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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
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
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
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
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