Year in Review: 2010

By any measure, the year 2010 was quite busy and quite successful for the Asian Pacific Community in Action. The agency continues to expand its services and now offers a unique blend of direct clinical and educational health services, advocacy, community mobilization and capacity development, medical referrals, and applied research. To our knowledge, there are just a handful of AAPI agencies in the nation that offer a similar continuum of services. Provided below are key events and accomplishments for the year:

January

• Funding received from the Asian American Justice Center to assist with Census 2010 efforts among local Asian Americans and Pacific Islanders; APCA co-chairs the Asian Pacific Islander Complete Count Committee in Maricopa County

• Grants approved from Chandler Regional Hospital to conduct diabetes and cardiovascular screening and from St. Joseph’s Medical Center to conduct mental health research and planning in the AAPI community

• Reception held for “Taste of Asia” honorees of the 5th Annual APCA Fundraising Dinner at the Golden Buddha Restaurant; attended by 40 individuals

• Health Through Action Leadership Fellows and Midwestern University students begin Project Lingo aimed at advocating for improved language interpretation services for AAPI communities in Arizona

February

• Southern Tucson Asian Pacific Islander Health Coalition meets for the first time; APCA Executive Director helps plan the meeting and makes keynote presentation at the meeting

• Dr. Kelly Hsu receives YWCA 2010 Tribute to Women award for Health and Science at the Biltmore Hotel

March

• Organized and sponsored a women’s health symposium at the Fiesta Inn in Tempe; attended by 50 individuals

• Received $63,000 grant award from the Nina Mason Pulliam Charitable Trust to plan and implement a medical interpretation program known as the “Asian Pacific Islander Health Language Access Program”

• Ms. Ditsworth teaches the first ever Chinese language workshop of “Living Well with a Disability” at the Chinese Senior Center

• APCA receives notification of continuing grant award for breast cancer education work from Susan G. Komen for the Cure

• Health Through Action Arizona Community Partnership completed the first Leadership Training with Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL)

• Health Through Action Arizona Community Partnership adopts the HTAA vision, mission, and core values

April

• Co-sponsored three-day workshop entitled “Community Advocacy & Training on Cancer and Health”, held at St. Joseph’s Medical Center, attended by 25 individuals

• HBV testing and education at the Chamorro Easter picnic, Cactus Park, Scottsdale, the first ever health program in this community

• Poster presentation on randomized telephone health surveys among Korean, Chinese and Vietnamese Americans presented at annual meeting of the ASU Southwest Interdisciplinary Research Center (SIRC)

• Presented Jade Ribbon Arizona initiative on national HBV webinar sponsored by the Asian Pacific Islander American Health Forum

• Received “Snap Shot” award from the Arizona Partnership for Immunization for work in HBV vaccination

• Ms. Elexia Torres joins APCA as its Programs Director on April 19

• Hosted a four-day training (April 21 – 24) in digital storytelling. The training, conducted by the Center for Digital Storytelling, was provided to APCA staff and members of its lay health advisor team

May

• Held 5th Annual APCA Fundraising Dinner, “A Taste of Asia” at the Marriott Buttes in Tempe; 290 individuals attended and approximately $40,000 was raised

• Partnered with the Arizona Foundation for Eye Health on a joint diabetes and vision screening event at Mekong Plaza; 56 individuals received screening and 21 received eye exams

• Partnered with Dr. Phuc Pham on a Preventive Services Clinic, 39 individuals were screened

• Held series of hepatitis B events, including support groups and “Lanterns for Life” community walk and picnic in response to global hepatitis awareness week

• Mini-grant funding received from the American Psychological Association for a project entitled “Island Stories: Increasing Cancer Awareness in the Native Hawaiian/Pacific Islander Community through Digital Storytelling”

• HBV screening held at Mountain Park Health Center at the Chinese Cultural Center; 23 individual were screened

• Ms. Wendy Tee rejoins the APCA board of directors

June

• Ms. Ditsworth and two community members attend the four-day Stanford Chronic Disease Self Management Program training; they are now licensed to teach the course and train other trainers

• Lay health advisor trainings are held, with a total of 11 women finishing training and becoming eligible to offer stipend-based breast and cervical cancer presentations

• Mr. Hirano is invited to attend a national meeting on food and tobacco policy among Asian Americans and Pacific Islanders in San Francisco; the meeting was sponsored by the Asian Pacific Partners in Empowerment, Advocacy and Leadership (APPEAL)

• Ms. Hasan is appointed to the National Advisory Committee on Research Development related to the conduct of health research on Asian Americans and Pacific Islanders

• Ms. Hasan presents Jade Ribbon Arizona Hepatitis B Campaign at the Just Metropolis Conference in San Francisco; the conference was sponsored by the Planners Network, Young Planners Network and Association for Community Design for Social Responsibility

July

• 14 individuals are recruited and participate in “Community Interpreter Training”; these individuals subsequently contract with APCA to provide medical interpretation at the refugee screening clinic

• APCA renews a contract with the Maricopa County Department of Public Health to continue to provide emergency preparedness education and awareness

August

• Co-sponsored a kidney screening event with the Arizona affiliate of the National Kidney Foundation at the Korean Global Mission Church, Tempe; this was the most well attended such event ever held by the local Kidney Foundation

• Co-sponsored a mental health forum with Magellan Health Services; more than 60 individuals attended

• Partnered with the Indo American Foundation to conduct diabetes and cardiovascular screening; 75 individuals received screening and physician consultation

September

• Justin Tai and Monica Weintraub join APCA as Public Allies; Mr. Tai is serving as the Volunteer Program Manager and Ms. Weintraub as the Outreach Events Coordinator

• Ms. Kamana Khadka joins the APCA staff as the Administrative Office Manager

• Received a national grant from OCAPICA (Orange County Asian Pacific Islander Community Alliance) for breast and cervical cancer work among Chamorro women

October

• Partnered with the Greater Phoenix Chinese Christian Church on a health screening and vaccination event

• Sponsored a meeting entitled “Community Conversation on Immigration and Health Care in Arizona” at the JACL Hall; attended by a diverse audience of 65 individuals

• Conducted HBV screening at two different Chinese linguistic schools, testing a total of 68 individuals

• Ms. Yonsu Yi joins the APCA staff as the Korean Community Development Specialist

November

• Presented two research papers at the annual meeting of the American Public Health Association in Denver, Colorado

• Conducted an HBV screening event at Mountain Park Health Center next to the Chinese Cultural Center; 29 individuals were screened

• Partnered with the 3000 Club’s “Market on the Move” initiative to provide flu vaccine to 140 individuals at Mekong Plaza

• Ms. Liza Merrill joins the APCA staff as the Chamorro Community Development Specialist

• Ms. Michelle (Yue) Zhang joins the APCA staff as the Financial Specialist

• Drs. Kathy Nakagawa and Candace Lew join the APCA board of directors

December

• Ms. Emma Ditsworth successfully completes a five-day “train-the-trainer” medical interpretation workshop entitled “Bridging the Gap” in Seattle

• Partnered with the 3000 Club on a flu vaccination/diabetes screening event

• Conducted HBV screening and flu vaccination event at Mountain Park Health Center in Tempe; 37 individuals were screened

• Held a curriculum development session for the use of digital stories; attended by 20 individuals

-Doug Hirano, MPH, APCA Executive Director

Racial and Ethnic Differences in Health Report Released

Once every two years, the Arizona Department of Health Services releases a report entitled “Differences in the Health Status Among Race/Ethnic Groups, Arizona." The latest edition has just been released, and I would recommend that anyone interested in Arizona health disparities give it a quick review. It’s a comprehensive source of comparative health statistics by race/ethnicity.

As in previous editions, data for Asian Americans is not disaggregated by ethnicity. This masks poor health indicators by ethnic subgroup, leading to very good health rankings for Asian Americans as a whole. Indeed, Asian Americans rank “better than average” in more indicators than any other racial/ethnic group.

That being said, the report is definitely worth a review. Credit should be given to the state health department for continuing to publish this important information.

Here’s an excerpt from the report:

In 2009, Asian residents of Arizona ranked best or second best among race/ethnic groups on 53 of 70 indicators, including measures of utilization of prenatal care services, low infant mortality, low incidence of teen pregnancies, and reportable diseases. Asians median age at death was the second highest among the race/ethnic groups in Arizona in 2009. Asians also had the lowest risk of injury mortality in motor vehicle accidents, as well as drug-induced deaths and firearm-related mortality. In 2009, not a single Asian or Pacific Islander of the State died from human immunodeficiency virus (HIV) disease. However, following an improvement in their overall score from -21.9 in 2005 to -37.4 in 2007, the 2009 average score of -29.2 signified no further improvement. The rate of fall-related deaths jumped from 3.9 in 2000 to 10.8 in 2009 (See Comparative Rates and Ratios for 2000-2009). The total mortality rate of 472.8 deaths per 100,000 Asian or Pacific Islander residents of the State was the lowest rate among the race/ethnic groups, but it was the highest rate for Asians since 2005. So were the mortality rates for cancer, chronic lower respiratory diseases, diabetes, and fall-related injuries.

APCA will soon be reviewing its progress on goals and objective in its two-year strategic plan (2009 – 2010), and data from this report will be an important source of information in developing future goals and objectives.

-Doug Hirano, MPH, APCA Executive Director

Healthy People 2020: Where’s Hepatitis B Screening?

The federal government has just released the latest incarnation of our national health objectives: Healthy People 2020. As a nation, we’ve been systematically identifying our health goals since 1980, with the publication of a document known as “Health Objectives for the Nation.” Healthy People 2000 and Healthy People 2010 are successors to the original document. This time around, let’s hope that more progress can be made to reduce the health disparities between groups in this nation.

I did notice that the objectives relating to hepatitis B do not reference a stated interest in identifying individuals already infected and referring them into care and treatment. This is disappointing given that there are far more individuals in the United States unknowingly infected with HBV than HIV. Indeed, there are objectives relating to increasing screening for HIV and for hepatitis C, but not hepatitis B.

If this is an oversight, it is a big one. CDC has already passed over addressing viral hepatitis as a “winnable battle.” Those of us working on issues around hepatitis B among Asian Americans and Pacific Islanders would seem to be doing so without leadership in this area from our federal government. Be that as it may, we must stay the course and redouble our efforts.

-Doug Hirano, MPH, APCA Executive Director

Giving Thanks

I have many, many reasons to give thanks this Thanksgiving Day, some of which will be enunciated around the dinner table later today. In this post, however, I choose to give thanks to the 2,499 men who participated in a research trial testing the effectiveness of taking an anti-HIV medication to prevent HIV infection. In a major new study published recently in the New England Journal of Medicine, it was shown that taking a daily anti-HIV pill reduces the risk by 44% of becoming infected with HIV among gay men. This is an incredibly important finding with significant implications for HIV prevention in the 21st century. Here’s the link to a New York Times article about the study.

For this study to occur, however, men from around the world (Brazil, Ecuador, Peru, South Africa, Thailand and the United States) had to agree to participate. This means that each participant consented to being evaluated every four weeks for several years, knowing that he had a 50% chance of being randomly assigned to the placebo group (unbeknownst to him). While all participants received safe sex education, condoms and STD treatment, as indicated, being in the placebo group meant that the individual did not receive the study medication with its potential value of preventing infection. The result is that a number of men in the placebo group became infected with HIV, some of whom very likely would not have been infected had they been selected for the treatment group. In essence, they risked their lives for the sake of health research.

While there are still many knotty issues surrounding this new HIV prevention medication (e.g., efficacy outside the group of gay men, cost, drug accessibility, and drug resistance, to name a few), it’s certainly a time for celebration and thanks. Many millions of people will benefit from the results of this study. My hat is off to all 2,499 men who participated in the study. From those of us working in the HIV/AIDS field in the past, present and future: we salute you.

-Doug Hirano, MPH, APCA Executive Director

Conversation with Dr. Leonard Syme

Recently, I had the good fortune of spending some time with Dr. Leonard Syme. Dr. Syme is Professor Emeritus at the UC Berkeley School of Public Health and for some time now has been decrying the traditional public health approach that would have experts descending upon stricken communities with “risk factor” based interventions. Indeed, he is quite fond of recounting the failure of his five-year project funded by the National Cancer Institute that attempted to reduce smoking rates in Richmond, California.

“Richmond is a poor city with high rates of unemployment, crime, and drug use. It also has heavy levels of air pollution from nearby oil refineries. At the time, there were few health facilities. And our research team descended on this trou­bled community with a brilliant plan to do a smoking cessation project! It is doubtful that smoking was high on the priority list of people in this community, but our team paid little attention to that.”

Dr. Syme emphatically states that these types of community interventions have not worked in the past and will not work in the future. However, one approach he believes has promise is to involve communities in addressing their own concerns.

“The evidence now shows that no matter how elegantly wrought a physical solution, no matter how efficiently designed a park, no matter how safe and sanitary a building, unless the people living in those neighborhoods can in some way participate in the creation and management of these facilities, the results will not be as beneficial as we might hope.”

In other words, assisting individuals and communities to develop a sense of control over their own destinies, he believes, is an important part of the equation of good health.

Those of us working to improve the health of communities would be wise to consider Dr. Syme’s insights. He has only come to these conclusions after a quarter of a century of study of risk factors and associated interventions. By the way, I don’t think Dr. Syme is necessarily advising us to drop a disease-based focus (e.g., breast cancer, smoking and hepatitis B), but it certainly seems advisable to acknowledge the interests of the communities and to ensure their maximal involvement in their own health.

- Doug Hirano, MPH, APCA Executive Director

A Case for Race Disaggregation

We have been working closely with the Arizona Cancer Registry of the Arizona Department of Health Services (ADHS) for the past two years. The result is a brief report entitled “Cancer Cases by AAPI Race Distribution 1995 – 2007” that examines cancer reporting by ethnic subgroup of Asian Americans and Pacific Islanders in Arizona. The report makes a case that reporting of specific AAPI subgroups can help with cancer control efforts. Here’s a directive from ADHS that will be released in conjunction with the report:

The Arizona Department of Health Services (ADHS) reminds physicians to list the specific race of patients when sending disease reports to the Department. Race-specific information is important for planning and delivering effective public health programs. It also can be helpful at the clinical level. For example, persons born in Korea or China have an elevated risk for cervical cancer, and rates of stomach cancer are elevated in China and Japan. Unfortunately, the use of the generic term “Asian” without further specification has increased from 35% in 1995 to 50% in 2007. The Arizona Cancer Registry is partnering with the Asian Pacific Community in Action to promote the collection of demographic data regarding patient race, Hispanic ethnicity, tribal affiliation, and place of birth. When these factors are framed as clinically important, patients are unlikely to perceive the questions as intrusive. Including these data elements in the patient registration form or physician notes will greatly facilitate the accurate classification of patient race.

As a colleague once stated, there is a lot of suffering hidden by the aggregation of the many AAPI ethnicities and nationalities into a monolithic category of “Asian/Pacific Islander”. We strongly support disease reporting by the racial/ethnic categories as outlined in guidelines developed by the federal Office of Management and Budget.

We thank the Arizona Cancer Registry, and Dr. Tim Flood and Ms. Lana Khatib specifically, for their generous assistance in developing and disseminating this report.

- Doug Hirano, MPH, APCA Executive Director

An Afternoon With TED

I had the pleasure of spending my Saturday afternoon with a roomful of catalysts and optimists at TEDxPhoenix. For the uninitiated, TED stands for Technology, Entertainment and Design, and it’s a forum in which thought leaders take about 18 minutes to share “ideas worth spreading." The talks are thought provoking, funny, challenging, and inspirational. I would recommend a quick visit to the TED website to view a few of the presentations from their annual conferences. Some are truly extraordinary. My personal favorite is a talk by a global health professor named Dr. Hans Rosling.

Today’s speakers at TEDxPhoenix (a locally produced version of TED) included folks such as Jany Deng, program manager of the Arizona Lost Boys Center, Jolyana Bitsuie, Navajo Language Instructor, Phoenix Indian Center (and former Ms. Navajo Nation), and Helene Neville, nurse, fitness coach and trainer. Each had a very different story, but each was compelling and inspirational.

It was a pleasant afternoon. Each talk had something of interest. However, I couldn’t help but wonder whether I could muster an interesting TED-type presentation some day. There is some discussion about a TEDMed conference in Phoenix in the near future. This of course would focus on innovative and creative ideas about health and medicine. Perhaps my day will come . . .

-Doug Hirano, MPH, APCA Executive Director

Walking the Talk in Cause Marketing

I recently came across a thought-provoking post on a website called Good. Titled “Next year let’s skip breast cancer awareness month,” the author questions the commitment of the many corporate supporters of Breast Cancer Awareness Month (October), whose pink ribbon marketing significantly increases sales but often with just a fractional contribution to breast cancer work. Worse, she makes a case that some pink ribbon corporate sponsors actually contribute to breast cancer incidence by using carcinogenic materials in their products (e.g., plastics and cosmetics). She believes such supporters would do better to find ways to produce safer products than to create pink-hued corporate marketing products and campaigns.

While I admire her iconoclastic mentality, I must question her epidemiology. According to the American Cancer Society website, there is not yet a proven link between environmental pollutants and breast cancer.

Still, I think she raises an important point about “cause marketing.” While I think it is perfectly acceptable for corporate partners to derive a financial benefit from their support of a cause, it would be optimal if the partner were fully invested in the cause. For instance, in addition to donating some proceeds to breast cancer work, wouldn’t it be good if corporate partners had policies providing work site lactation rooms for breastfeeding mothers – given that studies suggest that breastfeeding decreases breast cancer risk? Wouldn’t it be good if corporate partners offered employees discounted or free gym memberships – given the link between obesity and breast cancer and the growing evidence that increased physical activity decreases breast cancer risk? Wouldn’t it be good if these employers provided affordable employee access to health insurance coverage so that women could access potentially life-saving mammograms?

In these cynical times, as companies try to buff their images through alignment with good causes, it would seem to me that charitable organizations hold corporate partners accountable for “walking the talk."

Doug Hirano, MPH, APCA Executive Director

Thoughts on Serving Asian Americans: Dr. Peter Young

I recently had the opportunity to visit with Dr. Peter Young (see photo), an internal medicine physician who practices in north Phoenix. Dr. Young, who speaks Mandarin and Cantonese, has been practicing in the Phoenix area for 12 years now. Through word of mouth, his practice has gone from almost no Asian American patients to about 30% Asian. He has even had office signage (see photo) translated into Chinese.

In working with Asian community members, particularly foreign-born Asians, he stresses the importance of patience. He spends more time in explaining Western medicine and in listening to his Asian patients. Sometimes, he says, it takes several visits to develop a rapport with these patients.

He says that Asian patients expect him to know about traditional Chinese medicine (even though he went to medical school in the United States). He will ask them to bring any traditional medications they are currently taking. Some are resistant to blood testing and taking Western medications, but he says that taking the extra time to explain the need for tests and medicine assists.

Because of the increased risk for hepatitis B among Asian Americans, Dr. Young will screen for hepatitis B. He has had several patients with advanced liver cancer due to hepatitis B infection and laments the fact that some wait until they have symptoms (e.g., weight loss and bloating) until they seek care, which is often too late for successful intervention.

I want to thank Dr. Young for his time and thoughtful perspective on serving Asian Americans.

Doug Hirano, MPH, APCA Executive Director

The Hispanic Mortality Advantage

A new report from the Centers for Disease Control and Prevention (CDC) provides the definitive data suggesting that the Hispanic population in the United States has a higher life expectancy at birth and at almost every subsequent age than the non-Hispanic white and non-Hispanic black populations. As stated in the report:

The finding of higher life expectancy for the Hispanic population seems paradoxical because on average the Hispanic population has lower socioeconomic status than the non-Hispanic white population. Given the relationship between socioeconomic status and mortality, a mortality profile similar to that of the non-Hispanic black population would seem more likely for the Hispanic population.

The study authors suggest that this apparent longevity paradox has three potential explanations: data artifact, migration effects and cultural effects. They seem comfortable that the effect of data artifact has been addressed methodologically, and seem to suggest that the migration effect (i.e., healthier individuals migrate into the country and sicker individuals return home to die) has as yet no firm basis in evidence. That leaves the potential impact of culture as perhaps a key explanation:

Finally, cultural effects in the form of family structure, lifestyle behaviors, and social networks may also explain the Hispanic mortality advantage by conferring a protective barrier against the vicissitudes of minority status and low socioeconomic conditions.

Clearly, the statisticians have done their job in confirming a significant difference in life expectancy based upon Hispanic ethnicity. The ball is now firmly in the court of public health professionals, cultural anthropologists, sociologists, and others to identify and measure the impact of the protective factors involved within the Hispanic community. (This work should be conducted among Asian Americans as well, who also benefit from relatively long life expectancy.) A better understanding of factors outside of socioeconomic status that lead to longer life can potentially serve as a basis to intervene in the premature death that impacts other racial/ethnic groups, notably African Americans and Native Americans, both of whom suffer from shorter life expectancies than the majority population.

Doug Hirano, MPH, APCA Executive Director

Battling for Attention

The National Viral Hepatitis Roundtable (NVHR) recently issued a press release decrying the fact that controlling hepatitis B and C is not among the “six winnable battles” identified by the Centers for Disease Control and Prevention (CDC).

Here are some excerpts from the release:

"The CDC's newly released 'six winnable battles' strategy makes a mockery of the broad-based, comprehensive, and integrated public-health strategy that our nation so desperately needs. In seeking to win six narrowly defined health care battles, the CDC may well lose the overall public-health war.

"The CDC's omission of viral hepatitis from its list of 'winnable battles' is not simply an oversight - it's an abdication of duty to many Americans who may well lose their battle with chronic viral hepatitis in the decades to come."

In a prior blog entry, I had commended the CDC for having the wisdom (and nerve) to identify just a few key health areas for strategic focus.

However, I fully expect that other passionate and well-intentioned public health agencies and advocates will join the NVHR in questioning the completeness of CDC’s winnable battle list. And, I think, most will have a good argument. There are many, many other areas of extreme public health urgency (e.g., diabetes, substance abuse, Novel H1N1 flu, and domestic violence, to name a few). However, it should be pointed out that the six winnable battle areas (HIV, motor vehicle injuries, obesity/nutrition/physical activity/food safety, healthcare associated infections, teen pregnancy and tobacco) cover a lot of ground in terms of health impact, and there is crosscutting value in effectively working on these health concerns (e.g., efforts to control HIV also benefits efforts to control the spread of other sexually-transmitted diseases, including hepatitis B and C).

Most importantly, though, the CDC is the leading public health institution in the world, and as a citizen and a public health professional, I expect the agency to exert leadership. The identification of “winnable battles” is a bold and controversial step. It provides strategic perspective to those of us battling in the trenches, but shouldn’t be perceived as a mandate.

As I stated in my prior blog entry, for those of us working on improving health among Asian Americans and Pacific Islanders, controlling hepatitis B is our “winnable battle”. In that regard, I will continue to support the efforts of the NVHR (APCA is a member) to put hepatitis B and C on the national radar screen and to advocate for additional resources.

-Doug Hirano, MPH, APCA Executive Director

Culturally Effective Medicine: an interview with Dr. Phuc PhaE

To better understand the actual nuts and bolts of providing culturally effective medicine, I had the opportunity to spend some time talking to Dr. Phuc Pham, a Phoenix-based internist. Dr. Pham is well known in the local Vietnamese American community and serves a large percentage of Vietnamese patients. I was curious to ask him about the differences in serving this population as compared to Anglo patients. Here were some of his insights:

• Vietnamese patients defer to physician authority more so than Anglo patients.

• Vietnamese patients are generally less knowledgeable about health and medicine, though this is changing as they are able to access Vietnamese language TV and radio.

• Vietnamese patients can be fearful of Western medicines, and some prefer to try herbal remedies first. They may faithfully take two or three medicines but seem resistant to taking more than that.

• Not surprisingly, Vietnamese patients that have been seen by non-Vietnamese physicians find communication difficult and prefer a Vietnamese-speaking physician.

• Vietnamese patients occasionally seek care in their native country, but sometimes have diagnostic tests run again in the US because of concerns about quality of care.

• Traditional practices such as “coining” (placing hot coins on the skin to alleviate fever) are still used in Vietnamese households.

• Vietnamese patients are more likely to discontinue taking medications after completing the first bottle because they mistakenly believe that completing the bottle is a “cure” rather than an ongoing form of therapy.

Dr. Pham believes that medical schools should offer courses in “cultural medicine” to better prepare medical students to serve diverse populations. Mandatory rotations among culturally diverse populations (e.g., refugee communities) would also assist.

I want to thank Dr. Pham for sharing his time and insights. He has become a valued APCA volunteer and supporter.

-Doug Hirano, MPH, APCA Executive Director

The Next Generation: The Arizona Collaborative Consortium

The Asian Pacific Arizona Initiative (APAZI) is an initiative coordinated by the ASU Asian Pacific American Studies program to educate Arizonans about the diversity, issues and specific needs of Asian Americans and Pacific Islanders (AAPIs) in Arizona. As a community member, I was privileged to serve on the APAZI Advisory Committee during its planning and execution of a report documenting the economic and social/cultural impact of the AAPI community and corresponding policy implications. This report, “The State of Asian Americans and Pacific Islanders in Arizona”, was published in October 2008 and has been widely disseminated within the AAPI community, to policymakers, and many others. A sequel to this report is planned for 2012.

Other racial/ethnic groups have produced similar reports, i.e., “The State of Latino Arizona” and “The State of Black Arizona”. Leaders from each of these communities (including the Native American community) have now begun meeting under the name “Arizona Collaborative Consortium” to discuss a framework for combining the efforts of the various racial/ethnic communities in continuing to gather and utilize data and research to improve quality of life in their respective communities.

We met this past Saturday to continue the dialogue and discussion. Dr. Karen Leong (pictured above), Asian Pacific American Studies professor, laid out a draft model for collaborative research and action. For my part, I suggested that the data gathering and research efforts be connected to efforts to mobilize communities to create positive action for social change. Too often, very creditable and actionable reports collect dust on the shelves of policymakers who are either ideologically opposed to social change or who lack the motivation or incentive to move an initiative forward. Grass roots mobilization must be at the core of policy change, and I’ll be curious to see if the Consortium can be the nexus for collaborative and effective action in this regard.

- Doug Hirano, MPH, APCA Executive Director

New Grant to Reach the Chamorro Community

I’m happy to report that APCA was just awarded a Legacy Project grant from the Center of Excellence in the Elimination of Disparities (CEED) to conduct a breast and cervical cancer education project within the local Chamorro population in Maricopa County. APCA was one of only a handful of awardees in a national grant competition.

Within this project, APCA will be developing and disseminating culturally appropriate educational materials and training and deploying a group of Chamorro lay health advisors to educate and assist Chamorro women in accessing preventive services such as mammograms and pap smears. Funding will support a part-time community outreach specialist.

For more information, contact Ms. Elexia Torres, Programs Director, at elexia@apcaaz.org or at (602) 284-8565.

-Doug Hirano, MPH, APCA Executive Director

A Conversation on Immigration Policy and Health

On October 2nd, an event entitled “A Community Conversation on Immigration & Health Care in Arizona,” will be held. This community forum is being sponsored by Health Through Action Arizona and the Asian and Pacific Islander American Health Forum and will examine the health impact of immigration policy. This event will be an opportunity for health care professionals, policy makers, community-based workers and community members to talk about the impact of immigration policy not just on enrollment into health care programs, but also on health issues such as domestic violence, communicable disease control, and service utilization. To our knowledge, this is one of a very few gatherings to discuss the relationship between immigration policy and health. A representative from the National Immigration Law Center will by speaking at the event, which will be held from 10 am to 2 pm at the Japanese American Citizen’s League, 5414 W. Glenn Drive, Glendale. Further information is available on the events page of our website.

Introducing the "Community Development Specialist"

We’ve recently announced a job opening for a “Community Development Specialist." This position was formerly known as a “Health Outreach Specialist." This is more than just a name change. The change in position title represents a shift in our approach to outreach. In the past, the Health Outreach Specialist would reach out to one or more Asian American or Pacific Islander communities largely to recruit community members for APCA events. In addition, the Health Outreach Specialist would assist individuals requiring medical referrals and/or enrollment in health care programs for low-income individuals and families.

Going forward, a key responsibility of the Community Development Specialist will be to develop sustainable relationships with key community stakeholders, enlisting support for a wide variety of APCA activities, including but not limited to advocacy, volunteerism, applied research, and fundraising. The Development Specialist will also be more active in assessing community needs – serving as a liaison between APCA and the communities we serve. We believe that success in meeting our mission is highly dependent upon communities that are actively participating in all aspects of our work.

To continue the highly important event recruitment and medical referral efforts, we will be utilizing our growing pool of trained Lay Health Advisors and volunteers. The new Community Development Specialist and other staff members will help coordinate these efforts.

For the moment, we are looking for our new Community Development Specialist to focus on work within the Korean American community. Individuals interested in performing the work described above should contact Ms. Elexia Torres, APCA Programs Director, at (602)284-8565 or at elexia@apcaaz.org.

- Doug Hirano, MPH, APCA Executive Director

An Epidemic Silence

The silence is deafening. Every day, 6,000 Asian Americans and Pacific Islanders residing in Maricopa County live another day with a disease they don’t even know they carry. It’s a disease that may have already taken the lives of family and friends. It’s a disease that is so widespread in their native countries that it’s present in big cities, the rural countryside, the mountains, the plains, inland, and on the coasts. In many areas, it’s been passed along for generations. Mostly, it’s a disease that no one is talking about. The silence is deadly.

Hepatitis B is a virus that attacks the liver and causes liver cancer and cirrhosis. For those with “chronic” infection, the virus is carried for life. In the United States, it is a disproportionately significant source of death and disability among Asian Americans and Pacific Islanders. More than 50% of the 1.25 million individuals with chronic hepatitis B in the United States are Asian Americans and Pacific Islanders. Tragically, less than half are aware that they are infected, even though a simple blood test can detect the presence of the virus.

Here are some simple, but possibly life-saving facts about hepatitis B:

• Among foreign-born Asian Americans and Pacific Islanders, many are infected as infants during childbirth or as young children through household exposure;

• One can carry the virus for decades without any symptoms – and still develop serious liver disease later in life;

• There is a vaccine that can prevent those who have not yet been exposed to the virus from becoming infected;

• Only a blood test can definitively diagnose hepatitis B;

• There is no cure for hepatitis B, but there are several FDA-approved treatments that can slow down the replication of the virus in the liver.

Every Asian American or Pacific Islander should get tested for hepatitis B. The only exceptions would be those who have already been tested and American born children less than 18 years of age. Ask your doctor for a hepatitis B test and vaccination.

Protect your family. Protect your community. Spread the word about hepatitis B. Break the silence!

-Doug Hirano, MPH, APCA Executive Director

AAPI Mental Health Forum

Yesterday, more than 60 individuals attended a mental health forum sponsored by APCA and Magellan of Arizona. Speakers included Dr. James Campbell, Dr. Young Lee, and Ms. Yen Nguyen, APCA Special Projects Coordinator – each of whom provided a perspective on mental health issues among Asian Americans and Pacific Islanders. Mr. Jeff Boldizsar, Deputy CEO of Magellan, provided an overview of Magellan’s services and opportunities for community members to get involved in improving access for AAPIs. Mr. Boldizsar shared data indicating that while AAPIs constitute 3% of the population in Maricopa County, they account for only 1% of enrolled Magellan clients.

Speakers noted that reasons for the under-utilization of mental services among AAPIs include the stigma surrounding mental illness, language barriers, lack of knowledge about mental health, differing cultural perspectives on mental health, and lack of knowledge about the availability of mental health services.

Participant suggestions included increasing the number of AAPI mental health providers, addressing policies that inhibit the provision of services to AAPIs, and conducting mental health educational campaigns.

A follow up meeting will be held for those interested in working further on mental health issues among local AAPIs. For further information, contact Ms. Yen Nguyen, APCA Special Projects Coordinator, at yen@apcaaz.org or (480) 626-3065.

- Doug Hirano, MPH, APCA Executive Director

Data is King

One of our core values is “We are science-based and data driven”. In this regard, we have conducted numerous surveys, focus groups and best practices reviews since our inception in 2002. We realize our ability to improve health and well being among our diverse communities depends upon our understanding of their health status, health beliefs and health behaviors. We will be placing summary reports on the “Publications” page on our website. I would encourage you to check this page out.

As a starting point, our “Publications” page will include results of our randomized phone surveys of the local Chinese, Vietnamese and Korean communities, conducted in 2008 and 2009. These phone surveys provide a wealth of data regarding issues such as access to health care, oral health care, preventive screening information, and behaviors such as physical activity and tobacco use. We will also be including a summary of our survey of AAPIs regarding emergency preparedness (2009), and our best practices reviews related to tobacco control and emergency preparedness.

Down the road, we will be adding PowerPoint presentations and other types of publications that we hope can inform the broader movement to improve AAPI health.

- Doug Hirano, MPH, APCA Executive Director

In Support of Colorectal Cancer Screening

At a recent diabetes/cardiovascular disease-screening event, one of the volunteer physicians offered to provide some pro bono colonoscopies to our clients. This is an extremely generous offer. It’s also a timely nudge for us to consider a more proactive role in encouraging Asian American and Pacific Islander individuals to seek age-appropriate colorectal cancer screening.

In reviewing data from our 2008 and 2009 telephone surveys, an average of 50% of Chinese, Vietnamese and Korean individuals in Maricopa County over the age of 50 years had ever received either a colonoscopy or flexible sigmoidoscopy. This is far less than the average of 64% among all Arizonans (Arizona Department of Health Services, 2008). In partnership with AAPI communities and our stakeholders, we will be working to increase this rate. Stay tuned.

Doug Hirano, MPH, APCA Executive Director

Winnable Battles

Public health practitioners are justifiably proud of the improvements in health status over the past 100 years. In fact, the Centers for Disease Control and Prevention has generated a list of the ten greatest public health achievements from 1900 to 1999. Major achievement areas include immunizations, tobacco, motor-vehicle safety, and control of infectious diseases, among others.

Now, ten years into the 21st century, those of us practicing public health must ask ourselves about our progress in this century. My sense is that we’ve made relatively slim headway in the past decade. Indeed, the end of the 20th century saw an unprecedented and largely unabated rise in childhood and adult obesity, and the beginning of the 21st century has seen deadly global outbreaks of SARS and novel H1N1 flu. Rates of tobacco use are still hovering around 20% here in the United States, and far higher in many other countries.

So, where do we go from here? Well, the CDC has offered a relatively new way of thinking about our 21st century health challenges. They have coined the term “winnable battles” to describe “public health priorities with large-scale impact on health and with known, effective strategies to intervene.” Winnable battle areas include HIV, motor vehicle injuries, obesity/nutrition/physical activity/food safety, healthcare associated infections, teen pregnancy and tobacco.

Interestingly, several winnable battle areas (i.e., tobacco and motor vehicle injuries) also show up on the list of the 20th century ten greatest public health achievements. Be that as it may, I think it is wise to generate a “winnable battle” list. It provides a clear health agenda for health departments, community-based organizations, and others interested in wide-scale health improvement.

For Asian Americans and Pacific Islanders though, I would add two additional winnable battles:

1. Screening and referring to medical care those individuals with chronic hepatitis B infection; and,

2. Increasing rates of screening for breast, cervical and colon cancer;

One in ten Asian Americans and Pacific Islanders carries the hepatitis B virus (HBV), a major cause of liver cancer. Most are unaware of their infection. A simple blood test can detect the presence of the virus, and there is now treatment that can decrease the likelihood of serious liver disease due to HBV infection.

Studies indicate that Asian Americans and Pacific Islanders do not receive preventive screenings for breast, cervical and colon cancer as often as non-Hispanic whites. The scientific literature now includes proven interventions to increase screening rates for these cancers among AAPIs.

A focus on winnable battles is efficient and sensible. We must act on this knowledge. Let’s hope that our collective legacy includes success in these areas.

Doug Hirano, MPH, APCA Executive Director

Big Happenings in Tucson

In early February, a group of community members from the Tucson area began meeting around health issues affecting Asian Americans and Pacific Islanders. I’m happy to say that I attended that inaugural meeting and have remained involved. Now named the Southern Arizona API Health Coalition, the group is using a classic health improvement model (assessment – intervention – evaluation) to examine and address health issues and concerns among southern Arizona API residents. To date, three subcommittees have been formed to address health services, elder care and cultural competency. The group has no funding at the moment but brings lots of energy and passion and is looking to leverage local resources through the University of Arizona and the Pima County Health Department. On behalf of APCA, I have offered our technical assistance and consultation. I will continue to report on the progress of this impressive effort.

-Doug Hirano, MPH, APCA Executive Director

CDC Prevention Specialist - Epilogue

I had previously written about the ongoing process of recruiting an early career public health practitioner to come work for APCA through the CDC Prevention Specialist program. A few weeks ago, I traveled to Atlanta to interview one such Prevention Specialist. We had a nice discussion but I sensed that we were not her highest priority. I was right. In the end, she selected a different assignment. It was a game try on our part. APCA was one of a very few non-profit organizations in the running for one of the 25 Prevention Specialists. Almost all eventually chose to be placed at a state or local health department. I believe one chose a placement with a university, and another chose to be placed with a national health policy organization. We’ll give it some more thought before deciding to pursue this again next year.

- Doug Hirano, MPH, APCA Executive Director

Leading for Good

It was my pleasure this past Sunday to attend a brunch on behalf of Karen Ramsey (pictured), President and CEO of Lead for Good, a new non-profit organization. A quote from the Lead for Good website: “Recognizing that every nonprofit organization thrives with great leadership, Lead for Good helps individuals become great leaders so they may better serve the missions of their nonprofit organizations.”

I can personally attest to Karen’s effectiveness as a leadership coach. She served as my coach for nine months during my time in an executive mentorship program offered by the Organization for Nonprofit Executives, also known as ONE. In that time, she guided me through some difficult situations at our agency. My pre- and post-360 evaluation reviews would indicate that I became a more effective executive director through her coaching and through the mentorship program generally. I would urge you to check out the Lead for Good website, and ask yourself the question as to whether you can stand some improvement as a nonprofit leader. If so, Karen can help.

-Doug Hirano, MPH, APCA Executive Director

Deep Metaphors in Health

Last week, I tuned into an interesting Robert Wood Johnson Foundation webinar on communicating about health. We in public health often talk about the “social determinants” of health. When this term is used without explanation, I’m relatively certain it means very little to the average person. However, translated, this means that health outcome is largely predicted by the physical, economic, and social environment in which one lives.

According to research cited during the webinar, Democrats support the notion that societal factors influence health. For Democrats, for instance, poverty is a hole created by systems imbalances that trap individuals and puts them at risk for poor health. On the other hand, Republicans tend to view health metaphorically as an individual journey in which people have an opportunity to make choices. Poor choices result in roadblocks to good health.

Now, this research is not about whether Democrats or Republicans are correct about the real factors behind poor health. The value of generating deep metaphors is to gain a better understanding of the frames people use to view the world. In other words, for those of us who often communicate about health matters, it’s not about who is right or wrong, it’s about finding a common language that speaks persuasively to multiple viewpoints. I would urge you to explore the RWJF website for further information.


-Doug Hirano, MPH, APCA Executive Director

Berman 1 – Maddow 0

I took a few spare moments this morning to watch a YouTube video of MSNBC’s Rachel Maddow interviewing a fellow named Rick Berman, president of Berman and Company, a Washington DC public affairs firm. I didn’t pick this video randomly. I’ve been meaning to watch it for some time now because I know someone who works for Berman and Company, and I occasionally have a chance to chat with her about her work.

By way of background, Berman and Company is paid to represent the interests of various industries and their related products: tobacco, high fructose corn syrup, and alcohol, to name a few. As such, they conduct marketing campaigns against such things as increases in the minimum wage, health care reform, and smoking bans. You get the idea. By all accounts, they’re very good at what they do.

In the interview, Rachel Maddow accuses Mr. Berman of using an additional and unethical tactic: forming non-profit organizations (e.g., Center for Consumer Freedom, Center for Union Facts, and the American Beverage Institute) as front groups from which to lobby the interests of well-heeled industry donors. Rachel’s point is that the anonymity involved in donating to non-profit agencies allows big business and other special interests to remain at arms length in their support of Berman and Company’s edgier, no-holds-barred public opinion campaigns. In addressing this accusation, Mr. Berman correctly points out that non-profit agencies representing “the left” have the same right to withhold donor identities. There was much more to the interview, but suffice it to say Mr. Berman emerged relatively unscathed.



While I might be aghast at the company Mr. Berman keeps (i.e., the tobacco, alcohol and food industries, among others), I’m wondering why those of us working to improve the public’s health don’t have a similar public affairs machine. Berman’s group produces TV, magazine and newspaper ads, writes op-ed pieces, creates websites, testifies at hearings across the nation, conducts client training, and otherwise takes an aggressive approach towards influencing public opinion in a variety of areas. Where is the public opinion campaign to ensure healthy food access in poor neighborhoods, to expand culturally accessible health care, or to ensure that kids get sufficient physical activity and healthy food while at school? I would argue that we cannot afford not to have such support, and until we do, the public is apt to listen to whoever has the megaphone.

As a footnote to the Maddow interview, I did my own bit of research and discovered that Mr. Berman has not only created several non-profit organizations, but he serves as the President of each agency, and also contracts a significant portion of agency revenue to his own for-profit firm for “management fees”. This practice would seem to allow industry donors both to remain anonymous and to take receive tax breaks for non-profit donations that eventually make their way to a for-profit company. It’s also interesting that there doesn’t appear to be a conflict of interest in Mr. Berman and his various non-profit boards of directors agreeing to contract large sums of money to Mr. Berman’s own agency. I’m not an attorney, but there’s something not right there.

- Doug Hirano, MPH, APCA Executive Director

Community Forum on Mental Health – August 28, 2010

We’re still finalizing the details, but I thought it wise to announce an upcoming community forum on mental health being co-sponsored by APCA and Magellan of Arizona. This event will be held from 10 am to 1 pm on Saturday, August 28th. The location will be Phoenix Baptist Hospital, 2000 W. Bethany Home Road (South Building of the Wellness Center). The event targets both professionals and community members and will address mental health issues in the Asian American and Pacific Islander communities here in Maricopa County. While the speaker panel is still being developed, confirmed speakers include Dr. James Campbell and Dr. Young Lee. Results of community listening sessions coordinated by APCA and Magellan of Arizona will be presented. Lunch will be provided at no cost. For more information, contact Ms. Yen Nguyen, APCA Special Projects Coordinator, at (480) 626-3065 or yen@apcaaz.org.

- Doug Hirano, MPH, APCA Executive Director

Obesity: a growing problem among AAPI youth?

Last December, a Taiwanese researcher released data regarding overweight and obesity among children in Taiwan. These data suggest that the rate of overweight and obesity among Taiwanese children has surged from 6% a decade ago to 25% today -- a four-fold increase in just ten years. This 25% rate of overweight and obesity is not far off US levels of about 33%.

The researcher, Dr. Chu Nian-feng of Shuang Ho Hospital near Taipei, speculates that Westernized diets and sedentary lifestyles are to blame for the epidemic. He noted that typical meals for Taiwanese children now approach 1,000 calories, as compared to 400 calories ten years ago. In addition, he states, “They watch TV, play video games, and sit in front of computers. How can they not become overweight?”

These data lead to one important question: Is a similar epidemic of childhood obesity occurring among Asian American children here in the United States?

Unfortunately, there is insufficient data to definitively answer this question. However, pieces of the puzzle do exist. For instance, 2005 data from a nationally representative sample of four-year-old children and found that Asian American children had an obesity rate of 12.8% -- significantly less than the national average of 18.4%. The rate among Asian American children was significantly lower than all other racial/ethnic groups, except non-Hispanic white children.

A separate study examined 2006 and 2007 rates of obesity among Asian American children (5th, 7th and 9th grades) attending public school in Los Angeles County. These data indicated a 12.1% rate of obesity among Asian American students – as compared to a rate of 22.9% among all students. (Data also indicated fairly significant variation by ethnic subgroup, with a range of 8.4% to 17.5% among Asian subgroups.)

Both studies would seem to indicate that current obesity rates among Asian American youth are significantly lower than general population rates. This is good news.

Unfortunately, there are some warning signs. Some study data suggest that the obesity rate is continuing to rise among Asian American youth while having leveled off among other racial/ethnic groups. In addition, according to the California Department of Public Health, 43% of Asian American teens consume fast food on a daily basis compared to 35% of white teens, and only one out of three Asian American children eats the recommended daily portion of fruits and vegetables. In addition to their poor eating habits, Asian American children may not be as physically active as their peers. Based on the U.S. Department of Education, only 39% of 10th grade Asian boys participated in after-school sports, the lowest participation rate of any ethnic group. Similarly, only 34% of 10th grade Asian girls participated in sports, second only to Hispanic girls at 32%.

Rather than wait for the perhaps inevitable increase in obesity rates among AAPI children, it is imperative that those of us working in Asian American health act quickly to get in front of an impending epidemic. APCA currently does not have any programming in the area of childhood obesity, but we remain vigilant regarding available resources and continue to monitor the peer-reviewed literature for evidence-based approaches.

- Doug Hirano, MPH, APCA Executive Director

No time for HIV/AIDS complacency

I have only had a chance to glance through the new National HIV/AIDS Strategy, but I can tell you it could not have come any sooner. Interest in HIV/AIDS, which has become a largely treatable disease, has waned in this country over the last decade. With 56,000 new infections annually, and 1.1 million individuals currently infected, now is not the time for declaring victory on this front.

The document was created with broad input and addresses four main areas for concerted action: reducing new infections, increasing access to care and improving health outcomes for people living with HIV, reducing HIV-related health disparities and health inequities, and achieving a more coordinated national response to the HIV epidemic.

For me, I like the vision for the plan: “The United States will become a place where new HIV infections are rare, and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance will have unfettered access to high-quality, life-extending care, free from stigma and discrimination."

I look forward to the day that a similar national plan is developed for the hepatitis epidemic in this country. But for now, we need to remain vigilant on multiple health fronts. HIV/AIDS is an infection with a profound impact on this country and the world. Effective action is absolutely critical.

- Doug Hirano, MPH, APCA Executive Director

Addressing Disabilities Among AAPIs

One is five Americans suffers from a disability. For those of us working in the public health arena, we sometimes neglect to factor issues surrounding disability into our equation of overall wellness and health. Disabilities directly impact our ability to work with communities on other health issues, such as tobacco use, physical activity, and breast cancer screening. I’m glad that my friend, Jean Lin, and her colleagues with Asians and Pacific Islanders with Disabilities of California are actively providing leadership, education and advocacy related to Asian Americans and Pacific Islanders with disabilities. They are sponsoring a conference in Long Beach, California on October 29 -30 that no doubt will be well worth attending.

For our part, we’ve just begun to address disability issues among local AAPIs. For instance, earlier this year, our staff member, Ms. Emma Ditsworth, conducted a training entitled “Living Well with Disabilities” at the Chinese Senior Center. This series of workshops utilizes an evidence-based curriculum that focuses on providing the information and skills to assist disabled individuals in optimizing their health and wellness. To our knowledge, Emma conducted the first ever Chinese-language version of this workshop. For more information about this workshop, feel free to contact Emma at (480) 452-5771 or at emma@apcaaz.org
(She’s currently on vacation, so make a note to contact her after she’s back in early August).

- Doug Hirano, MPH, APCA Executive Director

Prevention Specialist Update

A couple of weeks ago I wrote about my impending trip to the CDC in Atlanta to interview a potential “Prevention Specialist” to join APCA for the next two years. Well, I am back and pleased to say that I had a nice chat with one of the candidates interested in working with APCA. She is bright, energetic and has a lot of relevant work experience as related to the projects we had outlined for the position. Now, it’s a bit of a numbers game and a waiting game. There were 60 or so agencies represented at the interviews – each competing for one of the 25 Prevention Specialists. Most of these organizations were state or county health departments, and a few were universities. Of the very few non-profit agencies represented, I suspect APCA was the smallest in terms of staff numbers and the most grass roots.

Each Specialist now ranks their top few organizations, and each organization ranks their top Specialist. This information is fed into a computer, and matches are then recommended. We’ll hear in mid-August about the results. Stay tuned!

-Doug Hirano, MPH, APCA Executive Director

Assessing New Partnerships

As a staff, we spent some time recently talking about partnerships. This is germane because individuals and agencies occasionally approach us with an interest in working collaboratively to reach the local Asian American/Pacific Islander community. Suggested collaborative work includes but is not limited to health fairs, workshops, and outreach efforts. These requests are generally more than welcome, given that the local AAPI community tends to under-utilize a wide variety of health and human services. Having said that, we have limited resources upon which to spend a significant amount of time working outside our current grant and contract obligations.

Given these resource limitations, we thought that developing a list of criteria to assess the relative value of potential partnerships might make sense. Here’s what we came up with (not necessarily in any particular order):

· Resource intensiveness – how much time and effort will be taken in working collaboratively with a new partner?

· Mission/project alignment – are the interests of the partner in line with our existing goals and objectives?

· Scientific validity – is the area of interest an area of health disparity for AAPIs? Is there an evidence-base supporting the proposed efforts?

· Nurturing a future relationship – is the interested partner an entity that we want to work more extensively with in the future? Does this new relationship potentially leverage other resources and relationships?

· Capacity development – does this new partnership/relationship build our agency capacity or the community’s capacity?

· Innovation – does a new partnership – particularly with non-traditional partners – represent an opportunity to test new ways and areas in which to collaborate?


These then are some of our staff thoughts relating to partnership development. We will still review future partnership opportunities on a case-by-case basis, but it helps for us to have a framework for thinking about the value (for all involved) of new partnerships.

-Doug Hirano, MPH, APCA Executive Director

CDC's Science Clips

Thanks to Will Humble, director of the Arizona Department of Health Services for the following reference. For anyone with more than a passing interest in public health, his blog is worth checking out.

Will’s most recent blog post references the Center for Disease Control and Prevention’s publication called Science Clips. This weekly report provides a summary of CDC-authored publications and key scientific articles in featured topic areas (e.g., “communicable diseases” and “maternal and child health”). It’s “one stop shopping” for individuals interested in keeping up-to-date on health research. The links will direct you to the related abstracts as listed in PubMed – a compendium of the peer-reviewed scientific research. Unfortunately, access to the full articles is largely limited to those with electronic subscriptions to the specific journals in question. Still, through access to the abstracts, it’s a simple means to stay current on all things public health.

Good-bye to APCA Public Ally Volunteer

Today, we say “good-bye” to Ms. Anh Vuong, our Public Ally volunteer for the past nine months. Her assignment with APCA has come to a close. She very ably managed our volunteer program, assisted at outreach events, and otherwise served as a trusted and passionate staff member. She will continue to serve in a leadership capacity with the Advocacy/Leadership Committee of our Health Through Action – Arizona program. Anh is and will remain a part of the APCA "family." We wish her good luck with her future endeavors.

Rapid Hepatitis C Testing Now Available

The Food and Drug Administration (FDA) has just approved a rapid test to detect hepatitis C infection. This test, called OraQuick HCV Rapid Antibody Test, utilizes whole blood from a venous blood draw to generate a test result within 20 minutes. It does not require an instrument for diagnosis.

Orasure Technologies, the manufacturer of the test, hopes to receive FDA approval of the test version that utilizes oral fluid or whole blood from a fingerstick. This will make the test more palatable for individuals put off by a venous blood draw. The test is already approved in Europe for use with oral fluid and whole blood from a fingerstick.

In any case, this is a marked step forward in the fight to identify the many individuals who are unknowingly infected with hepatitis C. According to the Centers for Disease Control and Prevention, there are approximately 3.2 million people in the United States chronically infected with HCV and each year, about 17,000 people are newly infected. It is speculated that the majority of the 3.2 million individuals are unaware of their infection status. Earlier detection can lead to better treatment outcomes. Hepatitis C is a major cause of liver disease, leading to 12,000 deaths annually in the United States.

With more than 350 million people chronically infected with hepatitis B, it is hoped that progress can be made in developing rapid testing for hepatitis B as well. In the United States, an estimated 1.25 million individuals are infected with hepatitis B. The majority of these individuals are Asian Americans and Pacific Islanders and, as with hepatitis C, most individuals are unaware of their infection status.

-Doug Hirano, MPH, APCA Executive Director

Can We Really Eliminate Health Disparities?

For the past nine months, I’ve been meeting with some folks from other health-related organizations here in the valley. We share an interest in addressing the fact that selected groups of people systematically suffer worse health outcomes (i.e., health disparities) when compared to the general population. We are in the early stages of forming a cross-cultural institute to address the problem of health disparities here in Maricopa County. Here’s an excerpt from the draft document that we’ve been developing:

“Despite steady improvement in the overall health of the U.S. population, racial and ethnic minorities, with few exceptions, experience higher rates of illness and death than non-minorities. African Americans, for example, experience the highest rates of death from heart disease, cancer, stroke, and HIV/AIDS when compared to any other U.S. racial or ethnic group. American Indians disproportionately die from diabetes, liver disease, and unintentional injuries. Hispanic Americans are almost twice as likely as non-Hispanic whites to die from diabetes. In addition, some Asian-American subpopulations experience rates of stomach, liver and cervical cancers that are well above the national averages.”

This paragraph succinctly describes our collective problem related to health disparities. These disparities continue to exist 25 years after the 1985 landmark report from the U.S. Department of Health and Human Services that originally called for action on health disparities.

I personally believe that with our current science, technology and health promotion evidence base, health disparities can be eliminated. However, this is not a quick fix. Health disparities are directly associated with multiple overlapping issues, including poverty, educational attainment, the physical environment, access to health services, and personal health behaviors. Race and culture matter as well. For even when all other factors are adjusted for, people of color in this country suffer disproportionately in terms of preventable disease and death.

APCA is glad to be involved with a group of agency representatives that is willing to expend the time and resources to tackle health disparities in Maricopa County, and we thank St. Luke’s Health Initiatives for supporting our group through its TAP Program. We have a large task at hand. We believe that our cross cultural institute must advocate for social and health policies that level the playing field so that everyone – regardless of race, ethnicity, disability status or sexual identity – has an opportunity for good health. We also believe that more work is needed in the health care and public health sectors to provide culturally proficient health services.

I will continue to update this blog about our efforts. Anyone interested in this initiative should feel free to contact me for further information.

- Doug Hirano, MPH, APCA Executive Director

The Match Game

Community capacity to conduct population-based health improvement work is severely lacking in most parts of the country. Most of the expertise in public health resides within local and state health departments and is deployed at the community level with varying levels of success. Fortunately, there is a little known program out of the federal Centers for Disease Control and Prevention known as the Public Health Prevention Service. This program places individuals known as “Prevention Specialists” in public health settings – both governmental and community-based – for two years. Prevention Specialists come at no cost to the participating agencies and bring Master’s level training and at least two years of public health experience, including one year at the CDC.