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