Cultural barriers to health care for southeast Asian refugees.

Many Southeast Asians now living in the United States experience severe health problems, attributable to physical trauma and inadequate health care in Asia, and low socioeconomic status in this country. Evidence indicates that despite their health problems, Southeast Asian refugees underuse the American health care system. Cultural reasons for this underuse are examined. Southeast Asian cultural attitudes toward suffering, such as beliefs that suffering is inevitable or that one's life span is predetermined, can cause Southeast Asians not to seek health care. Cultural beliefs about the sources of illness and correspondingly appropriate forms of treatment can be a barrier to Western health care. Many lack familiarity with Western diagnostic techniques and treatments and thus are apprehensive. Health care providers' ignorance of Southeast Asian cultures can interfere with communication with patients, resulting in culturally irrelevant services or misinterpretation of side effects of Southeast Asian folk medicines. Southeast Asians' lack of familiarity with American culture can make health care services geographically and economically inaccessible and can cause Southeast Asians to be ignorant of available services or how to access them. An understanding of Southeast Asian cultures and additional outreach efforts by Western medical practitioners and health care providers are needed to improve the use of health care services by Southeast Asian refugees in this country.     

Factors related to biomedical research productivity in Asian countries

By and large, biomedical research is not a priority sector in Asian countries due to many factors. Lack of resources and trained manpower are certainly among these factors. We investigated the factors related to biomedical research productivity in Asian countries based on Medline data. The number of biomedical articles published in the indexed journals from each country of Asia and Oceania during 1990-1998 was used as a surrogate of total biomedical research productivity. Multiple regression analysis revealed that low gross national product per capita (p<0.013), insufficient number of physicians (p<0.047), and inadequate public spending on the health sector (p<0.049) were responsible for the meager number of biomedical publications in Asian countries.     

Socio-economic disparity in food consumption among young children in eight South Asian and Southeast Asian countries

BACKGROUND/OBJECTIVESThis study examined socio-economic differences in diverse food consumption among children 6–23 months of age in South Asia and Southeast Asian countries.SUBJECTS/METHODSData from Demographic and Health Surveys in four countries in South Asia (n = 15,749) and four countries in Southeast Asia (n = 10,789) were used. Survey-design adjusted proportions were estimated for the following 10 food items: grains, legumes, dark green leafy vegetables (DGLV), vitamin A-rich fruits, vitamin A-rich vegetables, other fruits and vegetables (OFV), fish, meat, dairy, and eggs. An equity gap was defined as an arithmetic difference in the proportion of each food item consumed in the past 24-hours between the wealthiest and lowest quintiles and between rural and urban areas, denoted by percentage points (pp).RESULTSThe consumption of most of the 10 food items was higher in the wealthiest quintiles and urban areas across eight countries. The size of equity gaps was greater in Southeast Asia than in South Asia, particularly for vitamin A-rich fruits (3.3–30.0 pp vs. 0.3–19.6 pp), vitamin A-rich vegetables (12.1–26.7 pp vs. 2.4–5.9 pp), meat (17.7–33.4 pp vs. 3.4–13.4 pp), and dairy (14.7–32.5 pp vs. 3.3–11.4 pp). However, the size of equity gap in egg consumption was greater in Southeast Asia than South Asia (11.2–19.8 pp vs. 11.0–26.7 pp). Relatively narrower gaps were seen in the consumption of grains (0.3–12.9 pp), DGLV (0.6–12.4 pp), and fish (0.1–16.8 pp) across all countries.CONCLUSIONSEquity gaps in food consumption differed by socio-economic status and region. Reducing equity gaps in nutrient-rich foods and utilizing regionally available food resources may increase child dietary quality.     

Biodiversity and health: Lessons and recommendations from an interdisciplinary conference to advise Southeast Asian research,society and policy

Southeast Asia is an economic, biodiverse, cultural and disease hotspot. Due to rapid socio-economic and environmental changes, the role of biodiversity and ecosystems for human health ought to be examined and communicated to decision-makers and the public. We therefore summarized the lessons and recommendations from an interdisciplinary conference convened in Cambodia in 2014 to advise Southeast Asian societies on current research efforts, future research needs, and to provide suggestions for improved education, training and science–policy interactions. First, we reviewed several examples of the important role of ecosystems as ‘sentinels’ in the sense that potentially harmful developments for human health become first apparent in ecosystem components. Other ecosystem services which also benefit human well-being are briefly summarized. Second, we summarized the recommendations of the conference's roundtable discussions and added recent developments in the science–policy interface. The recommendations were organized along five themes: Ethical and legal considerations; implementation of the One Health approach; education, training, and capacity building; future research priorities; and potential science–policy interactions. While the role of biodiversity for human health needs further research, especially for zoonoses and emerging diseases, many direct and indirect benefits to human health are already apparent, but have yet to filter down to the science–policy interface in order to influence legislation and enforcement. Therefore, efforts to strengthen the interface in Southeast Asia should become a high priority in order to strengthen the health and resilience of Southeast Asian societies.     

Mental health services for Asian Americans and pacific islanders

Inquiries over the past three decades have shown that ethnic minorities drop out of treatment early and tend to have poorer outcomes in psychotherapy. Despite the widespread acceptance that culturally responsive therapy and programs will produce better treatment outcomes for ethnic minorities, few studies have empirically tested this proposition. This paper reviews two types of interventions, ethnic match and parallel programs, to make the mental health system more responsive to the needs of Asian Americans and Pacific Islanders. This study was supported in part by the National Research Center on Asian American Mental Health (MH44331) and research grant MH47526.     

Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups

ABSTRACT

Objectives: This paper is an examination of cancer/health communication factors (i.e. cancer/health information seeking, patient-provider communication (PPC), cancer screening information from providers) and screening for breast and cervical cancer among Asian Americans and five Asian ethnic groups (Chinese, Filipinos, Japanese, Koreans, Vietnamese) in comparison to Whites. Additionally, the relationship between cancer/health communication disparity and cancer screening gaps between Asian Americans and Whites was investigated.

Design: Data comes from a nationally representative sample of 2011–2014 Health Information National Trends Surveys (HINTS).

Results: Asian Americans and most Asian ethnic-groups reported significantly lower rates of cancer/health information seeking and lower evaluations for PPC as compared to Whites, though differences within Asian ethnic groups were observed (Koreans’ greater cancer/health information seeking, Japanese’ higher PPC evaluation). When the cancer/health communication factors were controlled, Asian Americans’ odds of cancer screening were increased. Especially, Asian Americans’ odds of adhering to the breast cancer screening guideline became nearly 1.4 times greater than Whites.

Conclusion: This research demonstrates that health organizations, providers, and Asian American patients’ collaborative efforts to increase the access to quality cancer information, to make culturally competent but straightforward screening recommendations, and to practice effective communication in medical encounters will contribute to diminishing cancer disparities among Asian Americans.     

Population characteristics and health care needs of Asian Pacific Americans

Asian Pacific Americans are one of the smallest but fastest growing minority groups in the United States. Between 1970 and 1980, this population increased 142 percent, from 1.5 million to 3.7 million. This dramatic growth is due largely to a change in U.S. immigration policies in the mid-1960s and the continuous influx of refugees from Southeast Asia since 1975. Despite such sharp increase, Asian Pacific Americans remain one of the most poorly understood minorities, and their health care needs have received relatively little attention. Health policy makers, planners, and service providers need to have a better understanding of the population characteristics of Asian Pacific Americans in order to address their needs properly. Asian Pacific Americans are largely recent immigrants and refugees. They are extremely heterogeneous and bipolar in socioeconomic status and health indices. Because of their small numbers until the last two decades, many health workers have had little exposure to this minority, their culture, and health problems. Health workers need to be sensitive to the ethnocultural barriers that confront recent arrivals; be aware of the genetic disorders, infectious diseases, and mental health problems common in this population; and realize that anatomical and physiological differences may require attention in certain surgical procedures and medical management. Neglecting the health care needs of Asian Pacific Americans is not simply a violation of the principle of equality for all, but also an imprudent act that increases the mortalities and morbidities and health care costs of the nation.     

Sarcopenia in Asia: Consensus Report of the Asian Working Group for Sarcopenia

Sarcopenia, a newly recognized geriatric syndrome, is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Despite the clinical significance of sarcopenia, the operational definition of sarcopenia and standardized intervention programs are still lacking. It is generally agreed by the different working groups for sarcopenia in the world that sarcopenia should be defined through a combined approach of muscle mass and muscle quality, however, selecting appropriate diagnostic cutoff values for all the measurements in Asian populations is challenging. Asia is a rapidly aging region with a huge population, so the impact of sarcopenia to this region is estimated to be huge as well. Asian Working Group for Sarcopenia (AWGS) aimed to promote sarcopenia research in Asia, and we collected the best available evidences of sarcopenia researches from Asian countries to establish the consensus for sarcopenia diagnosis. AWGS has agreed with the previous reports that sarcopenia should be described as low muscle mass plus low muscle strength and/or low physical performance, and we also recommend outcome indicators for further researches, as well as the conditions that sarcopenia should be assessed. In addition to sarcopenia screening for community-dwelling older people, AWGS recommends sarcopenia assessment in certain clinical conditions and healthcare settings to facilitate implementing sarcopenia in clinical practice. Moreover, we also recommend cutoff values for muscle mass measurements (7.0 kg/m² for men and 5.4 kg/m² for women by using dual X-ray absorptiometry, and 7.0 kg/m² for men and 5.7 kg/m² for women by using bioimpedance analysis), handgrip strength (<26 kg for men and <18 kg for women), and usual gait speed (<0.8 m/s). However, a number of challenges remained to be solved in the future. Asia is made up of a great number of ethnicities. The majority of currently available studies have been published from eastern Asia, therefore, more studies of sarcopenia in south, southeastern, and western Asia should be promoted. On the other hand, most Asian studies have been conducted in a cross-sectional design and few longitudinal studies have not necessarily collected the commonly used outcome indicators as other reports from Western countries. Nevertheless, the AWGS consensus report is believed to promote more Asian sarcopenia research, and most important of all, to focus on sarcopenia intervention studies and the implementation of sarcopenia in clinical practice to improve health care outcomes of older people in the communities and the healthcare settings in Asia.     

A 1993 Status Report on the Health Status of Asian Pacific Islander Americans: Comparisons with Healthy People 2000 Objectives

PURPOSE OF THE PAPER: The purpose of this paper is to offer a current assessment of the health status of Asian Pacific Islander Americans (APIAs) with respect to relevant Healthy People 2000 objectives and an assessment of Federal resource allocations targeted at APIAs. SUMMARY OF METHODS UTILIZED: The author reviewed documents from the relevant progress reports made to the Assistant Secretary on Health on Healthy People 2000 objectives, other Federal documents, and a review of the literature. PRINCIPAL FINDINGS: Adequate progress has been made on only one of the eight objectives targeted at APIAs; progress on the remaining objectives is either "not on target," require more data to evaluate, or inappropriate for APIAs at this time. Examples of APIA health problems not included in Healthy People 2000 objectives were documented. Illustrations of inadequate allocations of Federal health resources were cited. CONCLUSIONS: APIAs have been among the most neglected minority group with regards to health status surveillance, health services, and have been the most overlooked in Federal resource allocations. However, as greater awareness of data deficits and health status is presented, policy makers have the opportunity to improve the situation. A policy to improve the health status of APIAs must be multifaceted and minimally include the facets of data needs, intervention approaches, a research agenda, and advocacy. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: A 1993 review of the health status of APIAs with regards to the eight Healthy People 2000 and areas not covered by Healthy People 2000 were reviewed. KEY WORDS: Asian Americans, health status, health policy, health planning, tobacco, diet, diseases     

Smoking behaviors among immigrant Asian Americans: rules for smoke-free homes

BACKGROUND: Higher acculturation is associated with Asian-American smoking prevalence decreasing in men and increasing in women. Asian immigrants in California are significantly more likely than their counterparts in Asia to have quit smoking. Smoke-free environments may mediate this acculturation effect because such environments are not widespread in Asia. METHODS: In 2006, Asian-American current and former smokers were analyzed using the 2003 California Health Interview Survey. A multivariate logistic regression analysis examined how the interaction between having a smoke-free-home rule and immigrating to the U.S. is associated with status as a former smoker and lighter smoking. RESULTS: For recent Asian immigrants (<10 years in the U.S.) and longer-term residents (born/>or=10 years in the U.S.), having a smoke-free-home rule was associated with status as a former smoker (OR 14.19, 95% CI=4.46, 45.12; OR 3.25, 95% CI=1.79, 5.90, respectively). This association was stronger for recent immigrants (p=0.02). Having a smoke-free-home rule was associated with lighter smoking only for longer-term residents (OR 5.37, 95% CI=2.79, 10.31). CONCLUSIONS: For Asian Americans, smoke-free-home rules are associated with status as a former smoker, particularly among recent immigrants, and lighter smoking in long-term residents. Interventions encouraging Asian Americans to adopt smoke-free-home rules should be evaluated.     

Rural and remote health research: Does the investment match the need?

Objective

To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000–2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005–2014.

Design

This is a retrospective analysis of publicly available datasets.

Setting

National Health and Medical Research Council Rural and Remote Health Research 2000–2014.

Outcome measures

‘Australian Rural Health Research’ was defined as: research that focussed on rural or remote Australia; that related to the National Health and Medical Research Council's research categories other than Basic Science; and aimed specifically to improve the health of Australians living in rural and remote areas. Grants meeting the inclusion criteria were grouped according to the National Health and Medical Research Council's categories and potential benefit. Funding totals were aggregated and compared to the total funding and Indigenous funding for the period 2005–2014.

Results

Of the 16 651 National Health and Medical Research Council‐funded projects, 185 (1.1%) that commenced funding during the period 2000–2014 were defined as ‘Australian Rural Health Research’. The funding for Australian Rural Health Research increased from 1.0% of the total in 2005 to 2.4% in 2014. A summary of the funding according to the National Health and Medical Research Council's research categories and potential benefit is presented.

Conclusion

Addressing the health inequality experienced by rural and remote Australians is a stated aim of the Australian Government. While National Health and Medical Research Council funding for rural health research has increased over the past decade, at 2.4% by value, it appears very low given the extent of the health status and health service deficits faced by the 30% who live in rural Australia.     

The role of payment and financing in achieving health equity

Objective

The aim was to identify healthcare payment and financing reforms to promote health equity and ways that the Agency for Healthcare Research and Quality (AHRQ) may promote those reforms.

Data Sources and Study Setting

AHRQ convened a payment and financing workgroup–the authors of this paper–as part of its Health Equity Summit held in July 2022. This workgroup drew from its collective experience with healthcare payment and financing reform, as well as feedback from participants in a session at the Health Equity Summit, to identify the evidence base and promising paths for reforms to promote health equity.

Study Design

The payment and financing workgroup developed an outline of reforms to promote health equity, presented the outline to participants in the payment and financing session of the July 2022 AHRQ Health Equity Summit, and integrated feedback from the participants.

Data Collection/Extraction Methods

This paper did not require novel data collection; the authors collected the data from the existing evidence base.

Principal Findings

The paper outlines root causes of health inequity and corresponding potential reforms in five domains: (1) the differential distribution of resources between healthcare providers serving different communities, (2) scarcity of financing for populations most in need, (3) lack of integration/accountability, (4) patient cost barriers to care, and (5) bias in provider behavior and diagnostic tools.

Conclusions

Additional research is necessary to determine whether the proposed reforms are effective in promoting health equity.     

Caring for Southeast Asian refugee patients in the USA

This paper concerns care of refugees from Southeast Asia who speak little English and are relatively unfamiliar with the formal health care system in the United States. It aims to demystify the behaviors of refugee patients and to support health practitioners who are attempting to care for them. Western medicine is discussed in terms of the expectations that refugees tend to hold of it, and of the conflicts with Southeast Asian beliefs and practices which it presents. Despite language differences, health care agents can increase the effectiveness of their communication with persons from Southeast Asia, primarily by allowing for their viewpoints. Topics discussed are: the first encounter with a refugee patient; use of interpreters; obtaining informed consent; "the passive obedient" patient; the "non-compliant" patient; body image; sources of social support for healing; use of medications; traditional self-care practices; and death and depression.     

Heterogeneity within the Asian American community

BACKGROUND: Educational interventions are grounded on scientific data and assumptions about the community to be served. While the Pan Asian community is composed of multiple, ethnic subgroups, it is often treated as a single group for which one health promotion program will be applicable for all of its cultural subgroups. Compounding this stereotypical view of the Pan Asian community, there is sparse data about the cultural subgroups' similarities and dissimilarities. The Asian Grocery Store based cancer education program evaluation data provided an opportunity to compare data collected under identical circumstances from members of six Asian American cultural groups. METHODS: A convenience sample of 1,202 Asian American women evaluated the cultural alignment of a cancer education program, completing baseline and follow-up surveys that included questions about their breast cancer knowledge, attitudes, and screening behaviors. Participants took part in a brief education program that facilitated adherence to recommended screening guidelines. RESULTS: Unique recruitment methods were needed to attract participants from each ethnic group. Impressions gained from the aggregate data revealed different insights than the disaggregate data. Statistically significant variations existed among the subgroups' breast cancer knowledge, attitudes, and screening behaviors that could contribute to health disparities among the subgroups and within the aggregate Pan Asian community. CONCLUSION: Health promotion efforts of providers, educators, and policy makers can be enhanced if cultural differences are identified and taken into account when developing strategies to reduce health disparities and promote health equity.     

Asian dust storms and diabetes hospitalization: a nationwide population-based study

This study analyzed the association between Asian dust storms events and diabetes hospital admissions during 2000–2009 in Taiwan using time-series autoregressive model with explanatory variables. Data came from National Health Insurance Research Database, Taiwan Environmental Protection Agency, and Central Weather Bureau. There were 1,283,509 diabetes hospital admissions and 55 ADS events. Our study showed that Asian dust storms were positively associated with diabetes hospital admissions for women, but the connection was delayed rather than immediate. The females who were aged above 74 and who were active in the labor market were more vulnerable to Asian dust storms.     

Correlates of Mental Health Treatment Receipt Among Asian Americans with Perceived Mental Health Problems

The Journal of Behavioral Health Services & Research - Compared with other ethnic groups, Asian Americans report the lowest rates of mental health treatment and service utilization. This is...     

Assessing progress of the Pan American Health Organization's Policy Research for Health in member states

The improvement of health in the twenty-first century is inextricably linked to research for health. In response to growing international appeal to address regional health needs, the Pan American Health Organization (PAHO) and its Member States approved the Policy on Research for Health (CD49/10) in 2009. This document represents the flagship regional policy on research for health and outlines how health systems and services in the region can be strengthened through research. It has been implemented by the two components of PAHO —the Member States and the Pan American Sanitary Bureau. The policy contained a specific directive mandating PAHO to report on its implementation, development of subsequent strategies, and action plans targeting its governing bodies. The Americas are the first World Health Organization (WHO) region to issue a regional Policy on Research for Health, which was harmonized with WHO's Strategy on Research for Health, approved in 2010. Attending to the recommendations issued by PAHO's Advisory Committee on Health Research and WHO's Advisory Committee on Health Research, the PAHO Department of Knowledge Management, Bioethics and Research set out to advance the assessment of the implementation of the Policy on Research for Health through the creation of a monitoring and evaluation Scorecard. Indicators relevant to the Policy on Research for Health objectives were mapped from the Compendium of Impact and Outcome Indicators, with new indicators created. A practical framework based on available indicator data was proposed to generate a baseline policy assessment and incorporate a means of incrementally enhancing the measurements. In this case study, we outline the iterations of the PAHO Policy on Research for Health Scorecard, as well as the lessons learned throughout the development process that may be a valuable guide for health research entities monitoring and evaluating the progress of their own policies.     

Tools for thoughtful action: the role of ecosystem approaches to health in enhancing public health

The intimate interdependence of human health and the ecosystems in which we are embedded is now a commonplace observation. For much of the history of public health, this was not so obvious. After over a century of focus on diseases, their biologic causes and the correction of exposures (clean water and air) and facilitation of responses (immunizations and nutrition), public health discourse shifted to embrace the concept of determinants of health as extending to social, economic and environmental realms. This moved the discourse and science of public health into an unprecedented level of complexity just as public concern about the environment heightened. To address multifactorial, dynamic impacts on health, a new paradigm was needed which would overcome the separation of humans and ecosystems. Ecosystem approaches to health arose in the 1990s from a rich background of intellectual ferment as Canada wrestled with diverse problems ranging from Great Lakes contamination to zoonotic diseases. Canada's International Development Research Centre (IDRC) played a lead role in supporting an international community of scientists and scholars who advanced ecosystem approaches to health. These collective efforts have enabled a shift to a research paradigm that embraces transdisciplinarity, social justice, gender equity, multi-stakeholder participation and sustainability.     

Symposium on understanding and influencing consumer food behaviours for health: executive summary report

Food consumption patterns in Asia are rapidly changing. Urbanization and changing lifestyles have diminished the consumption of traditional meals based on cereals, vegetables and root crops. These changes are accompa-nied by an increasing prevalence of chronic diseases among Asian populations. ILSI Southeast Asia and CSIRO, Australia jointly organized the Symposium on Understanding and Influencing Food Behaviours for Health, focusing on the use of consumer science to improve food behaviour. The goals of the Symposium were to present an understanding of Asian consumers and their food choices, examine the use of consumer research to modify food choices towards better health, illustrate how health programs and food regulations can be utilized effectively to promote healthier choices, and identify knowledge gaps regarding the promotion of healthy food behaviour in Asian populations. There is no difference in taste perception among Asians, and Asian preference for certain tastes is determined by exposure and familiarity largely dictated by culture and its underlying values and beliefs. Cross-cultural validity of consumer science theories and tools derived from western populations need to be tested in Asia. Information on consumption levels and substitution behaviours for foods and food products, obtained using consumer research methods, can guide the development of food regulations and programs that will enable individuals to make healthier choices. Existing knowledge gaps include consumer research techniques appropriate for use in Asian settings, diet-health relationships from consumption of traditional Asian diets, and methods to address the increasing prevalence of over- and undernutrition within the same households in Asia.