The State of Asian Americans & Pacific Islanders in Arizona – Volume 2

The Asian Pacific Community in Action, in association with Health Through Action Arizona and the ASU Asian Pacific American Studies program, is happy to announce the publication of the second volume of “The State of Asian Americans & Pacific Islanders in Arizona.” Because this volume is focused on health, the publication is subtitled “Health Risks, Disparities and Community Responses.”

This document builds upon the original “State of Asian Americans and Pacific Islanders in Arizona” by providing a detailed look at the state of health among Asian Americans and Pacific Islanders (AAPIs) in Arizona. Essay topics include but are not limited to cancer, infectious diseases, mental health, domestic violence, women and children’s health, immigration, reproductive issues and emergency preparedness.

The essays were authored by a wide variety of talented individuals, including representatives of the Asian Pacific Community in Action, ASU, the Arizona Department of Health Services, the Maricopa County Department of Public Health, the University of Arizona, and the Arizona Family Planning Council, among others. This collective voice offers new information about the health of AAPIs in Arizona within the state’s distinctive sociopolitical environment. Importantly, community assets and resources are identified, and recommendations for enhancing the health and prosperity of AAPIs are offered.

I am proud to be associated with this publication. It goes beyond my original concept of a “data book” on AAPI health status and tells a far larger story on a much broader canvas. Special thanks goes to Dr. Kathy Nakagawa for her willingness to focus this particular volume on health, for inviting APCA to be a substantial partner in its development, and for her hard work relating to the document’s design and editing. Ms. Zeenat Hasan, Health Through Action Arizona Director, worked equally hard in coordinating the many moving parts involved in this effort and deserves significant recognition for her efforts.

We thank APS and the Asian and Pacific Islander American Health Forum for their generous support of this project, and we offer special thanks to the AAPI community members willing to serve as photo models and to Mr. Nick Oza for his stunning photography.

Most importantly, read the document! Myself, I learned a lot in reading it cover to cover. An electronic copy is available on the Publication page of the APCA website, and hard copies are available through APCA by contacting Ms. Kamana Khadka at kamana@apcaaz.org or (602) 265-4598. By the way, the first volume of the “State of Asian Americans and Pacific Islanders in Arizona” document is still available on the APAS website.

- Doug Hirano, MPH, APCA Executive Director

Video challenge winner: Corey Hour

Congratulations to Corey Hour, the winner of our 2011 Video Challenge! Corey is a local 21-year-old Cambodian American student who has developed skills in photography and videography. In his video, "Growing Up: Asian American," he describes his life changing trip to Cambodia and his desire to have an impact on his community. He states that through his work, “I’m hoping to leave a lasting impression to influence and motivate this generation to help one another and find their voice.” Check out his video on the APCA website.

The 139th Annual Meeting of the APHA

This past week I had the pleasure of attending the annual meeting of the American Public Health Association in Washington DC. Anyone working in the field of public or community health should try to attend this meeting at least once in his or her life. Admittedly, it is not cheap. The registration fee is generally north of $400, and rooms in the downtown DC area run more than $200 a night. However, if you can afford it, it’s worth the money.

This year’s meeting, titled “Healthy Communities Promote Healthy Minds and Bodies," drew over 13,000 registrants and featured hundreds of sessions on a wide variety of topics. I happened to attend some very interesting sessions on hepatitis B programs, innovative research methods, social justice/health equity, and the CDC initiative “Communities Putting Prevention to Work." I also had a chance to spend some time with my new colleagues in the Asian Pacific Islander Caucus (APIC).

While I enjoyed a number of the many speakers, I wanted to provide a shout out to Dr. David Chavis of Community Science in Maryland. He entered the session late, having just returned from South America and still suffering from a bout of intestinal distress. In his presentation, entitled “Paradox of Public Health and Social Justice: Being a Professional in the Social Change Process,” he noted that factors such as poverty, discrimination, poor education, lack of political voice, and other social justice issues are strongly associated with poor health, and that public health as a science has recognized the need to integrate social change work with classic health improvement models. However, he cites two challenges in successfully integrating these two approaches.

First, public health professionals generally work in risk adverse institutions such as government, foundations, academia, and funder dependent non-profits. There are few rewards, and frequent resistance to actual social change. Conflict, a critical component of change, is denied as an option.

Second, unlike many other social movements, the need for scientific knowledge is substantial in health justice work, yet public health and other professionals often see their knowledge and the status it gives them as disempowering to disenfranchised communities. The blanket position that "the community knows best" frequently unnecessarily puts communities in the position of having "to re-invent the wheel."

Dr. Chavis offers several suggestions to address these two challenges:

1. Be the organizational change that you would like to see in the community. Embrace social justice within the organization.
2. Learn how to use power and conflict for progressive social change.
3. Form true partnerships with community leaders.
4. Engage and learn about other movements (e.g., education and economic).
5. Prepare students for social change work.
6. Treat community leaders and residents as adults. Stop “dummying down”. Educate.
7. Treat this work as if it’s life or death.

I think Dr. Chavis’ recommendations are on the mark. Non-profit organizations like the Asian Pacific Community in Action are right at the intersection of public health science and health justice. To be most effective, our disease specific work (e.g., hepatitis B screening and breast cancer education) needs to be integrated with purposeful community organizing and mobilization efforts. The challenge for us is to lend science and rigor to community work while recognizing that community interests and assets are at the heart of social change. I thank Dr. Chavis for his insights and encouragement.

- Doug Hirano, MPH, APCA Executive Director

The life you save . . .

I’m finding the New York Times to be a good source of public health information – usually with an interesting personal angle. I would recommend a recent story by Dr. Pauline Chen, entitled From Needle Stick to Cure for Hepatitis.

Within this relatively short question and answer piece, Dr. Chen offers insight into the occupational hazards of medicine, provides a brief history and clinical overview of hepatitis C, and chronicles the inspiring story of Dr. Douglas Dieterich – a physician infected for many years with hepatitis C (known as non-A, non-B hepatitis at the time of his exposure).

In brief, Dr. Dieterich’s story is a testament to courage, persistence and altruism. But go ahead and read the story. I would only add one comment that his recurrent symptoms of jaundice and fever are a bit atypical. Most individuals do not experience any symptoms due to hepatitis C infection, and often get sick only after it is too late for effective treatment. Early screening and detection is therefore a key to addressing hepatitis C.

As stated previously, APCA has recently been awarded a grant to conduct hepatitis C screening and education. It’s humbling to know that our screening program leverages the fact that effective treatment now exists for hepatitis C – through some of the very research conducted by Dr. Dieterich himself. Many, many people owe a debt of gratitude to Dr. Dieterich for his persistence and his optimism, as he states it: “I think it’s the beginning of the end of hepatitis C, and this is one of the happiest statements I can make.”

- Doug Hirano, MPH, APCA Executive Director

Good News About Hepatitis C

I’m happy to report that APCA has received notice that it will be receiving a grant from Vertex Pharmaceuticals to conduct hepatitis C screening and education. According to the CDC, hepatitis C is “the most common chronic bloodborne infection in the United States; an estimated 3.2 million persons are chronically infected.”

Receipt of this new grant award is good news on two fronts. First, we can always use some additional financial support in these difficult economic times, and second and more importantly, identifying individuals chronically infected with the hepatitis C virus is now more important than ever – given the recent progress in treating this infection. With the advent of new hepatitis C therapies, up to 80% of infected individuals can have the virus cleared from their bloodstream indefinitely (known as “sustained virologic response”). This is essentially curing the disease.

However, like chronic hepatitis B infection, infection with the hepatitis C virus (HCV) is very often asymptomatic, and most infected individuals are unaware that they carry the virus. Finding out one’s infection status through a simple blood test is therefore critically important and can provide an HCV-infected individual a very good chance of avoiding the severe liver disease (e.g., cirrhosis and liver cancer) often association with infection.

Consequently, we are pleased to be able to initiate a hepatitis C public education and screening program targeting local Asian Americans and Pacific Islanders through this new grant program and thank Vertex Pharmaceuticals for its support.

- Doug Hirano, MPH, APCA Executive Director

Of Viruses and Cancer

I came across an interesting story in New York Times yesterday. The story, “Human Papillomavirus, 1985,” describes Dr. Peyton Rous’ conjecture and eventual demonstration that viruses can cause cancer. He demonstrated this fact through his work with solid tumors in chickens back in 1914.

Seventy years later, scientists would still be trying to prove that viruses cause cancer in humans. In 1983, Dr. Harald zur Hausen, definitively connected infection with the human papillomavirus (HPV) with cervical cancer. Indeed, he discovered and made HPV16 and 18, the two strains most commonly associated with cervical cancer, available to the scientific community for vaccine development. More than two decades later (2006), a vaccine for HPV infection was approved for use in girls and young women ages 9 to 26 years of age. Given that 5% of all cancers worldwide are caused by HPV, the development and widespread use of the vaccine will eventually save tens of thousands of lives every year.

While most of us have never heard of Drs. Rous and zur Hausen, we clearly owe them a debt of gratitude. I’m happy to say that both received the Nobel Prize for their work.

Particularly among Vietnamese American women, cervical cancer rates are disproportionately high. In fact, rates of cervical cancer are several-fold higher among Vietnamese women, when compared to all other racial/ethnic groups. Efforts to educate and vaccinate the Vietnamese and other Asian American and Pacific Islander communities are warranted.

Interestingly, the article did not mention the other virus that causes cancer in humans: the hepatitis B virus (HBV). HBV infection is conclusively linked with liver cancer. Given the disproportionately high rates of HBV infection among Asian Americans, it is not surprising that liver cancer rates are much higher for Asian Americans, when compared to non-Hispanic whites. The 1982 development of a vaccine to prevent hepatitis B infection by Dr. Baruch Blumberg is another milestone in the history of cancer prevention, but perhaps that is a story for another time.

- Doug Hirano, MPH, APCA Executive Director

A Death in the APCA Family

It is with extreme sadness that I report the death of Ms. Shwuing Fu, publisher of the Asian American Times. She died this past weekend in a car accident. She was a good friend to APCA – generously finding space in her newspaper to report on our events and activities and donating fine art to our fundraiser silent auctions. She worked tirelessly to report community news throughout the various Asian American and Pacific Islander communities. She was both a good friend and good colleague. She will be sorely missed, but not forgotten.

- Doug Hirano, MPH, APCA Executive Director

World Hepatitis Day Proclamation

WORLD HEPATITIS DAY, 2011

BY THE PRESIDENT OF THE UNITED STATES OF AMERICA

A PROCLAMATION

Across our Nation, millions of Americans are living with viral hepatitis. As many as three-fourths of Americans living with the disease are unaware of their status and are not receiving care and treatment for their condition. Raising awareness about hepatitis is crucial to effectively fight stigmas, stem the tide of new infections, and ensure treatment reaches those who need it.

On World Hepatitis Day, we join with people across our country and around the globe in promoting strategies that will help save lives and prevent the spread of viral hepatitis.

Viral hepatitis is inflammation of the liver, and can cause a lifetime of health issues for people who contract it. Hepatitis B and C viruses are the cause of a growing number of new liver cancer cases and liver transplants. In the United States, hepatitis is a leading infectious cause of death, claiming the lives of thousands of Americans each year. While we have come far, work still needs to be done to prevent and treat this disease.

Viral hepatitis touches Americans of all backgrounds, but certain groups are at greater risk than others. Past recipients of donated blood, infants born to mothers infected with viral hepatitis, and persons with sexually transmitted diseases or behaviors such as injection-drug use have risks for viral hepatitis. Baby boomers and African Americans have higher rates than others of contracting hepatitis C. Half of all Americans living with hepatitis B today are of Asian American and Pacific Islander descent, and one-third of people living with HIV also have either hepatitis B or hepatitis C. Worldwide, one in twelve people is living with viral hepatitis.

We must make sure that this "silent epidemic" does not go unnoticed by health professionals or by communities across our country. Under the Affordable Care Act, services including hepatitis immunizations for adults and hepatitis screenings for pregnant women are fully covered by all new insurance plans. My Administration has also released a comprehensive Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. The plan brings together expertise and tools across government to coordinate our fight against this deadly disease. Our goal is to reduce the number of new infections, increase status awareness among people with hepatitis, and eliminate the transmission of hepatitis B from mothers to their children.

The first step toward achieving these goals is raising public awareness of this life-threatening disease. We must work to reduce the stigma surrounding hepatitis, and to ensure that testing, information, counseling, and treatment are available to all who need it. The hard work and dedication of health-care professionals, researchers, and advocates will help bring us closer to this goal. On this day, we renew our support for those living with hepatitis, and for their families, friends, and communities who are working to create a brighter, healthier future.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim July 28, 2011, as World Hepatitis Day. I encourage citizens, Government agencies, nonprofit organizations, and communities across the Nation to join in activities that will increase awareness about hepatitis and what we can do to prevent it.

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-seventh day of July, in the year of our Lord two thousand eleven, and of the Independence of the United States of America the two hundred and thirty-sixth.

BARACK OBAMA

- Doug Hirano, MPH, APCA Executive Director

What’s the big idea?

The Center for the Future of Arizona is looking for “big ideas”. In early April 2011, the Center invited communities across the state to develop proposals that describe how they could improve civic health in Arizona. The reason for this call for proposals was quite simple: Arizona ranks very low on virtually all indicators used to measure civic health. Here’s a sample of the available data:

• Arizona ranks 40th in the nation for voter registration and 43rd for voter turnout among eligible citizens.
  


• 37% of Arizonans say they do not follow the news or discuss the news regularly.
  


• Arizona ranks 48th in the nation for exchanging favors with neighbors regularly and 45th for eating dinner with family/household members almost every day.

In addition, a Gallup Poll found that only 10 percent of Arizonans believe that elected officials represent their interests, and only 10 percent rate the performance of elected officials as “very good.” Other areas of concern included quality jobs for all Arizonans, a competitive P-20 education system and a healthy environment – each of which cannot be achieved without the sense of connection that Arizonans feel to one another.


This project, known as the “Five Communities Project,” is looking for big ideas to address the state of civic health and engagement in Arizona. The Center received 96 letters of intent in response to its April call for proposals – one of which was submitted by APCA. Happily, APCA is one of 33 organizations to be named as a semi-finalist in this competition.


Ultimately, there will be just five communities selected to partner with the Center in developing a collaborative proposal that will be submitted to some of the nation’s most esteemed and influential foundations. The objective is to provide partner communities with the resources to implement their plans over a three-year funding period.

What is our “big idea”? Suffice it to say that we’re envisioning a more cohesive and engaged Asian American and Pacific Islander community in the greater Phoenix metropolitan area. I’ll provide greater detail on our “Thirdspace” initiative in a future blog entry. For now, we’re pleased to be named a semi-finalist and are hard at work on the next iteration of our proposal.

-Doug Hirano, MPH, APCA Executive Director

World Hepatitis Day

The World Health Organization has designated July 28th as World Hepatitis Day. However, we don’t have to look globally to find a crisis related to hepatitis B infection.

Data from the Arizona Department of Health Services indicate that Asian Americans have constituted 40% of all reported cases of chronic hepatitis B in Maricopa County over the past five years. Considering that Asian Americans constitute only 3% of the population, this is alarming.

Nationally, it is estimated that 1 in 12 Asian Americans is permanently infected with hepatitis B, a virus that attacks the liver. For all other Americans, the rate of chronic hepatitis B infection is just 1 in 1,000. Without medical monitoring and treatment, 25% of individuals with chronic hepatitis B infection will suffer and possibly die due to severe liver cirrhosis and/or liver cancer. The Centers for Disease Control and Prevention (CDC) estimates that 65% of all individuals infected with hepatitis B are unaware of their infection.

These data suggest that nationally there are more Asian Americans undiagnosed with hepatitis B than all Americans undiagnosed with HIV/AIDS. Compared to HIV/AIDS, very little attention is paid to the problem of chronic hepatitis B – particularly among Asian Americans. This is a shame given that a simple blood test can detect the infection and a vaccine exists to prevent infection. We need to continue to spread the word that all Asian Americans get tested and vaccinated for hepatitis B.

In recognition of World Hepatitis Day, we are hosting a free hepatitis B testing and education event at the Vietnamese Community Center, 2051 W. Warner Road, Suite 22, Chandler, from 9 am to 1 pm on Saturday, July 30th. Information will also be provided to help individuals without health insurance coverage to enroll in publicly funded health insurance programs or otherwise find affordable medical care. Further information is available from the Asian Pacific Community in Action at (602) 265-4598 or www.apcaaz.org.

Stroke Hits Home

My 82-year-old mother suffered a stroke last Monday. She passed out at a grocery store and was taken by ambulance to a local hospital (in San Jose). After the first few hours, her outlook was surprisingly good – verbally responsive and without any signs of paralysis. However, later in the day she began having trouble breathing, and her speech became slurred. Her CT scan indicated a large clot in the lower brain. Her chance of survival was now deemed to be 50%.

I had just spoken to her the day before, and all seemed fine. It was Father’s Day, and she was cheery and looking forward to dinner at my brother’s house. For an elderly woman, she was in relatively good health. She worked hard out in the yard, tending to her vegetables, shaping the shrubs, and keeping the weeds at bay.

Stroke is the 3rd leading cause of death in the United States – behind heart disease and cancer. Its warning signs tend to be slurred speech, trouble seeing in one or both eyes, confusion and/or severe headache – none of which my mother displayed before fainting at the grocery store. In fact, my dad, who was with her at the time, had to work hard to convince the EMTs to send an ambulance right away – perhaps because her symptom history did not match those of a typical stroke victim.

I also know that time is of the essence in treating a stroke victim. There is a short window by which intervention can effectively avert permanent brain damage or death. My dad’s ability to get an ambulance to the scene probably saved her life.

Asian Americans are not necessarily at increased risk for stroke; however, stroke is an equal opportunity debilitating condition. Risk factors include but are not limited to tobacco use, hypertension, overweight and obesity, and heart disease. More information is available through the Centers for Disease Control and Prevention.

I’m glad to say that my mom is making a remarkable recovery. Her speech is clear, she has a good appetite, and she’s strong enough to get out of the hospital bed on her own (against the nurses’ orders). Twenty years ago, her outcome may have been much different, but for all the complaints about high tech, low touch, overly expensive medicine, it can produce seeming miracles. The doctors used a catheter, guided by CT, to administer medication in the affected area of the brain and to clear the clot.

My mom is not out of the woods yet and has a few weeks of rehabilitation ahead of her, but she seems on the road to recovery. We’re thankful to the folks at Good Samaritan Hospital in San Jose for their rapid response and compassionate care.

- Doug Hirano, MPH, APCA Executive Director

A warm reception from our President

With approximately 200 Asian American and Pacific Islander colleagues, I had the pleasure of visiting the White House today in acknowledgment of Asian American and Pacific Islander Heritage. Here’s what my “thank you” note to the President will read:

"Thank you, Mr. President, for the opportunity to visit your stately home. Your hospitality in the form of your kind words and the hors d’oeuvres and beverages was most generous – particularly since you already had a lot on your plate, including an imminent national TV appearance about the war in Afghanistan.

While I didn’t get a chance to speak to you directly, I did have the chance to speak to one of your key health officials, Dr. Howard Koh – your Assistant Secretary for Health and Human Services (pictured). He was kind enough to say that he would look into my suggestion that the federal government support a hepatitis B testing day for Asian Americans. Considering that there is already an HIV/AIDS awareness day for Asian Americans, it would seem reasonable that attention be paid to the preponderance of chronic hepatitis B infection among this group as well.

I will be following up with Dr. Koh about this matter. I believe hepatitis B among Asian Americans needs to stay on the radar screen until something more is done. There are far more Asian Americans unknowingly infected with chronic hepatitis B than all Americans unknowingly infected with HIV/AIDS. We on the front lines in various communities throughout the nation fight the good fight to increase hepatitis B awareness among the general public, among Asian Americans and Pacific Islanders, and the medical community, but sometimes one is not a prophet in his or her own land. Hearing more from our federal officials about this preventable epidemic of liver disease due to hepatitis B is critical and essential. Action can prevent more death and disability due to hepatitis B.

Again, thank you for your cordiality, and I hope that you and your family stay well. Please feel free to come visit us in Arizona, and we would be happy to share some of our Asian American and Pacific Islander hospitality in return."

- Doug Hirano, MPH, APCA Executive Director

Hello Mr. President . . .

I very recently received an invitation to a White House reception that will be recognizing Asian American and Pacific Islander heritage. It appears that President Obama and the First Lady will both be in attendance. Invitations were made to Asian American and Pacific Islander community leaders, and I’m proud to be considered in that grouping.

Will I be attending? Who could turn down an invitation that starts with “The President and Mrs. Obama request the pleasure of your company . . . ”?

In any case, if I have a chance to speak at any length with President Obama, I think I will remind him that five million Americans are currently infected with hepatitis B or hepatitis C, and that these individuals will need medical monitoring for the remainder of their lives because of their high risk for serious liver disease. I will let him know that many of these individuals are among the working poor or unemployed who do not have health insurance and cannot afford medical care. I will remind him that exemplary government programs like the Ryan White CARE Act support medical care and treatment for low-income individuals with HIV/AIDS, but no such program exists for individuals with hepatitis B or C. I will remind him that more than half of the 1.4 million individuals chronically infected with hepatitis B are Asian Americans and yet there is virtually no large-scale public health effort to encourage Asian Americans to get screened for hepatitis B or to educate physicians to offer screening to these individuals.

I think I will remind him that Title VI of the Civil Rights Act assures individuals of language access in health care facilities that receive federal dollars, yet thousands of individuals are denied these services on a daily basis in facilities throughout the nation. I will remind him that Asian Americans and Pacific Islanders are the fastest growing racial/ethnic groups in this country and that while health care facilities are doing better in offering culturally competent services to Hispanic Americans, Asian Americans and Pacific Islanders are a virtual afterthought when it comes to culturally competent care.

Lastly, I think I will thank him profusely (and offer a fist bump) for his leadership and vision on the Affordable Care Act and let him know that our agency is actively supporting its continuation. Having said that, I will let him know that the same political will exerted on the ACA will be more than sufficient to address the continuing health disparities related to hepatitis and language access. I will humbly offer my assistance, proffer my business card, and then wander off in search of hors d’oeuvres.

- Doug Hirano, MPH, APCA Executive Director

AHCCCS

According to a recent New York Times article, the Arizona Medicaid program, known as AHCCCS, is considering charging a $50 fee to smokers and obese individuals. This would apply only to childless adults. The idea is that since both smoking and obesity lead to preventable disease and illness and increased health care costs then why not have such individuals pay more for their coverage?

On the surface, this seems reasonable. An extra $50 fee might be just the incentive individuals need to make lifestyle changes relating to tobacco use, healthy eating and active living. If they make the needed changes to quit smoking and/or lose weight, then everyone wins – they’re healthier in the long run, and AHCCCS incurs less medical costs. If they don’t manage to make the behavior changes, then at least the State of Arizona can apply the extra revenue from the fees to partially offset the additional health care costs these individuals incur.

However, the third alternative is perhaps the most worrisome. If they don’t have the extra $50 to spare and can’t make the changes needed, then they will be deterred from receiving health insurance coverage. These individuals are indeed at increased risk for illness and therefore have a disproportionately high need for routine medical care – the very care that can help them quit smoking or work to drop some pounds. Perhaps AHCCCS should consider offering smoking cessation assistance and weight management counseling to all those who would be impacted by this new policy prior to its implementation?

Also, one could argue that obesity is not purely an individual behavioral choice. Genetics do come into play, and studies indicate that the economic, social and physical environment in which people live can influence obesity-related behaviors such as diet and physical activity. To a lesser extent, tobacco use is a product of both individual choice and environmental circumstance. In my mind, though, obesity is perhaps too far outside an individual’s choice to make it a logical candidate for penalization through a fee.

Lastly, I found it interesting that this fee would only be applied to childless adults. Don’t obese and smoking parents also incur greater health care costs related to their obesity and tobacco use? In fact, wouldn’t decreasing tobacco use among parents decrease the likelihood of secondhand smoke exposure among children?

In any case, one has to give credit to AHCCCS for thinking creatively about both revenue stream and health-related behaviors. It will be curious to track the impact of this proposal if it gets implemented.

- Doug Hirano, MPH, APCA Executive Director

Now a word about the “undead”

The Centers for Disease Control and Prevention recently released a blog post about how to prepare for an attack of zombies. Tongue firmly in cheek, the CDC is trying to attract the attention of the general public regarding preparations for a real emergency. Apparently, they are succeeding. This particular blog post was so popular it crashed their server. I guess the public has an appetite for news about the undead, and, I guess the normally staid scientists at the CDC actually do have a sense of humor.

The Asian Pacific Community in Action is taking a more traditional approach to emergency preparedness. Through the leadership of APCA Special Projects Coordinator, Ms. Yen Nguyen, we have recently organized a coalition of Asian American and Pacific Islander community members around emergency preparedness. This coalition will work to better prepare the AAPI community for emergencies of all kinds (e.g., biological terrorism and natural disasters) in a manner that is culturally responsive. However, it should be noted that we make no promises about preparations for attacks of zombies. You’ll have to contact the CDC about that.

To find out more about our emergency preparedness initiative, contact Ms. Yen Nguyen at (480) 626-3065 or at yen@apcaaz.org

-Doug Hirano, MPH, APCA Executive Director

Tiger, tiger shining bright

An article recently published in New York magazine is all the rage among Asian Americans on the Internet. The article, “Paper Tigers: What happens to all the Asian-American overachievers when the test taking ends?”, offers insight into being a member of the “model minority”. The author, Wesley Yang, examines life’s options for high performing Asian American students, and he doesn’t necessarily paint a pretty picture. He cites the racial bias that makes it more difficult for Asians to be admitted into Ivy League schools, and he references the “bamboo ceiling” that keeps Asian Americans from rising to corporate upper management because while technically skilled, they are often perceived as lacking the charisma and networking skills associated with leadership positions. He provides the data below:

“According to a recent study, Asian-Americans represent roughly 5 percent of the population but only 0.3 percent of corporate officers, less than 1 percent of corporate board members, and around 2 percent of college presidents.”

While I find the content of the article interesting, I think it is perhaps more significant that the piece made it as the cover story of New York magazine. I would suspect that Amy Chua, the Tiger Mom (Battle Hymn of the Tiger Mother), has much to do with this, since Yang’s article is also a rebuttal to the extreme work ethic espoused by Chua.

If nothing else, this article has stimulated discussion within the Asian American community and perhaps will provide a point of reference for mainstream Americans in viewing Asian Americans as individuals with needs that sound startlingly American – upward mobility at work, social lives, and an ability to feel comfortable in your own skin.

-Doug Hirano, MPH, APCA Executive Director

An Affair to Remember

Our annual fundraising dinner, “A Taste of Asia”, has come and gone. Held this past Saturday at the Doubletree Paradise Valley Resort, the dinner was successful on multiple fronts. The Asian appetizer reception was quite lively and included the successful sale of almost all 60 or so silent auction packages. The dinner program went smoothly. As usual, our hosts, Ethel Luzario and Ted Namba, did a wonderful job keeping the program moving along. I think our honorees – Steve Sanghi, Mr. and Mrs. Dennis Yee, and Asian American WWII veterans – felt good about their portion of the program. Each had a nice digital video segment and a chance to say a few words. Our major sponsors – Wells Fargo, APS, Blue Cross/Blue Shield, and Gilead Sciences – seemed pleased. Lastly, the talent competition was engaging and had quite a diverse group of participants. In the end, our “face changing” participant triumphed ahead of a number of surprisingly talented participants. All in all, it was indeed an affair to remember.

-Doug Hirano, MPH, APCA Executive Director

My 15 Minutes of Fame

My friend and colleague Mr. Fred Taylor invited me to be on his radio show, Men’s Health, yesterday. I was happy to speak about health issues in the local Asian American and Pacific Islander communities and did my best to share what I knew about our mission and related activities towards improving the health of Asian Americans and Pacific Islanders. However, I guess you never know what to expect on live radio. Fred’s co-host, Dr. Bob Gear (pictured on right), had some interesting questions for me about sanitation practices in local Chinese restaurants and also related to illegal immigration among Asians in Arizona. I think my responses to these questions were politic. In any case, I’m hoping I won’t be getting any phone calls from Sheriff Joe Arpiao or the Chinese Restaurant Association any time soon.

-Doug Hirano, MPH, APCA Executive Director

Cancer Health Disparities Planning

This past Friday, a group of about 20 community and academic leaders met to discuss how to best address the many disparities related to cancer here in Arizona. The meeting, held at the Talking Stick Resort, included a lively discussion about the need for enhanced collaboration, advocacy and education. Dr. Tim Flood (pictured with Justin Tai, APCA Public Ally) provided profiles of cancer disparities by racial/ethnic group as a lead-in to the facilitated discussion. The Cancer Health Disparities group is a subcommittee of the Arizona Cancer Control Coalition, led by the Arizona Department of Health Services.

Doug Hirano, MPH, APCA Executive Director

The life you save . . .

The Asian Pacific Community in Action recently held a birthday party for the Affordable Care Act, which was passed on March 23, 2010. That same day, we stopped by Congressman Ed Pastor’s office to drop off a small birthday cake and express our community’s support of the ACA.

Both of these activities were atypical for us, as we are often focused on directly providing health education and clinical services to our populations of interest. However, this recent advocacy work is a taste of things to come. In the coming months, we will be exercising our right and obligation to speak up for the rights and interests of our communities. If we don’t, who will?

“In Germany they first came for the communists, and I didn’t speak up because I wasn’t a Communist.
Then they came for the Jews, and I didn’t speak up because I wasn’t a Jew.
Then they came for the trade unionists, and I didn’t speak up because I wasn’t a trade unionist.
Then they came for the Catholics, and I didn’t speak up because I was a Protestant.
Then they came for me – and by that time, no one was left to speak up.”

--Pastor Martin Niemoller

- Doug Hirano, MPH, APCA Executive Director

And the winner is . . .

It’s official. Asians and Native Hawaiians and other Pacific Islanders are the fastest growing racial groups in Arizona. New 2010 Census data indicates that those of only Asian race increased by 91.6% between 2000 and 2010. Hawaiians and other Pacific Islanders increased by 87.9% for the same period.

In comparison, the White population increased by 20.5%, the Black population by 63%, and the American Indian/Alaska Native population by 15.9%. Individuals of Hispanic or Latino origin increased by 46.3%.

As additional 2010 Census data becomes available, I will provide updates.

-Doug Hirano, MPH, APCA Executive Director

A Taste of Asia

It's time again for "A Taste of Asia," the signature annual fundraising dinner event of the Asian Pacific Community in Action. This year, we will be holding it on Saturday, April 23, 5:30 pm at the elegant Doubletree Paradise Valley Resort in Scottsdale. Tickets are $100. We will have our usual sumptuous reception, offering hors d'oeuvres from local Asian restaurants, a silent auction and a talent competition. In addition, we will be honoring several community leaders, including Mr. Steve Sanghi, CEO, Microchip Technology, Mr. and Mrs. Dennis Yee, community volunteers, and local Asian American WWII veterans. It promises to be an exciting and entertaining evening. Please join us!

You can get more information about the event at the APCA website, www.apcaaz.org, or you can directly register at http://www.eventbrite.com/event/1414387471.

For further information, please feel free to contact Ms. Kamana Khadka at (602) 265-4598 or kamana@apcaaz.org.

-Doug Hirano, MPH, APCA Executive Director

The Saga of Wong Kim Ark

As discussions intensify regarding American citizenship as a birthright, I am reminded never to take U.S. citizenship for granted – particularly as an American of Japanese descent. For a very long time, individuals of Asian descent faced almost insurmountable barriers to becoming American citizens – either through naturalization or birth.

The Naturalization Act of 1790 afforded U.S. citizenship only to immigrants who were “free white persons.” In 1870, naturalization laws were changed to include persons of African nativity and descent. However, individuals from Asia were not allowed to become naturalized American citizens until the 1943 passage of the Magnuson Act.

And while the Fourteenth Amendment to the Constitution passed in 1868 ostensibly conferred citizenship to all individuals born in the United States, for Asian residents, this birthright to citizenship had to be determined by the Supreme Court.

In 1894, Wong Kim Ark, an individual born in the United States of non-citizen Chinese parents, was denied re-entry into this country after a trip to China. He was detained at the Port of San Francisco on the basis that he was not a bona fide American citizen. He successfully sued for re-entry at the federal district court level; however, the United States government took the case to the Supreme Court, which eventually determined that Mr. Ark was a citizen by virtue of his birth in the United States – even though his parents were not and could not become citizens (due to the Chinese Exclusion Act of 1882).

Sadly, the specter of birthright citizenship restrictions has recently reappeared. This is a shame. For all the pain and suffering brought about by racist immigration policy to those of us with Asian roots, it appears that our Hispanic brothers and sisters are now being similarly targeted. Has history taught us nothing? Are we doomed to repeat our failings? This country was founded on the principle that we are all equal under the law. We still struggle to get this right at times, but we’ve made significant strides in civil rights over time. A return to restricted birthright citizenship will set us back, all of us — Hispanics, Asians, all of us with immigrant roots — more than 100 years.

Many, many people – including myself – owe Wong Kim Ark a debt of gratitude for his efforts over a century ago to fight for his American citizenship. Let’s hope his efforts were not in vain.

- Doug Hirano, MPH, APCA Executive Director

Input for the AAPI White House Initiative

In response to a request from the White House AAPI Initiative, APCA has offered some suggestions to the US Department of Health and Human Services for improved health outcomes among Asian Americans and Pacific Islanders. These suggestions relate to creating a better system of care for individuals chronically infected with hepatitis B (similar to the current Ryan White CARE Act for individuals infected with HIV), developing a national initiative for AAPI health promotion work, ensuring translation of federal health information into Asian languages, and supporting more research into culturally proficient health interventions among AAPIs. The document is available on the “Publications” page of our website.

-Doug Hirano, MPH, APCA Executive Director

National Black HIV/AIDS Awareness Day – A Model for the Asian American Community?

February 7th was the 11th anniversary of National Black HIV/AIDS Awareness Day. HIV/AIDS has had a disproportionate impact on the Black community in this country.

Here’s quote from the CDC website:

“By race/ethnicity, African Americans face the most severe burden of HIV in the United States. At the end of 2007, blacks accounted for almost half (46%) of people living with a diagnosis of HIV infection in the 37 states and 5 US-dependent areas with long-term, confidential, name-based HIV reporting.”

State, local and national organizations have created and implemented activities focused on motivating African Americans to get tested and learn their HIV status, as well as educating communities about the importance of prevention. No doubt these efforts have saved lives.

It would seem high time that the Asian American communities across the nation organize a similar day related to hepatitis B. Asian Americans constitute more than 50% of all individuals chronically infected with hepatitis B, yet there is little national attention to this problem. I have contacted a colleague of mine with the CDC Viral Hepatitis Division about the possibility of replicating a national HBV recognition day in the Asian American community. I will keep you posted as to his response. However, it should be said that regardless of the CDC interest in this initiative, Asian American communities throughout the country should organize and act.

- Doug Hirano, MPH, APCA Executive Director

White House Offers Input Opportunity for Asian Americans and Pacific Islanders

For those of us who have been advocating for the health and well being of Asian Americans and Pacific Islanders, there’s an interesting opportunity to guide the federal government’s efforts in this arena. The White House Initiative on Asian Americans and Pacific Islanders is coordinating an effort to provide comment on government plans to enhance services for AAPIs.

Each major government department has or is developing a plan to improve services to AAPIs. These draft plans are available on-line. The public has 30 days to provide comment once the initial draft plan is completed. Our area of interest is the Department of Health and Human Services, which includes key agencies such as the Centers for Disease Control and Prevention, the Office of Minority Health, the Health Resources and Services Administration and the National Institutes of Health. With concerted and strategic effort, these agencies can have a sizable impact on the health and well being of populations such as AAPIs suffering from health disparities such as hepatitis B, tuberculosis, tobacco use and diabetes. Communities have an obligation to participate, however. This is an important opportunity.

Here’s a link to the plan.

The deadline for comment is February 17th. I’ll provide a draft of our suggested comments in an upcoming blog entry.

- Doug Hirano, MPH, APCA Executive Director

Civility

A couple of weeks ago, APCA was asked by the American Jewish Committee to sign on to an eloquent “statement of civility.” We were happy to do so. The tragic assassination attempt and related deaths in our own backyard left many of us feeling helpless and hopeless. If anything good can come of this, it will be because we continue to look for the good in all people, and we maintain our faith in the strength of our institutions, including the democratic process. Here is a link to the civility statement.

-Doug Hirano, MPH, APCA Executive Director

The Spirit Catches You

The January 27, 2011 edition of the CDC MMWR (Morbidity and Mortality Weekly Report) includes an interesting case history of childhood lead poisoning in a Cambodian family in New York City. Through follow-up investigation, it was found that the child was very likely poisoned by a string amulet adorned with leaded beads (see photo). The toddler had been wearing the amulet for several months and had been observed mouthing the amulet. These amulets are believed to confer protection to the child. Based upon this incident, the guidance given by the CDC to health department staff members, medical practitioners, and others was as follows:

Educational efforts are needed to inform Southeast Asian immigrants that amulets can be sources of lead poisoning for children. Health-care providers and public health workers should ask about this custom when seeking a source of exposure in Southeast Asians with elevated BLLs. Targeted educational efforts in Southeast Asian communities also should be considered. This case also underscores the importance of being aware of different cultural practices, such as wearing amulets, and highlights the need to assess and reassess the same risk factors and rephrasing questions using different words when communicating with immigrant families.

I would suggest that it will take more than a traditional educational campaign to convince Southeast Asian parents to discontinue the use of such amulets. After all, this is very possibly a tradition steeped with significant religious significance and/or with centuries of empirical evidence suggesting the protective value of the amulet. Education, patience and cultural insight are likely warranted on both sides in reducing this lead poisoning risk.

For further information about cultural tradition and illness, there is a classic book, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, by Anne Fadiman, that describes the misunderstanding, pain and confusion sometimes inherent in cross cultural health work. It’s required reading for anyone interested in cross cultural health and medicine.

-Doug Hirano, MPH, APCA Executive Director

CDC Releases New Health Disparities Report: What’s Missing?

The Centers for Disease Control and Prevention has issued a landmark report on health disparities – the first produced by the CDC that covers a variety of health problems. Areas addressed include environmental health, health care access, infant deaths, motor vehicle deaths, suicides, HIV infection, obesity and diabetes, among other areas. It’s required reading for those of us working to end health disparities and is a nice companion piece to the recently released Healthy People 2020 document.

Having said that, there will probably be discussion about the health areas that were not included in this health disparities report. Here’s how the CDC folks explained what was and what wasn’t included in the report:

Topics included in CHDIR 2011 were selected on the basis of one or more of the following criteria: 1) leading causes of premature death among segments of the U.S. population as defined by sex, racial/ethnicity, income or education, geography, and disability status; 2) social, demographic, and other disparities in health outcomes; 3) health outcomes for which effective and feasible interventions exist; and 4) availability of high-quality national-level data.

It can be argued that areas such as breast cancer qualify to be addressed on the basis of the aforementioned criteria. Breast cancer is clearly a major cause of premature death; demographic disparities exist (African American women have disproportionately high mortality rates), effective interventions (early screening and detection) exist, and high-quality national-level data (vital statistics) are available. Why wasn’t breast cancer addressed in this report?

For those of us focused on issues that face Asian Americans and Pacific Islanders, there is the question as to why hepatitis B was not addressed in this report. Hepatitis B among AAPIs also meets at least three (and arguably four) of the four aforementioned criteria. In a prior blog entry, I had commented on the lack of attention to hepatitis B in the Healthy People 2020 document. There would seem to be a pattern here.

Clearly, more work remains for those of us advocating for more attention to the silent epidemic of hepatitis B – particularly among AAPIs. In a future entry, I will discuss a short term opportunity to provide important input to the federal government on this topic.

-Doug Hirano, MPH, APCA Executive Director

New Census Numbers on Asian Americans in Maricopa County

While we wait for the Census 2010 data to become available, the U.S Census recently released new “American Community Survey” data for the period 2007 - 2009. The American Community Survey (ACS) continuously gathers detailed data on a sample of U.S. residents. Previously, some of this data was gathered through the “long form” of the decennial census, but is now gathered on an ongoing basis through the ACS.

The new ACS data for the period 2007 – 2009 estimates almost 4 million residents of Maricopa County. Among those identifying as “Asian alone”, there are 119,076 individuals, or almost exactly 3.0% of the total county population. For the sake of comparison, the “Asian alone” number for the 2000 Census was 66,445. Thus, there was a 79% increase in the number of individuals identifying themselves as “Asian alone” in Maricopa County. The county as a whole experienced a 28.6% population increase for the same time period.

The ACS provides detailed Asian subgroup data if the subgroup has an estimated population of 20,000 or more. Data regarding selected subgroups is provided in the table below.

American Community Survey – Maricopa County, 2007 - 2009

Individuals interested in reviewing the recent ACS data can access this data on the U.S. Census website at http://factfinder.census.gov.


-Doug Hirano, MPH, APCA Executive Director

Secrets to Health and Wealth in 2011

On January 22nd, APCA will be partnering with an agency known as SCORE on a workshop entitled “Secrets to Becoming Healthy and Wealthy in the New Year.” This workshop will be providing tips to starting or improving a small business as well as tips for obtaining optimal health.

Greater Phoenix SCORE(R) is a new APCA partner. It is a non-profit agency that offers various types of assistance to small businesses. Their tagline is “Counselors to America’s Small Business”, and they literally offer free one-on-one small business counseling to interested individuals. By partnering with SCORE, we hope to help Asian Americans and Pacific Islanders improve their small business outcomes. Healthy small businesses create new jobs and help keep people out of poverty. This is an important component to good health, and APCA looks forward to establishing this new relationship.

Here’s the program information:

Date: Saturday, January 22, 2011
Time: 9 am to 11 am
Location: Shangri-La Restaurant, 2992 N. Alma School Road, Chandler
Speakers: Mr. Marty Robbins, SCORE and Mr. Doug Hirano, APCA

Individuals interested in attending should contact Ms. Emma Ditsworth at (480) 472-5771 or at emma@apcaaz.org.