Tackling Asian American Health Disparities

In recognition of Asian Pacific American Heritage Month, Tell Me More takes a look at health care in the Asian-American community. A recent issue of the American Journal of Public Health dedicated entirely to this topic found striking disparities between certain groups of Asian Americans and non-Asians. Kathy Lim Ko, director of The Asian and Pacific Islander Health Care Forum, joins guest host Allison Keyes for a conversation about why these health gaps exist, and how they can be bridged.

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ALLISON KEYES, host:

As we continue coverage of Asian-American Heritage Month, we want to turn next to some surprising news about health disparities between those of Asian descent and other Americans, as well as major differences among groups within the Asian-American community.

With us to discuss the overall trends found by recent studies detailed in the American Journal Public Health is Kathy Ko. Ko is President and CEO of the Asian Pacific Islander Health Forum, which had input on the special edition of the journal. Kathy, welcome to the program.

Ms. KATHY KO (President and CEO, Asian Pacific Islander Health Forum): Thank you, Allison. Thank you for having me today.

KEYES: So, what is the first thing on your list when you think of Asian-American Health issues versus those of the general American public?

Ms. KO: There's a model minority myth for Asian-Americans, Native Hawaiians and Pacific Islanders that we don't have health problems. We had heart-wrenching cases of Asian-American women who've gone in to see physicians and being told that Asian women don't get breast cancer. One of the biggest challenges that we face is a lack of data on specific ethnicities and groups that can reveal the health disparities that do exist in our community.

KEYES: When you say model minority myth, who thinks that? And does that affect the way the Asian-American community deals with health issues?

Ms. KO: Well, because the Asian-American, Native Hawaiian and Pacific Islander communities are so diverse, but when we gather the data together and everyone is lumped together you see information that's provided that says that Asians are healthier than other groups. However, if you start to take that apart and really look at it in separate groups, we see that certain groups have some of the highest rates of certain diseases as compared to any other communities across the country.

So, for example, one of the highest risk groups for breast cancer is U.S.-born Vietnamese women, who are four times greater of dying of breast cancer than any other groups. Or Native Hawaiians, who experience extremely high rates of diabetes and obesity as compared to other communities. Or even in issues of coverage of care, Korean children are four times more likely to have no health insurance as compared to others. So we need to look at the data that really looks at specific communities as opposed to lumping everyone together.

KEYES: A few of the studies I've seen suggest that culturally appropriate care might lower rates of certain types of cancer. What does that mean? Is it about the language disparities? What does that mean?

Ms. KO: Yes. I think there are a number of factors in there. Language is a huge issue. If you can't communicate with you provider, then they can't really understand the experiences that you're having, the symptoms you're having. And so, the ability to diagnose and then finally treat your condition is really limited.

But also, culturally appropriate care is really important. There's certain cancer sites that are more common in certain ethnicities and if the treating physician or clinician isn't aware of that they may not go through the kind of tests that are necessary to find the problem.

KEYES: Is there a particular group within the Asian-American community that is having more of a problem with this than others?

Ms. KO: Well, in general I think we see Southeast Asian communities and Native Hawaiian, Pacific Islander communities that for whom the data has just not been as revealing or the numbers that have been surveyed or studied have just not been as significant. So we know anecdotally that there are more challenges in those communities, that there are a lot of health risks but we have not been able to reveal those at either state or federal level data.

KEYES: You said a couple of minutes ago that Native Hawaiians are twice as likely to be obese as whites in their state. Why is that and is there a cultural issue?

Ms. KO: Well, we don't really know that. I think it's really a question of there hasn't been enough research that's been available or done in our specific communities to really reveal what the issues are. I mean, we know that the transition from native diets to more Western lifestyles has really affected the health of any community that makes that transition. So we really need more data and research to be able to tell what the reasons are for that.

KEYES: I wonder if some of these disparities are because Asian-Americans turn away from so-called Western medicine and therefore, they aren't going to hospitals. They're, you know, doing the same kind of medicine that they practiced in their home countries.

Ms. KO: I think that what we've see is that the complimentary medical practices, complimentary health practices have been helpful. But really, the issue I think in many of our communities is access to care. So we have really high rates of un-insurance and with a lack of insurance, then accessing care that's also linguistically and culturally accessible is a real challenge. So with the opportunity to get direct access to care, then some of the issues that people are facing will get diagnosed and then treated.

KEYES: In the health care reform that was just passed, is there anything in the bill that directly affects Asian-Americans?

Ms. KO: Yes. In the health care reform bill it's really unprecedented the number of people who will have been formerly uninsured and now will be covered, which is really wonderful. And for low income communities, expansion of the Medicaid program is really a wonderful thing. At the same time, there are restrictions on legal immigrants being able to access Medicaid and that will still leave numbers, large numbers of uninsured, low income immigrants who are here legally to be able to access care.

At the same time, access to the exchanges that each state is supposed to set up, there are questions that we have about the affordability of those exchanges, especially if you would otherwise qualify for Medicaid, but are restrictive because of your immigration status.

KEYES: So moving forward, under the reform bill, what would be some of the most important issues that you would like to see addressed for the Asian-American community to help reduce the number of these disparities?

Ms. KO: Well, really, the access to coverage is really important. To have legal immigrants who do pay taxes, who are a part of the working environment and really have - be able to qualify for Medicaid services, that would be really wonderful. We do have about 12 or 13 states, plus the District of Columbia that has taken that option in Medicaid, and we would really encourage more and more states to do that.

Also, coverage of children, immigrant children, there is that ability for states to also take that option and that would really help because certainly we really want to make sure that our future generations are healthy and well. So coverage issues and then also language access. There are opportunities for states to also, again, tap additional Medicaid matched dollars federal dollars for language access for interpretive services and those would also make the services themselves more accessible.

KEYES: Really briefly, are groups within the Asian-American community aware of this problem and are they trying to do anything themselves to fix it?

Ms. KO: Yes. We have the privilege of working with 12 different communities across the country in places that have large Asian-American, Native Hawaiian and Pacific Islander populations, such as in Atlanta, Georgia or Utah, Minnesota. And all of those communities are organizing themselves to get more access to care, to go to their states and their local health departments to try to get more services that really address the needs of our communities.

KEYES: Kathy Ko is President and CEO of the Asian Pacific Islander Health Forum. She joined us from San Francisco. Kathy, thank you much.

Ms. KO: Thank you very much.

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