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.

Year in Review: 2010

By any measure, the year 2010 was quite busy and quite successful for the Asian Pacific Community in Action. The agency continues to expand its services and now offers a unique blend of direct clinical and educational health services, advocacy, community mobilization and capacity development, medical referrals, and applied research. To our knowledge, there are just a handful of AAPI agencies in the nation that offer a similar continuum of services. Provided below are key events and accomplishments for the year:

January

• Funding received from the Asian American Justice Center to assist with Census 2010 efforts among local Asian Americans and Pacific Islanders; APCA co-chairs the Asian Pacific Islander Complete Count Committee in Maricopa County

• Grants approved from Chandler Regional Hospital to conduct diabetes and cardiovascular screening and from St. Joseph’s Medical Center to conduct mental health research and planning in the AAPI community

• Reception held for “Taste of Asia” honorees of the 5th Annual APCA Fundraising Dinner at the Golden Buddha Restaurant; attended by 40 individuals

• Health Through Action Leadership Fellows and Midwestern University students begin Project Lingo aimed at advocating for improved language interpretation services for AAPI communities in Arizona

February

• Southern Tucson Asian Pacific Islander Health Coalition meets for the first time; APCA Executive Director helps plan the meeting and makes keynote presentation at the meeting

• Dr. Kelly Hsu receives YWCA 2010 Tribute to Women award for Health and Science at the Biltmore Hotel

March

• Organized and sponsored a women’s health symposium at the Fiesta Inn in Tempe; attended by 50 individuals

• Received $63,000 grant award from the Nina Mason Pulliam Charitable Trust to plan and implement a medical interpretation program known as the “Asian Pacific Islander Health Language Access Program”

• Ms. Ditsworth teaches the first ever Chinese language workshop of “Living Well with a Disability” at the Chinese Senior Center

• APCA receives notification of continuing grant award for breast cancer education work from Susan G. Komen for the Cure

• Health Through Action Arizona Community Partnership completed the first Leadership Training with Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL)

• Health Through Action Arizona Community Partnership adopts the HTAA vision, mission, and core values

April

• Co-sponsored three-day workshop entitled “Community Advocacy & Training on Cancer and Health”, held at St. Joseph’s Medical Center, attended by 25 individuals

• HBV testing and education at the Chamorro Easter picnic, Cactus Park, Scottsdale, the first ever health program in this community

• Poster presentation on randomized telephone health surveys among Korean, Chinese and Vietnamese Americans presented at annual meeting of the ASU Southwest Interdisciplinary Research Center (SIRC)

• Presented Jade Ribbon Arizona initiative on national HBV webinar sponsored by the Asian Pacific Islander American Health Forum

• Received “Snap Shot” award from the Arizona Partnership for Immunization for work in HBV vaccination

• Ms. Elexia Torres joins APCA as its Programs Director on April 19

• Hosted a four-day training (April 21 – 24) in digital storytelling. The training, conducted by the Center for Digital Storytelling, was provided to APCA staff and members of its lay health advisor team

May

• Held 5th Annual APCA Fundraising Dinner, “A Taste of Asia” at the Marriott Buttes in Tempe; 290 individuals attended and approximately $40,000 was raised

• Partnered with the Arizona Foundation for Eye Health on a joint diabetes and vision screening event at Mekong Plaza; 56 individuals received screening and 21 received eye exams

• Partnered with Dr. Phuc Pham on a Preventive Services Clinic, 39 individuals were screened

• Held series of hepatitis B events, including support groups and “Lanterns for Life” community walk and picnic in response to global hepatitis awareness week

• Mini-grant funding received from the American Psychological Association for a project entitled “Island Stories: Increasing Cancer Awareness in the Native Hawaiian/Pacific Islander Community through Digital Storytelling”

• HBV screening held at Mountain Park Health Center at the Chinese Cultural Center; 23 individual were screened

• Ms. Wendy Tee rejoins the APCA board of directors

June

• Ms. Ditsworth and two community members attend the four-day Stanford Chronic Disease Self Management Program training; they are now licensed to teach the course and train other trainers

• Lay health advisor trainings are held, with a total of 11 women finishing training and becoming eligible to offer stipend-based breast and cervical cancer presentations

• Mr. Hirano is invited to attend a national meeting on food and tobacco policy among Asian Americans and Pacific Islanders in San Francisco; the meeting was sponsored by the Asian Pacific Partners in Empowerment, Advocacy and Leadership (APPEAL)

• Ms. Hasan is appointed to the National Advisory Committee on Research Development related to the conduct of health research on Asian Americans and Pacific Islanders

• Ms. Hasan presents Jade Ribbon Arizona Hepatitis B Campaign at the Just Metropolis Conference in San Francisco; the conference was sponsored by the Planners Network, Young Planners Network and Association for Community Design for Social Responsibility

July

• 14 individuals are recruited and participate in “Community Interpreter Training”; these individuals subsequently contract with APCA to provide medical interpretation at the refugee screening clinic

• APCA renews a contract with the Maricopa County Department of Public Health to continue to provide emergency preparedness education and awareness

August

• Co-sponsored a kidney screening event with the Arizona affiliate of the National Kidney Foundation at the Korean Global Mission Church, Tempe; this was the most well attended such event ever held by the local Kidney Foundation

• Co-sponsored a mental health forum with Magellan Health Services; more than 60 individuals attended

• Partnered with the Indo American Foundation to conduct diabetes and cardiovascular screening; 75 individuals received screening and physician consultation

September

• Justin Tai and Monica Weintraub join APCA as Public Allies; Mr. Tai is serving as the Volunteer Program Manager and Ms. Weintraub as the Outreach Events Coordinator

• Ms. Kamana Khadka joins the APCA staff as the Administrative Office Manager

• Received a national grant from OCAPICA (Orange County Asian Pacific Islander Community Alliance) for breast and cervical cancer work among Chamorro women

October

• Partnered with the Greater Phoenix Chinese Christian Church on a health screening and vaccination event

• Sponsored a meeting entitled “Community Conversation on Immigration and Health Care in Arizona” at the JACL Hall; attended by a diverse audience of 65 individuals

• Conducted HBV screening at two different Chinese linguistic schools, testing a total of 68 individuals

• Ms. Yonsu Yi joins the APCA staff as the Korean Community Development Specialist

November

• Presented two research papers at the annual meeting of the American Public Health Association in Denver, Colorado

• Conducted an HBV screening event at Mountain Park Health Center next to the Chinese Cultural Center; 29 individuals were screened

• Partnered with the 3000 Club’s “Market on the Move” initiative to provide flu vaccine to 140 individuals at Mekong Plaza

• Ms. Liza Merrill joins the APCA staff as the Chamorro Community Development Specialist

• Ms. Michelle (Yue) Zhang joins the APCA staff as the Financial Specialist

• Drs. Kathy Nakagawa and Candace Lew join the APCA board of directors

December

• Ms. Emma Ditsworth successfully completes a five-day “train-the-trainer” medical interpretation workshop entitled “Bridging the Gap” in Seattle

• Partnered with the 3000 Club on a flu vaccination/diabetes screening event

• Conducted HBV screening and flu vaccination event at Mountain Park Health Center in Tempe; 37 individuals were screened

• Held a curriculum development session for the use of digital stories; attended by 20 individuals

-Doug Hirano, MPH, APCA Executive Director

Racial and Ethnic Differences in Health Report Released

Once every two years, the Arizona Department of Health Services releases a report entitled “Differences in the Health Status Among Race/Ethnic Groups, Arizona." The latest edition has just been released, and I would recommend that anyone interested in Arizona health disparities give it a quick review. It’s a comprehensive source of comparative health statistics by race/ethnicity.

As in previous editions, data for Asian Americans is not disaggregated by ethnicity. This masks poor health indicators by ethnic subgroup, leading to very good health rankings for Asian Americans as a whole. Indeed, Asian Americans rank “better than average” in more indicators than any other racial/ethnic group.

That being said, the report is definitely worth a review. Credit should be given to the state health department for continuing to publish this important information.

Here’s an excerpt from the report:

In 2009, Asian residents of Arizona ranked best or second best among race/ethnic groups on 53 of 70 indicators, including measures of utilization of prenatal care services, low infant mortality, low incidence of teen pregnancies, and reportable diseases. Asians median age at death was the second highest among the race/ethnic groups in Arizona in 2009. Asians also had the lowest risk of injury mortality in motor vehicle accidents, as well as drug-induced deaths and firearm-related mortality. In 2009, not a single Asian or Pacific Islander of the State died from human immunodeficiency virus (HIV) disease. However, following an improvement in their overall score from -21.9 in 2005 to -37.4 in 2007, the 2009 average score of -29.2 signified no further improvement. The rate of fall-related deaths jumped from 3.9 in 2000 to 10.8 in 2009 (See Comparative Rates and Ratios for 2000-2009). The total mortality rate of 472.8 deaths per 100,000 Asian or Pacific Islander residents of the State was the lowest rate among the race/ethnic groups, but it was the highest rate for Asians since 2005. So were the mortality rates for cancer, chronic lower respiratory diseases, diabetes, and fall-related injuries.

APCA will soon be reviewing its progress on goals and objective in its two-year strategic plan (2009 – 2010), and data from this report will be an important source of information in developing future goals and objectives.

-Doug Hirano, MPH, APCA Executive Director

Healthy People 2020: Where’s Hepatitis B Screening?

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