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A new study provides further evidence that a physically active lifestyle can extend the quantity and quality of life. The study found that there was a gain in life expectancy of 3.4 years for individuals who averaged 150 – 300 minutes of physical activity per week – when compared to individuals with no regular physical activity. Study results applied to individuals 40 years of age and older. Similar results in a study in Taiwan suggest the longevity benefits are transnational and cross cultural. Importantly, physical activity provided a benefit for individuals across the spectrum of body mass index, meaning that even obese individuals could expect to see some life expectancy gains with regular physical activity. Click here for a link to the study.
- Doug Hirano, MPH, APCA Executive Director
On the eve of Election Day, we can all use a reminder about the preciousness of the right to vote in this country. Click here to read about a 93-year-old World War II veteran diagnosed with terminal cancer whose last act as an American citizen was to cast an absentee ballot in the upcoming election. Mr. Frank Tanabe passed away a week after the photo was taken. This story is for those of us who need a little extra encouragement to go to their polling place and vote.
- Doug Hirano, MPH, APCA Executive Director
The APCA Scientific Advisory Council is off and running. The Council met for the first time on August 29th. This new council was established to provide advice to our organization on all issues of science. This will include review of written documents such as screening protocols and grant proposals. It will also include consultation on specific scientific or medical issues as they arise. We have put together a world-class group of scientists with expertise in women’s health, mental health, oncology, gastroenterology, medical anthropology, nursing, epidemiology, clinical research and health promotion. Here’s a list of our members and their affiliations:
- James Campbell, MD (chair)
- Heyoung McBride, MD, Arizona Oncology Services
- Linda Larkey, PhD, Arizona State University
- Mark Wong, MD, Banner Samaritan Medical Center
- Tim Flood, MD, Arizona Department of Health Services
- Angela Chen, PhD, Arizona State University
- Jennifer Weil, MD, National Institutes of Health
- Wendy Astudillo, NP, Phoenix Veterans Affairs Health Care System
- Seline Szkupinski-Quiroga, PhD, Arizona State University
Our first meeting was focused on getting to know each other and providing an introduction to APCA and its work. We had a preliminary discussion about diabetes screening and prevention and the need for tracking short-term outcomes to measure impact. Thanks so much to Dr. Jim Campbell for his willingness to chair this group. We plan to meet again in November and have more focused discussions on issues affecting the health of Asian Americans and Pacific Islanders in Maricopa County.
-Doug Hirano, MPH, APCA Exceutive Director
On early Friday morning, June 15, 2012, Mai Vo Bor, 37, and her elderly Vietnamese American parents were in a car heading west on the I-10 near Tonopah, about 50 miles west of downtown Phoenix. They were returning from a vacation in California. For some reason, they exited the freeway at 411th Avenue and were involved in a single-car accident about a half-mile off the freeway. The accident resulted in minor injuries to the parents and disabled the vehicle. Ms. Bor left her parents with the vehicle and went to seek help. Tragically, her body was found a mile from the accident scene later that same day. The Maricopa County Sheriff’s Office is still trying to determine if her death was due to exposure, injuries sustained during the accident, or perhaps foul play. Results of an autopsy are pending.
Myself, I don’t need to see a copy of the autopsy report to know the real cause of her death. It was not exposure, accident-related injuries, or foul play. I believe that Mai Vo Bor died due to a language barrier. Sheriff’s officers admit that they could not communicate with her parents because they spoke Vietnamese only. Had they been able to communicate with Mai’s parents, the officers would have almost certainly learned that Mai was on foot somewhere in the vicinity seeking help. Instead, the officers cleaned up debris from the crash, cleared away the disabled vehicle and transported Mai’s parents to the hospital, leaving the 37-year-old woman alone in the desolate area.
It was only later that day around 3 pm that an interpreter at the hospital learned from Mai’s parents that Mai had also been involved in the accident and was still missing. A search team found her naked body a few hours later.
Now, there are many unanswered questions related to this tragedy. Why did the family pull off of I-10 at Tonopah? What caused the single-vehicle accident? What was her time of death? Why was she found unclothed? There are probably a dozen other questions of interest to the investigation. However, I would argue that the most important question is this: Why did the officers not communicate with the parents at the scene of the accident? Do officers have access to remote telephonic language interpretation services? If not, then why not? If so, why did the officers choose not to utilize the system to interview the parents?
This is not to place blame on the Maricopa County Sheriff’s Office. But it is important to emphasize that Asian Americans are the fastest growing racial/ethnic group in Arizona, and 40% are of limited English proficiency. Language access is critically important in the kind of emergency situations faced by our public safety officers on a daily basis. Personally, I hope that Ms. Bor’s death will not be in vain and that the Sheriff’s Office and other government agencies will review their policies, protocols and systems around language access to ensure that all Arizona residents, regardless of language spoken, have equal and expedient access to high quality public services. It can be the difference between life and death.
- Doug Hirano, MPH, APCA Executive Director
A few weeks ago, I had a chance to make a presentation at the Arizona Department of Health Services regarding Asian American health disparities. Thank you to the Arizona Health Disparities Center for inviting me to speak and for coordinating this series of workshops around social and racial/ethnic inequalities in health.I titled my workshop “The Loudest Duck Gets Shot: Why Asian Americans are Dying in Silence.” My contention is that a “perfect storm” of factors continues to compromise the political effectiveness of Asian Americans in this country and that the result in at least one case (chronic hepatitis B infection and liver disease, which disproportionately impact Asian Americans) is that Asian Americans are dying unnecessarily. The “perfect storm” begins with a cultural disinclination to make waves (“the loudest duck get shot” is a Chinese proverb) and a proclivity towards “face-saving” (keeping problems within the family). In my mind, these tendencies continue to allow the “model minority” to also be the “invisible minority”. Elected officials and government don’t hear from their Asian American constituents, and not surprisingly, little gets done to address a preventable health problem like hepatitis B infection, which is killing Asian Americans on a daily basis. Another factor has an historical context. Asian Americans, like other people of color in this country, have a longstanding history of being oppressed and disempowered. For Asian Americans, this marginalization began not long after their entry into this country – beginning with the 1892 Chinese Exclusion Act and culminating in the 1924 Asian Exclusion Act, which for 40 years essentially halted all Asian immigration into the United States. To this day, many American-born Asian Americans are asked, “Where are you really from?” as if we are less than real Americans. Dr. Frank Yu coined the term “perpetual foreigner” to describe this state of marginal Americanism. It’s harder to impact the outcome of a game if you’ve been relegated to the sidelines. There are other important factors. Asian Americans are a very diverse group, constituting peoples from the Far East, Southeast Asia and South Asia – many of whom literally don’t speak the same language and some of whom are historically bitter enemies. Building political solidarity among such diverse groups can be challenging at best. My point is that Asian Americans need to be better organized and more vocal to address their own policy and systems related needs. In this country, “the loudest duck gets fed.” So, again using hepatitis B as an example, in addition to fighting the good fight and trying to scrape together resources to conduct hepatitis B education and screening among Asian Americans (working within the system), we also need to put a spotlight on and work to redress the inequities in overall hepatitis B funding (working the system). HIV/AIDS advocates learned this lesson decades ago, and that is largely why federal HIV/AIDS funding dwarfs viral hepatitis funding (even though far more Americans are infected with hepatitis B and hepatitis C, and far more die from these infections). I would venture to suggest that their advocacy, which resulted in a steep increase in federal investment in terms of HIV/AIDS prevention, screening, treatment and research, has saved hundreds of thousands of lives in the meantime. Asian Americans with hepatitis B infection deserve no less – but we must organize and speak up.I’ve placed my workshop slides here on our website if you would like to view the full presentation.
- Doug Hirano, MPH, APCA Executive Director
On May 14th, HBO will be premiering a new a series called the “Weight of the Nation”. The focus of this series is on the epidemic of overweight and obesity in this country.One of the key themes in this series is that the physical and social environment in which people live has a lot to do with their risk of becoming overweight or obese. This is counter to the idea which suggests that obesity is largely an individual problem related to discipline, willpower and personal responsibility. In anticipation of the series premiere, the Washington Post has published a brief interview with one of the series’ primary contributors, Marlene Schwartz, Deputy Director of the Rudd Center for Food Policy and Obesity and Yale University. I’m providing a link to this interview because I think Dr. Schwartz provides a simple, clear-eyed and compelling rationale for focusing efforts on the systems, policies and environments that predispose individuals and communities towards obesity, as opposed for instance to a purely educational approach.
I hope that this new series spurs much more dialogue on the matter. - Doug Hirano, MPH, APCA Executive Director
In response to a call for papers on Asian American and Pacific Islander health research, I put some thoughts on paper as to the type of research I think is needed for community agencies like APCA to more effective in its work. The paper, entitled “Asian American Health Research: What Community Agencies on the Front Lines Need to Know,” was accepted last year and has now made its way to print in the Spring 2012 issue of Progress in Community Health Partnerships: Research, Education, and Action. In this issue, I’m proud to be published alongside such friends and colleagues as Dr. Marguerite Ro, Dr. Winston Tseng, and Dr. Simona Kwon, among many others. I was also privileged to do an accompanying podcast related to my article. The transcript of the podcast is also published in this issue. To access copies of articles in this issue, click here.
Doug Hirano, MPH, APCA Executive Director
I recently attended a meeting at the Maricopa County Department of Public Health – ostensibly to review health status data and offer my opinion about the most pressing health issues confronting Maricopa County residents. However, within the course of discussion, I was surprised to learn that dengue fever and malaria are moving northward through Mexico, and both diseases will eventually be taking a toll on Arizona residents. The mere mention of these diseases brought back fond memories and youthful dreams.
As a callow graduate student in public health at UCLA, I had yearned for a career overseas investigating vector-borne diseases like dengue fever and malaria. My professors peppered their epidemiology lectures with stories of their own exploits in exotic foreign lands (one professor, Dr. Telford Work, helped discover West Nile Virus back in the late 1950s), and I imagined myself following in their footsteps.
Indeed, while working in the CDC STD Program, I had the opportunity to interview for a dengue fever epidemiology position in Puerto Rico. I was just certain that this position would jumpstart my brilliant career in global health, and that I would spend a good bit of the rest of my life finding adventure in foreign lands. Unfortunately, I was not selected for the position. I therefore find it ironic that while I never did make it overseas, exotic infectious diseases like dengue fever and malaria are – after all these years – making their way to me.
However, from my perch at APCA, I don’t anticipate playing any role in the fight against either dengue fever or malaria. So, sadly, it would seem that I never will achieve my dream of global health work. Well, not so fast.
The vast majority of people that our agency serves are in fact foreign born and bring to this country a health profile with diverse, global risks. Infectious diseases like tuberculosis and chronic hepatitis B infection are relatively common among new immigrants. So, too, are nutritional deficiencies such as rickets. Immigrants also bring to this country their indigenous conceptions of health. Our understanding of their disease risks, beliefs and behaviors is critical towards effectively working with them on health improvement strategies. As such, our work is partially ethnographic in nature, and we are in a sense cultural brokers of good health. To this end, we often find ourselves thinking globally and acting locally.
So, I’ve come to realize that my dream of global health work is being fulfilled right here in the Phoenix area, and I’m grateful every day for the opportunity to perform this work. And who knows, some day I might just dust off my barely used passport and spend a few weeks volunteering with an international health organization in some far off country. You never know, they might just learn a thing or two from an old global health hand like me.
-Doug Hirano, MPH, APCA Executive Director
This past Saturday morning, our home doorbell rang, and I sprang up with the expectation of greeting someone interested in trimming our mesquite trees or painting our house (both of which do need to be done). However, to my surprise, I found myself greeting Dr. Leland Fairbanks. Dr. Fairbanks is a retired physician well known in Arizona for his tireless work in tobacco control. Indeed, he is a public health icon and one of my local heroes.
He handed me a set of campaign brochures for various candidates for Tempe City Council and patiently explained why he supported each candidate. I listened to him for a bit, thanked him for his information, and assured him that I would be voting in the upcoming election.
We had actually met at an Arizona Public Health Association meeting many years ago, but I don’t believe he remembered me. So, before he walked off, I felt compelled to express my admiration for his past work. But before I could utter anything, he noticed the name on our door (“Casa de Hirano”) and commented that a woman with the last name of “Hirano” used to work on tobacco control with the state health department. I confirmed that my wife Rosalie had directed the state tobacco control program in the late 1990s. He smiled and said to say “hello” and then ambled off to visit with my neighbors.
I recount this story not as a chance encounter with a public health icon, but because I was so inspired that a man in his early 80s was going door to door on a Saturday morning advocating for things in which he believes. If anyone has earned a leisurely Saturday morning, it is he. I promised myself that on Monday morning I would make a few phone calls in support of a hepatitis B funding bill currently under consideration by Congress. Please consider taking a moment in the upcoming week to advocate for something you believe in.
- Doug Hirano, MPH, APCA Executive Director
What are the risk factors that may be linked to suicidal ideation and/or attempted suicide among Bhutanese refugees to the United States from 2008 to the present?
Since last week, our Nepali speaking interpreters have been busy in helping Center for Disease Control and Prevention (CDC) find an answer to the above question. Since 2008 approximately 35,000 Bhutanese refugees have been resettled in the United State. 16 suicide cases in 10 states have been reported to the Office of Refugee Resettlement (ORR). As our interpreters were undergoing two days training session with the CDC staff, another suicide had been reported to ORR. Considering the pattern in which suicide cases are increasing among the newly resettled Bhutanese refugee population, CDC is conducting “Epi-aid” study in collaboration with Office of Refugee Resettlement and Refugee Health Technical Assistance Center at the Massachusetts Department of Public Health.
A random sample of Bhutanese refugees from four states – Georgia, Arizona, New York, and Texas were selected from which a total of 579 Bhutanese refugees, age 18 and older will be interviewed using a set of pre-designed questionnaire which is about 90 minutes long. After two days of intense training on research ethics, informed consent, questionnaire, addressing difficult situations, distressed respondent guidelines, and role play sessions, our Nepali speaking interpreters are ready to assist in face-to-face interviews with Bhutanese refugees. The study findings will help better understand the underlying causes and associated risk factors for suicide in the Bhutanese community, provide evidence-based guidance on prevention of suicide and reducing emotional distress among Bhutanese refugees, and raise awareness of suicide risk factors and mental health resources to Bhutanese refugees in the United States.
There is definitely the need for linguistically competent and culturally appropriate mental health programs in Arizona to address the issues of Bhutanese refugees and also other individuals who have Limited English Proficiency. With the use of our professionally trained interpreters, Bridging Cultures is in a unique position to help bridge the gap between mental health patients and medical professionals/facilities. Our interpreters, some of who are former refugees, found Bhutanese Suicide Prevention study with CDC very meaningful. We are very positive about the outcomes of this study and enthusiastic about the changes it will follow. Please check back with us for more progress on this topic.
Kamana Khadka, Program Manager, Bridging Cultures
For the past year, I’ve been following the career of Jeremy Lin for two reasons: he was originally signed by the Golden State Warriors (my hometown basketball team) and because he is an Asian American. As has become well known in the past two weeks, there have been very few Asian American professional basketball players. Consequently, I’ve watched with increasing interest (and yes, glee) his sudden ascent to NBA stardom with the New York Knicks.
But I am becoming more interested in his impact on increasing the visibility of Asian Americans as a whole in this country. He has now graced the covers of Sports Illustrated and Time Magazine. Other magazine covers may soon follow. But the point is that he has singlehandedly reminded mainstream America that there are Asian Americans in this country.
For while we Asian Americans have become fond of complaining about being stereotyped as the “model minority”, the reality is that we have actually been the invisible minority – reduced to intermittent blips in the national consciousness, as comic relief (the “Harold and Kumar” movies), cautionary tales of alienation (Cho and the Virginia Tech mass murders), or cultural stereotypes (overbearing “Tiger moms”).
Well, Jeremy Lin’s story seems to have found a special resonance with mainstream America. He is “the little engine that could” and “the ant that moved the rubber tree plant” (though he is 6’ 3”). He is the embodiment of the favorite American fable that anyone can make it if they try hard enough. He is one of us.
However, we’re learning that fame and attention can come at a cost. Witness the ESPN headline regarding “Chink in the Armor” after a recent Knicks loss in which Lin committed numerous turnovers. Other racial slurs have made it into the media, and more will no doubt follow. He is a “feel good” story for some, but for others he is resurrecting repressed feelings of race hatred and intolerance.
Most importantly, though, Jeremy Lin is bringing long overdue attention to the forgotten minority. Perhaps the CNN producers of the “Latino in America” and “Black in America” series will now consider an “Asian American in America” series. While his story has become a global phenomenon, the Asian American experience is in fact full of equally fascinating and culturally distinctive stories. Let’s hope “Linsanity” is the impetus for Asian Americans to finally find a worthy place in the American consciousness.
- Doug Hirano, MPH, APCA Executive Director
A few weeks ago, I participated in a press conference on behalf of the Asian Pacific Community in Action, a Phoenix-based non-profit health services and advocacy organization. We were one of several Asian American agencies and individuals calling for the resignation of Sheriff Joe Arpaio. Since then, I have received several emails, letters and phone calls inquiring as to what Sheriff Joe has done to members of the Asian American community to deserve a call for his resignation.
My answer is not a simple one. In fact, it is as steeped in history as it is in recent events. Asian Americans have a long history of not being welcome in this country. Beginning with the 1882 Chinese Exclusion Act, significant barriers have been placed upon Asian immigration. In 1924, the National Origins Act essentially closed the doors to immigration from Asian nations. This door was not substantially re-opened until the Immigration Act of 1965.
Obviously, Sheriff Joe Arpaio had nothing to do with historical American policy regarding Asian immigration, and I am not directly aware of discriminatory treatment of Asian Americans at the hand of the Sheriff’s Office. However, I would argue that his racial profiling of the Hispanic community is a salient issue for the Asian American community. As Martin Luther King, Jr. said, “Injustice anywhere is a threat to justice everywhere.” With a majority of Asian Americans being foreign born, it is possible that we could be the future target of “crime suppression” sweeps.
Asian Americans have come a long way in the past 100 years of Arizona statehood. Indeed, we are now the fastest growing racial/ethnic group in Arizona, and the vast majority of us are extremely proud to be Arizona residents. However, until we all can live without fear of unlawful discrimination and racial profiling, I believe we are obligated to speak out. As Martin Luther King, Jr. also said, “Our lives begin to end the day we become silent about things that matter.” It is time for change: Sheriff Joe should go.
-Doug Hirano, MPH, APCA Executive Director
The Centers for Disease Control and Prevention (CDC) has just released data regarding the utilization of cancer screening tests (i.e., mammography, Pap smear and colonoscopy) by race/ethnicity. Here’s a direct quote from the report: “Screening rates for all three cancer screening tests were significantly lower among Asians than among whites and blacks.”
As an example, the rate of mammography within the past two years for Asian survey respondents was 64.1%. This compares to 72.8% among whites and 73.2% among blacks. Similarly, Asians received up-to-date colorectal cancer screening at a rate of 46.9%, as compared to 59.8% among whites and 55.0% among blacks. Data is also presented by Asian ethnic subgroups, including Chinese and Filipinos.
Early cancer detection greatly increases the chances of successful treatment. Clearly, Asian American health organizations and their partners must work to address this disparity in cancer screening rates. I would urge you to review this report. Click here for a link to the report.
-Doug Hirano, MPH, APCA Executive Director
We were recently asked to join other Asian American community members in a press conference demanding the resignation of Maricopa County Sheriff Joe Arpaio. One may wonder why an agency with a mission towards health improvement would want to go out on a limb against a county sheriff. I’m providing the text of my comments as an explanation:My name is Doug Hirano. I am the executive director of the Asian Pacific Community in Action. We’re a non-profit agency that works on behalf of the rapidly growing Asian American and Pacific Islander community to ensure that they have equal access to the health services and information that can help them achieve good health. Since 2002, we’ve helped thousands of Asian Americans and Pacific Islanders get immunized, get screened for life-threatening diseases, and find a regular source of medical care. All of our programs are tailored to serve first generation immigrants and refugees facing real challenges of poverty, language, education and unemployment. In our 10 years of service, our work has taught us the power of grassroots advocacy, and so we also work to promote policies and practices that are fair to the needs of all Asian American and Pacific Islander individuals -- regardless of country of origin or citizenship status.It has become clear that the policies and practices of the Sheriff’s Office are a problem for communities of color, including Asian Americans and Pacific Islanders, many of whom are recent immigrants and refugees. Many of our service recipients come to the United States seeking a just and fair society. Unfortunately, the discrimination, racial profiling and unconstitutional retaliatory actions taken by the Sheriff’s Office are reminiscent of the policies and actions for which they originally left their home countries. We are concerned that our community members are not seeking the government services they need and are entitled to because of the hostile and fear inducing atmosphere created by the Sheriff’s Office. Data indicate that Asian Americans and Pacific Islanders are over-represented among the very poor, but do not utilize government-funded services such as behavioral health care, cancer screening and nutrition services proportionate to their population size. For an agency charged with improving the health and well being of our communities, this is unacceptable.We believe that government services and policies are meant to level the playing field for all. We believe that law enforcement must protect everyone’s safety and rights equally. We believe in equal access to justice. Under Sheriff Joe Arpaio, none of these beliefs can be realized. Change is demanded. As Martin Luther King Jr. once said, “our lives begin to end the day we become silent about things that matter.” We therefore request that Sheriff Joe Arpaio resign from office immediately. Thank you. - Doug Hirano, MPH, APCA Executive Director
2012 is indeed a very exciting year for us. We received a grant from Healthy People 2020 to conduct nutrition education intervention/workshops in the Bhutanese community. Bhutanese are nationals of the Kingdom of Bhutan. Bhutan is a landlocked country in South Asia, located at the eastern end of the Himalayas. India borders the south, east, and west areas of Bhutan and China borders the north. Nepal and Bangladesh are also not too far from Bhutan.
The ancient traditions of Bhutan have been fiercely guarded as a result of having been almost completely cut off for centuries from the outside world. Bhutan, also known as “Land of the Thunder Dragon,” began to open up to the outsiders in the 1970s. Although ancient cultures and the breathtaking sceneries make Bhutan irresistible, tourism is restricted.
There might be restrictions in traveling to Bhutan, but there sure are no restrictions in learning from our Bhutanese friends who are among the newest members of our community in the United States. This project is a result our commitment in learning and growing together. Bhutanese community leaders identified the need for nutrition education among their people.
“Elders believe that they should drink water only when they sweat.”
“Regardless of whether or not they are in pain, some religiously take pain killers three times a day just like the medicines prescribed by their English-speaking doctors, whom they do not understand.”
“They suffer from diabetes, high blood pressure, cholesterol, stress, depression and yet eat fatty food cooked in corn oil which is cheap and comes by the gallon.”
“What do doctors really mean by exercising?”
We not only actively listened to the community but did our part in researching the facts. According to the Centers for Disease Control and Prevention, there is a severe case of Vitamin B12 deficiency among the Bhutanese, which results in numerous hematologic and neurologic disorders. A nutrition education/intervention is crucial.
We are in the process of developing a culturally appropriate and linguistically competent nutrition education curriculum specifically designed for the Bhutanese. In partnership with Bhutanese Community Association of Arizona, input from experienced Bhutanese medical assistants and staff members from Mountain Park Health Center, we are striving to build a curriculum that will reflect the input from the community leaders, members, and Bhutanese women who do almost all the cooking. The curriculum will be delivered by trained lay health workers fluent in English and Nepali. The curriculum will also be translated in Nepali, which is the language spoken by the Bhutanese resettled in the United States.
For further information, please contact Ms. Kamana Khadka at (602) 265-4598.
- Kamana Khadka, Program Manager, Bridging Cultures
While many of us have very recently made resolutions around our eating and exercise habits, the Centers for Disease Control and Prevention (CDC) is asking the public to adopt at least one additional New Year’s resolution: Be ready. To make this easy, they’ve initiated a “31 days of preparedness” blog offering a tip a day to improve readiness for any type of disaster or emergency.
The first three days’ of readiness tips have included some simple but sensible suggestions for preparing your “second home” – in other words, your automobile – for emergencies. Check back with the CDC blog for additional daily tips. I suspect you’ll be more knowledgeable and better prepared for the unexpected.
- Doug Hirano, MPH, APCA Executive Director
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