Culture and Public Health in Asian and Pacific Islander Americans (APIAs)

Chinese Lanterns In celebration of Asian American Heritage month in May, we’re highlighting a few key public health issues related to APIAs, and are participating in GE’s Asian Pacific American Forum (APAF) webinar series geared towards APIA professionals. We're hoping to bring greater awareness to some of the cultural factors that affect major health issues that APIA face today.

About the APIA Demographic

APIAs comprise roughly 5% of the US population and is a diverse group with more than 40 ethnic groups. There are varying levels of acculturation and different health needs among APIA groups; however, they are often grouped under one category in national data and therefore the unique differences of subgroups often go unnoticed. Furthermore, there is a lack of research and data about this group in general, which leads to an underestimation of true health needs, making it difficult to support programs and policies that can potentially benefit this population.

What Are the Top Health Concerns Today?

1)   Chronic Disease such as cancer, heart disease, stroke, and diabetes;

2)   Mental Health issues related to suicide, depression, and anxiety; and

3)   Aging Population Health issues including dementia, Alzheimer’s, and influenza

Other prominent health issues include HIV/AIDs, Hepatitis B, and health issues related to LGBT individuals.

What are the Current Barriers?

Culturally embedded norms and values among APIAs can act as barriers to optimal health. It can influence how one feels, such as shame or a sense of stigma associated with disease, and how one copes through avoidance, denial or suppression of feelings. This can lead to unhealthy coping mechanisms and delay treatment for disease until it's at a critical point or too late.

There are also structural and environmental influences such as a lack of culturally or linguistically appropriate educational materials or care at health institutions, or a lack of care providers who are in tune with health issues affecting APIA. Thus, awareness and knowledge of preventive measures and optimal health behaviors remains a challenge, particularly for largely immigrant populations that may have additional barriers related to english proficiency and acculturation.

APIAs also have a strong preference for informal support and tend to be self-reliant or prefer seeking help from friends, neighbors, religious figures, or healers before seeking formal care (according to the CAPE study).

The CAPE (Chinese American Psychiatric Epidemiology) Study found that Asians tended to delay treatment until it reached crisis proportions and only 17% sought treatment for mental health problems.

As you can see, there are cultural, environmental, and individual factors that when combined, act as a rather large barrier to seeking care or optimally managing one's health.

Artwork to Open up Dialogue

"Silent Treatment" from the Remedies Collection by Monica Ong ReedArtwork by Monica Ong Reed speaks to these cultural issues in addition to social problems like gender bias, stigma, and shame surrounding mental illness. Her striking and thought provoking work seeks to encourage dialogue about these issues that APIA are often silent about. Check out her artwork on www.monicaong.com or visit the Parachute Factory this summer to view the exhibition, Critical Condition, which highights important community issues in public health.

What Can You Do About it?

Start talking about these issues – end the silence. This is often the hardest part, and it's a matter of how you approach it. If your family member has an issue that you're concerned about, bring it up in a non-judgmental way that won't make them defensive or feel ashamed. Tell them how it makes you feel (e.g. worried or upset) and suggest some concrete options as a solution or offer to help look up some resources. And most of all, remind them how important they are to you, which is why you're concerned.

There are other actions you can take including encouraging others to seek help earlier on, volunteer at local community centers if you can speak the language, demand services or translation services for your family members or friends, and consider participating in research so that we can learn more about issues related to APIA and which types of treatments are more effective.

And remember that overcoming barriers to optimal health for APIAs is a community effort - it involves promoting awareness and speaking up about health/mental health issues at the most fundamental level to better understand existing barriers. Once we gain a better understanding we can implement culturally appropriate solutions that work.

Some Helpful Resources

National Asian American Pacific Islander Mental Health Association - A national directory of AAPI service providers that speak different languages

New York Coalition for Asian American Mental Health - Directory of organization and services

The Banyan Tree Project - National campaign to end the silence and shame surrounding HIV/AIDS in AAPI communities

Asian Human Services - A local health center providing wide-ranging services for the Asian, immigrant, and underserved communities in the Chicago area

API Wellness Directory - Asian and Pacific Islander HIV/AIDS health/social services directory

Resource Guide via Hyphen Magazine - This is a compendium in progress with hotlines and health centers, and includes an article on finding culturally competent healthcare.

For more, check out our Health Resources page.

Critical Condition: Please Support!

 

Please support this collective of women artists for Critical Condition, an exhibition giving voice to important community issues in public health. All donated funds will help to make this show possible at the Parachute Factory, a collaboration between the Yale Program for Recovery and Community Health (PRCH), the Community Services Network of Greater New Haven (CSN), and the Arts Council of Greater New Haven.

Featuring new work by artists Liana Dragoman, Monica Ong Reed, Silvia Rigon, and the Center for Digital Storytelling.

This exhibition positions the body as a stage – where embedded beliefs and social constructs collide and re-emerge as transformative narratives about cultural anomalies in public health. These artists and storytellers gather voices of witness and meditation, asking questions that are poignant but pointed.

What happens when a woman’s body cannot be translated? Why do scars persist and what do they teach us about silenced histories? When aberrations in cell growth spell out a terminal condition, what happens to our illusion of security? How do we contend with stigma in the face of domestic violence or HIV/AIDS? These ruptures call on us to revisit – and redefine – the social conditions from which they erupt, spill, and burn into our shared memory.

See You on the Flip Side! : An Exhibition on Narrative/Identity

February 3 – March 12, 2011 at the AC Institute in NYC

Thursday, February 3 is the opening of the group show "See You on the Flip Side!"on narrative and identity at the AC Institute in the Chelsea gallery district in New York from February 3–March 12, 2011. The exhibition will feature the "Remedies" series as well as the completed "Old Timer's Dis-ease" series that reflects on the cultural-medical experiences in my multi-generational family. I'm so pleased to be a part of this distinguished selection of works and to be able to share interesting stories that question Asian-American notions of identity.

I want to thank the poets of Kundiman and the Poetry Institute of New Haven for their support.

Jamie Zeller: Saving a Child's Heart

As a volunteer, Jamie comforts a child who has travelled a long way to Azur, Israel, for a life-saving heart surgery.

This year, I want to highlight the work that people are doing to improve the public health of communities that struggle to get access to medical care and empowerment. Often, we may think that contributing to society is the work of "experts" or people who make professions out of it, who have spent years earning medical degrees – but what I want to assert is that, each of us – despite our backgrounds, education levels, or professions – we can do things that make a difference, that ordinary people are capable of adding something to the global dialogue and that even simple choices or comforting words, can completely change the course of another person's recovery of health and of hope.

I want you to meet Jamie Zeller, who volunteered with Save a Child's Heart. She is a school teacher from the north suburban Chicago area who left her comfortable surroundings to go to Israel and help children and their families from around the world. These families came to seek the health care and support that we often take for granted in the United States.

Question: Tell us about the project you did and what Save a Child's Heart is all about.

Jamie: I volunteered with Save a Child's Heart in the spring/summer of 2009 and winter of 2010. The children's home is located in Azur, Israel. This organization provides heart surgeries for children who come from developing countries around the world. At the children's home, I spent time with the children and their mothers who are waiting for surgery or recovering from surgery before returning home.

When I volunteered at the Children's home, I had a very special connection with a little girl from Africa. She was barely 3 years old and had a huge scar from her neck down to her chest. I sat down with her on the couch and brought a bunch of story books to read and toys to play with. The day was sunny and slightly cool and we were looking outside. I had a distinct connection with her because I had recently gone through a major surgery and understood a thing or two about recovering and healing from such a medical trauma. This child stuck to me like white on rice. She craved the love and warmth from another person who cared about her. I was happy to be the volunteer to do that.

This lovely girl enjoys an afternoon at the children's home where she is recovering from the heart surgery she received at the nearby hospital. 

Question: What communities did you work with? What kinds of challenges did they have in terms of access to good health care or health awareness?

Jamie: I worked with children from Angola, Zanzibar and China. They are flown to Israel to get the proper care they need due to lack of health care or awareness in their native countries.

Question: Why was doing this important to you? What did you learn and how did the experience impact you?

Jamie: It was important for me to work with these children for various reasons – I am passionate about teaching children and spending time with them. By helping these children pass the time with story reading, playing games and making them laugh overall, I felt I was doing my part in assisting in their emotional healing. I also wanted to be there for their mothers if they needed help or someone to talk to. Learning about these children impacted me in such a powerful way because I saw their strength firsthand. These children possessed resilience and the ability to persist with their lives despite these medical challenges and obstacles in their way.

Question: How can people get support or get involved with Save a Child's Heart?

Jamie: This is so timely because now Save a Child's Heart is doing something to raise money for their organization. For Valentine's Day, SACH is encouraging people in the states to organize fundraising events such as Valentine's Day parties in order to raise money for the children to be able to fly to Israel and receive their heart surgeries, etc. In the SACH website, there are events and ways people can get involved whether in Israel at the Children's home in Azur, visiting patients at the hospital or in the states to raise $$ and awareness for this organization.    //

Please visit SACH's website to find out how you can support their cause. I also want to thank Jamie for sharing her experience, for being an example of how a person can go out into the world and give back. There are so many ways to do so and I think if we connect with people in our community, we will discover that there are so many opportunities everywhere for young people to get involved. To me, the time that one commits during youth to developing themselves, discovering their sense of purpose, and exploring unfamiliar places and people, is greater than any treasure that one might find.

What I find profound about this program is that the doctors there treat not only children from the Israeli communities but also the Palestinian communities as well. It shows us that we as human beings all want the same thing: healthy, happy lives. It also allows participants to connect with other people on a human level, no matter how different their beliefs and backgrounds, which is the foundation for equality in society. It shows us that compassion is greater than conflict, as long as we choose to act on it. If we think about it, when we give of ourselves to help another, in the end, two lives are actually saved.

Redesigning Packaging for Better Health

Image from www.target.com

I first heard of the designer Deborah Adler during a presentation on Health Literacy at work. Deborah was the designer who redesigned prescription medication bottles at Target. The idea for this project stemmed from an incident where her grandmother mistakenly took her husband’s medication because their names, Helen and Herman, dosage strength, and medication bottles looked similar. Fortunately, nothing terrible happened, but this got Deborah thinking about how prescription bottles could be redesigned to prevent the same thing from happening to others.

The new bottle is more intuitive and makes the information easy to read, has a different color ring at the base to distinguish among various family members, and has a slide out patient information card that is stored in the back. The redesign is wonderful and hopefully makes the process of taking medications more easily understandable and error free. Although this project was adopted by Target, I hope that medication packaging redesign will expand to other pharmacies so that this benefit can reach the broader population.

 Image from www.medline.com

The next interesting project Deborah is working on is redesigning wound care packaging with Medline to promote the appropriate use of wound care products by health care workers. As the demand for these products is increasing and appropriate application is essential for improving patient care, similar initiatives have been undertaken by other companies like Celox based in England. These designers are trying to make packaging easier to understand with simple illustrated instructions and color coding to prevent errors. It's truly a wonderful thing when designers get involved in health care. Sometimes it's not about inventing a new product, but redesigning what we already have.