How Asian Americans Can Get Health Care Right
Asian Americans are the fastest growing minority group in the United States. In 2008, Asian Americans numbered approximately 13.5 million, and accounted for 4.2% of the US population. By 2050, the Census Bureau predicts that the population will reach 41 million, or approximately 11% of the US population, highlighting the importance of addressing health issues specific to this group. Asian Americans are a heterogeneous group with respect to their cultural beliefs, socioeconomic backgrounds, and normative perceptions. For instance, although Asian Americans are more likely to have a college education than other members of the US population, on average, they also have a higher poverty rate than the national average, placing some groups at risk for having limited access to healthcare and health information; especially Asian American older adults (over 65).
The mechanics of designing healthcare outreach programs for Asian American elders are only part of the challenge. Policy makers must also be alert to several other necessary components of health-care sustainability, in which health education is the most important. As educated people are likely to make wiser choices, we should encourage Asian American older adults, through public health education programs, to adopt healthy lifestyles and be responsible for their own health.
While evidence-based health screening has been introduced for the early detection of common ailments, such as cancer, heart disease, hypertension and diabetes mellitus, most Asian American elders are not aware or have never been screened for chronic diseases. Chronic hepatitis B and liver cancer caused by hepatitis B in Asian Americans comprise one of the most serious, but frequently neglected by racial and ethnic disparities in the US. According to Department of Health and Human Services, there are 1.3 million chronic hepatitis B cases in the United States in 2010, half of which are among Asian Americans and Pacific Islanders. While hepatitis B virus is rare among white non-Hispanics in the United States (1.0%), as many as 1 in 10 Asian Americans carries the virus.
Rates of HBV and liver cancer vary across different Asian American sub-populations. Vietnamese men have the highest incidence of liver cancer of all ethnic groups (41.9/100,000) and, while lower, incidence rates among Korean males (24.8) and Chinese males (20.9) are still well above those of white males (3.7).
Although HBV screening and subsequent vaccination can prevent infection, of those Asian Americans screened in the aforementioned studies, 56.6% reported not having been screened previously for HBV. This lack of screening may be related to low HBV knowledge and a lack of direct screening recommendations from healthcare providers. Seventy-one percent of participants in the studies reported that had not been recommended for HBV, even though 89% had regular family physicians. As a result of these low HBV knowledge and screening rates, Asian Americans are often first diagnosed during late stage cancer, resulting in high mortality rates. Given these high rates of hepatitis B and liver cancer, Asian Americans are a minority group for whom valid, reliable, and accessible health information is sorely needed.
It is suggested that while interventions and prevention of HBV and liver cancer are sorely needed among Asian American older adults in general, target populations may have varying levels of understanding of preventive care screening and specific barriers that must be addressed. Specifically, levels of medical understanding, potential for stigma, and the role of community and religion varied across subgroups and should be integrated into future interventions accordingly. Studies have shown that it is critical to create a larger base of awareness within the Asian-American Community in order to facilitate this uptake of screening or vaccination. Facilitating a dialogue with policy makers, physicians, community organizations, and key stakeholders may move the critical interventions forward.
Executive Director of Institute of Asian American Adult Development.