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.