skip to main |
skip to sidebar
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
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
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
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:
- Be the organizational change that you would like to see in the community. Embrace social justice within the organization.
- Learn how to use power and conflict for progressive social change.
- Form true partnerships with community leaders.
- Engage and learn about other movements (e.g., education and economic).
- Prepare students for social change work.
- Treat community leaders and residents as adults. Stop “dummying down”. Educate.
- 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
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
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.
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
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
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
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
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
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
The federal government has just released the latest incarnation of our national health objectives: Healthy People 2020. As a nation, we’ve been systematically identifying our health goals since 1980, with the publication of a document known as “Health Objectives for the Nation.” Healthy People 2000 and Healthy People 2010 are successors to the original document. This time around, let’s hope that more progress can be made to reduce the health disparities between groups in this nation.
I did notice that the objectives relating to hepatitis B do not reference a stated interest in identifying individuals already infected and referring them into care and treatment. This is disappointing given that there are far more individuals in the United States unknowingly infected with HBV than HIV. Indeed, there are objectives relating to increasing screening for HIV and for hepatitis C, but not hepatitis B.
If this is an oversight, it is a big one. CDC has already passed over addressing viral hepatitis as a “winnable battle.” Those of us working on issues around hepatitis B among Asian Americans and Pacific Islanders would seem to be doing so without leadership in this area from our federal government. Be that as it may, we must stay the course and redouble our efforts.
-Doug Hirano, MPH, APCA Executive Director
A new report from the Centers for Disease Control and Prevention (CDC) provides the definitive data suggesting that the Hispanic population in the United States has a higher life expectancy at birth and at almost every subsequent age than the non-Hispanic white and non-Hispanic black populations. As stated in the report:
The finding of higher life expectancy for the Hispanic population seems paradoxical because on average the Hispanic population has lower socioeconomic status than the non-Hispanic white population. Given the relationship between socioeconomic status and mortality, a mortality profile similar to that of the non-Hispanic black population would seem more likely for the Hispanic population.
The study authors suggest that this apparent longevity paradox has three potential explanations: data artifact, migration effects and cultural effects. They seem comfortable that the effect of data artifact has been addressed methodologically, and seem to suggest that the migration effect (i.e., healthier individuals migrate into the country and sicker individuals return home to die) has as yet no firm basis in evidence. That leaves the potential impact of culture as perhaps a key explanation:
Finally, cultural effects in the form of family structure, lifestyle behaviors, and social networks may also explain the Hispanic mortality advantage by conferring a protective barrier against the vicissitudes of minority status and low socioeconomic conditions.
Clearly, the statisticians have done their job in confirming a significant difference in life expectancy based upon Hispanic ethnicity. The ball is now firmly in the court of public health professionals, cultural anthropologists, sociologists, and others to identify and measure the impact of the protective factors involved within the Hispanic community. (This work should be conducted among Asian Americans as well, who also benefit from relatively long life expectancy.) A better understanding of factors outside of socioeconomic status that lead to longer life can potentially serve as a basis to intervene in the premature death that impacts other racial/ethnic groups, notably African Americans and Native Americans, both of whom suffer from shorter life expectancies than the majority population.
Doug Hirano, MPH, APCA Executive Director
The National Viral Hepatitis Roundtable (NVHR) recently issued a press release decrying the fact that controlling hepatitis B and C is not among the “six winnable battles” identified by the Centers for Disease Control and Prevention (CDC).
Here are some excerpts from the release:
"The CDC's newly released 'six winnable battles' strategy makes a mockery of the broad-based, comprehensive, and integrated public-health strategy that our nation so desperately needs. In seeking to win six narrowly defined health care battles, the CDC may well lose the overall public-health war.
"The CDC's omission of viral hepatitis from its list of 'winnable battles' is not simply an oversight - it's an abdication of duty to many Americans who may well lose their battle with chronic viral hepatitis in the decades to come."
In a prior blog entry, I had commended the CDC for having the wisdom (and nerve) to identify just a few key health areas for strategic focus.
However, I fully expect that other passionate and well-intentioned public health agencies and advocates will join the NVHR in questioning the completeness of CDC’s winnable battle list. And, I think, most will have a good argument. There are many, many other areas of extreme public health urgency (e.g., diabetes, substance abuse, Novel H1N1 flu, and domestic violence, to name a few). However, it should be pointed out that the six winnable battle areas (HIV, motor vehicle injuries, obesity/nutrition/physical activity/food safety, healthcare associated infections, teen pregnancy and tobacco) cover a lot of ground in terms of health impact, and there is crosscutting value in effectively working on these health concerns (e.g., efforts to control HIV also benefits efforts to control the spread of other sexually-transmitted diseases, including hepatitis B and C).
Most importantly, though, the CDC is the leading public health institution in the world, and as a citizen and a public health professional, I expect the agency to exert leadership. The identification of “winnable battles” is a bold and controversial step. It provides strategic perspective to those of us battling in the trenches, but shouldn’t be perceived as a mandate.
As I stated in my prior blog entry, for those of us working on improving health among Asian Americans and Pacific Islanders, controlling hepatitis B is our “winnable battle”. In that regard, I will continue to support the efforts of the NVHR (APCA is a member) to put hepatitis B and C on the national radar screen and to advocate for additional resources.
-Doug Hirano, MPH, APCA Executive Director
Public health practitioners are justifiably proud of the improvements in health status over the past 100 years. In fact, the Centers for Disease Control and Prevention has generated a list of the ten greatest public health achievements from 1900 to 1999. Major achievement areas include immunizations, tobacco, motor-vehicle safety, and control of infectious diseases, among others.
Now, ten years into the 21st century, those of us practicing public health must ask ourselves about our progress in this century. My sense is that we’ve made relatively slim headway in the past decade. Indeed, the end of the 20th century saw an unprecedented and largely unabated rise in childhood and adult obesity, and the beginning of the 21st century has seen deadly global outbreaks of SARS and novel H1N1 flu. Rates of tobacco use are still hovering around 20% here in the United States, and far higher in many other countries.
So, where do we go from here? Well, the CDC has offered a relatively new way of thinking about our 21st century health challenges. They have coined the term “winnable battles” to describe “public health priorities with large-scale impact on health and with known, effective strategies to intervene.” Winnable battle areas include HIV, motor vehicle injuries, obesity/nutrition/physical activity/food safety, healthcare associated infections, teen pregnancy and tobacco.
Interestingly, several winnable battle areas (i.e., tobacco and motor vehicle injuries) also show up on the list of the 20th century ten greatest public health achievements. Be that as it may, I think it is wise to generate a “winnable battle” list. It provides a clear health agenda for health departments, community-based organizations, and others interested in wide-scale health improvement.
For Asian Americans and Pacific Islanders though, I would add two additional winnable battles:
1. Screening and referring to medical care those individuals with chronic hepatitis B infection; and,
2. Increasing rates of screening for breast, cervical and colon cancer;
One in ten Asian Americans and Pacific Islanders carries the hepatitis B virus (HBV), a major cause of liver cancer. Most are unaware of their infection. A simple blood test can detect the presence of the virus, and there is now treatment that can decrease the likelihood of serious liver disease due to HBV infection.
Studies indicate that Asian Americans and Pacific Islanders do not receive preventive screenings for breast, cervical and colon cancer as often as non-Hispanic whites. The scientific literature now includes proven interventions to increase screening rates for these cancers among AAPIs.
A focus on winnable battles is efficient and sensible. We must act on this knowledge. Let’s hope that our collective legacy includes success in these areas.
Doug Hirano, MPH, APCA Executive Director
I had previously written about the ongoing process of recruiting an early career public health practitioner to come work for APCA through the CDC Prevention Specialist program. A few weeks ago, I traveled to Atlanta to interview one such Prevention Specialist. We had a nice discussion but I sensed that we were not her highest priority. I was right. In the end, she selected a different assignment. It was a game try on our part. APCA was one of a very few non-profit organizations in the running for one of the 25 Prevention Specialists. Almost all eventually chose to be placed at a state or local health department. I believe one chose a placement with a university, and another chose to be placed with a national health policy organization. We’ll give it some more thought before deciding to pursue this again next year. - Doug Hirano, MPH, APCA Executive Director
A couple of weeks ago I wrote about my impending trip to the CDC in Atlanta to interview a potential “Prevention Specialist” to join APCA for the next two years. Well, I am back and pleased to say that I had a nice chat with one of the candidates interested in working with APCA. She is bright, energetic and has a lot of relevant work experience as related to the projects we had outlined for the position. Now, it’s a bit of a numbers game and a waiting game. There were 60 or so agencies represented at the interviews – each competing for one of the 25 Prevention Specialists. Most of these organizations were state or county health departments, and a few were universities. Of the very few non-profit agencies represented, I suspect APCA was the smallest in terms of staff numbers and the most grass roots.Each Specialist now ranks their top few organizations, and each organization ranks their top Specialist. This information is fed into a computer, and matches are then recommended. We’ll hear in mid-August about the results. Stay tuned!
-Doug Hirano, MPH, APCA Executive Director
Thanks to Will Humble, director of the Arizona Department of Health Services for the following reference. For anyone with more than a passing interest in public health, his blog is worth checking out.
Will’s most recent blog post references the Center for Disease Control and Prevention’s publication called Science Clips. This weekly report provides a summary of CDC-authored publications and key scientific articles in featured topic areas (e.g., “communicable diseases” and “maternal and child health”). It’s “one stop shopping” for individuals interested in keeping up-to-date on health research. The links will direct you to the related abstracts as listed in PubMed – a compendium of the peer-reviewed scientific research. Unfortunately, access to the full articles is largely limited to those with electronic subscriptions to the specific journals in question. Still, through access to the abstracts, it’s a simple means to stay current on all things public health.
Posts
