-quarter of respondents felt they had been treated unfairly due to their race or ethnicity, and the same proportion believed they would have received better care had they been of a different race. These statistics expose deep fissures in the healthcare system’s ability to provide equitable treatment to marginalized immigrant populations.

Chronic Conditions and Mental Strain Take a Toll

The physical health landscape for SSA immigrants shows a mix of promising and concerning trends. While 84% rated their general health as good or better, 16% described their health as fair or poor. Chronic conditions such as high blood pressure (34%), diabetes (14%), asthma (13%), and heart disease (9%) were relatively common. Compared to non-immigrant Black/African Americans, SSA immigrants fare slightly better, but these rates are still higher than the national average and illustrate underlying health burdens that require attention.

Mental health indicators also raised red flags. About 16% of SSA immigrants reported experiencing serious psychological distress during the worst month in the past year, while 8% said they were affected in the past 30 days. These findings point to the psychosocial weight carried by many immigrants, potentially exacerbated by migration stress, discrimination, caregiving roles, or financial hardship. Despite their resilience and community support systems, these burdens can manifest in ways that compromise both physical and mental health.

Resilience Amid Adversity: A Call for Tailored Policy

Perhaps one of the most compelling aspects of the study is the simultaneous presence of vulnerability and resilience within the SSA immigrant community. A substantial 43% reported experiencing four or more adverse childhood experiences (ACEs), over twice the national average. Moreover, nearly half of the respondents felt they had faced unfair treatment in society due to their racial or ethnic identity. Still, the community shows remarkable strength: 36% reported six to seven positive childhood experiences, and 33% were active caregivers for friends or family members.

These data points highlight the necessity of designing health policies and public services that are not only inclusive but also culturally sensitive. Despite their insurance coverage, educational credentials, and community involvement, SSA immigrants face systemic obstacles that cannot be addressed through blanket approaches. The researchers argue for the disaggregation of health data by national origin and call on policymakers to focus on the unique needs of SSA immigrants. In doing so, health equity can move from an aspiration to a reality for this growing, diverse, and dynamic population.