By Sue Misao
Northwest Asian Weekly
Basically, you’re as healthy as you can afford to be.
Like every subgroup, Asian Americans and Pacific Islanders have health concerns specific to them, often connected to immigrant or refugee status, income, access to health care, and, of course, genetics.
Some of the most noticeable health issues for the API community are hepatitis B and tuberculosis, said Sunshine Monastrial, senior planning and evaluation analyst for International Community Health Services (ICHS), mainly because it’s more of an issue in their home countries.
“One in 12 Asians are impacted by hepatitis B,” said Monastrial, “and two out of the three who have it are not aware they have it. Catching it early is important because it can lead to liver cancer.” Nationally, Asians make up about half the hepatitis cases, she added.
Asians make up more than half the total TB cases that were noted in 2012 in King County, Monastrial said, second only to African Americans. “TB disproportionately impacts those who were foreign born,” she said.
Diabetes is a third big issue, which Monastrial said most people find surprising. “Diabetes is usually associated with being overweight or obese, and most people don’t think Asians as overweight or obese,” she said. Filipinos, Pacific Islanders, and native Hawaiians are more likely to be at higher risk than their Asian counterparts.
Aggregated data on Asian Americans, Native Hawaiians, and Pacific Islanders tends to mask certain disparities among these groups, according to Marguerite Ro, chief in the office of the director at King County Health Department, specifically among Southeast Asians and Pacific Islanders, making them a “minority within an already invisible minority.”
You are what you eat
“Food is definitely a huge issue. When you compare Chinese in China vs. Chinese Americans, that’s where it’s most telling how food impacts our health,” said Monastrial. “The obesity and overweight rates are drastically different.”
A few generations down, she said, Asians feasting on a mostly American diet — compared to what people eat in Japan or China — increases their risk of diabetes.
Access to healthy food is imperative, said Monastrial. “There are several ‘food deserts’ in south King County, where there might not be a market or grocery store where you can purchase healthier foods, such as a banana or apple or vegetables, at a decent price,” she said, adding that it’s not limited to the API community, but impacts anyone who is low income.
Cancer is the leading cause of death in King County’s API community, said Monastrial.
Heart disease is second and strokes are third. Still, APIs have a longer life expectancy than the general population, she said, but Samoans and Native Hawaiians, both male and female, have the highest death rates among Asians.
Breaking it down to subgroups, Monastrial said Vietnamese American women have a higher cervical cancer rate than any ethnic group in the United States. The cause is unknown, she said, speculating genetics and the environment are key factors.
“We focus a lot of our mammogram and screening outreach to the Asian Indian, Pacific Islander, and Vietnamese communities because we have seen higher incidents of breast and/or cervical cancer in those groups,” she said. “In the Korean community as well, where the screening rates are lower.”
Monastrial ventured that among the reasons for lower screening in certain ethnic populations are the fear of results, the cost, and cultural issues that keep people from being proactive about getting tested. Services are still somewhat lacking for older people, said Ro, adding that a shortage of providers and language barriers reduce the capacity to ensure that long-term care needs are met.
As many as 61 percent of Asian women report experiencing physical and/or sexual violence by an intimate partner during their lifetime, according to the Asian & Pacific Islander Institute on Domestic Violence. Although the numbers vary among different studies, Monastrial believes domestic abuse is not adequately assessed or addressed in the API community, partly because of the cultural stigma associated with mental health and behavioral health issues.
Human trafficking also affects the API community disproportionately. “Almost half the human trafficking victims in the U.S. are from Asia or the Pacific Islands,” said Monastrial.
Recent news of human trafficking has been gaining traction in the Pacific Northwest, which is considered a hub for immigrants and refugees — a vulnerable population group. In January, King County launched an awareness campaign, with signs on Metro buses in eight languages, including Spanish, Amharic, Chinese, Korean, Russian, Tagalog, and Vietnamese.
Human trafficking is defined as compelling a person into any form of labor against their will in any industry, including sex work, agriculture, construction, domestic service (housekeeper, nanny), restaurants, salons, massage parlors, and small businesses. Half the victims are children.
Health insurance, yes
The biggest issue right now is making sure people are covered, said Ro. “Pacific Islanders have a really high rate of being uninsured,” she said. “People are really struggling, in part because the Washington Healthplanfinder system was not created to recognize the complexities of non-native residents.” Some of these include issues with name spellings on various forms and Green Card numbers. “They are working it through,” she said, although concern is high that the Pacific Islander communities are not getting the information they need.
The Affordable Care Act, also known as Obamacare, has open enrollment through the end of March. ICHS is one of 23 organizations in King County with “in-person assistors” trained to help people get enrolled. ICHS has already enrolled about 4,500 people.
“The rollout was initially a little bumpy,” said Monastrial, adding that Washington state’s enrollment has been one of the more successful ones, as an early adopter with resources in place.
“Obamacare is not in the news much recently because it’s succeeding,” she said. “It’s harder to find people who are not satisfied with the options they have.”
The Asian Counseling and Referral Service (ACRS) in the International District also offers assistance in several languages in signing up for health insurance.
Still, nearly 33,000 Asian Americans and over 2,400 Native Hawaiian/Pacific Islanders in King County remain uninsured, according to the King County Health Department.
The county is hosting enrollment events through the end of March in 25 locations throughout Seattle and in 15 additional King County cities. See them here: www.kingcounty.gov/healthservices/health/personal/coverage/calendar.aspx.
Health insurance, no
Not everyone in the API community is eligible for government health insurance.
“One misperception that people do have is that with health care reform, no one is going to be uninsured,” said Monastrial. “And that is a huge myth because there’s still eligibility requirements around immigration, and also there’s the people who are undocumented that would have no options to sign up for health insurance through any federally subsidized or paid-for programs.” At ICHS, she said, there will still be a sizable population that will be uninsured. But they can still see a doctor.
“We, as a federally qualified health center, can’t refuse anyone. We accept everyone, regardless of their ability to pay, and we’re required to provide them services in a language that they can understand and in a culturally appropriate way, based on where they’re coming from. We don’t ask about immigration status.” They also offer sliding scale discounts to those who can afford to pay some.
Money for that comes from the City of Seattle’s fund for uncompensated care, along with some federal grant money to help with overall operations.
Barriers to health care
Poor health among different ethnic groups is often a result of language barriers, low income, and reduced access — factors that co-exist within cultural norms. Each of these can contribute to a cycle of worsening health. Many people end up waiting until symptoms are at their worst before consulting a doctor for things that could have been prevented through regular access to health care. Cultural barriers, including the stigma associated with poor physical and mental health, and a lack of resources also play a part. Besides genetics, health outcome is directly related to the quality of health care one receives, said Monastrial, “and everything you do outside of a doctor’s office — where you live, where you work, and where you play.” (end)
Sue Misao can be reached at firstname.lastname@example.org.