Averting Impact

The Center for Disease Control and Prevention, in Atlanta, Georgia, began its campaign, "Healthy People 2010" with this statement from the CDC website: "Health is a basic need of all people, and as we find better ways to prevent and treat illness, no group should be left behind. This conviction is at the heart of public health. For the past century, the good news on the nation's health is that remarkable improvements have been enjoyed by all, regardless of race, ethnicity, sex, education, income, or geographic location." (www.cdc.gov/nccdphp/cdnr/cdnr_winter0201.htm)

Out here on the edge of the Pacific Ocean, Washington State reports one of the highest unemployment rates in the country, and is led by a 'Democratic' governor who has jolted the state with his penchant for cutting social services like state-funded healthcare.

Now Governor Locke, himself a child of immigrants, has raised an axe to benefits for thousands of immigrant and low-income residents of the state. Many residents who relied upon state insurance as they looked for jobs are now penalized for getting sick. Children will lose their benefits, adults will be cut from dental care, in all over 250,000 state residents will be left behind.

Insurance for primary physician care is one thing, receiving consistent, continuous care for being a diabetic, afflicted with cardiovascular disease, cancer or HIV/AIDS is another financial conundrum. Not only patients, but also Urgent Care facilities, caregivers and eventually 'consumers' in general will feel the crunch. The impact on immigrant communities is glaring; the impact on South Asians has not even entered the minds of public health officials. As an ethnic group, South Asians are facing extremely limited outreach, social and public health services, all problems exacerbated by the fact that there are distinct class lines and geography between populations.

The South Asian Public Health Association (SAPHA) released a study including details on the impacts of chronic illnesses, women's health concerns, and youth health on the respective state of health' of our communities. Their findings urge communities to find ways to sway the motivations of 'hack and slash' administrations, like the one in Washington State. Their findings also encourage the creation of alternative, community-based, more preventative options.

One in five of the state's approximate 30,000 South Asians is already uninsured. Shopkeepers and restaurateurs rarely carry health insurance policies for their businesses. Many recent immigrants are contract workers, H1 visa holders, employees of small businesses, waiters, cooks, check out clerks and children, all of whom are usually left with no health benefits. Primary care or chronic illness treatment are well beyond their finances. It is contending with this last point that warrants the most concern. Trying to convince policy makers of the need for 'spending money' on our health will be difficult. Especially, when there is evidence of a strong financial need for ongoing health programs.

In order to treat chronic illness, medical practitioners are often led by the desire to treat the symptom. This falls short of more recent medical training and the new models for caring for people with chronic illness. The reliance on clinical diagnoses, alone, leaves out huge aspects of a person's life- their time with family, community, their jobs and themselves. Recommendations about diet changes often do not include ethnic foods, substitutions for Western foods or measurements readily understandable by the patient. Materials may be translated, but if the translator is not familiar with medical terminology, it can be as serious a difference between 'treating' a disease and 'curing' it.

What SAPHA Found

In order to determine the accuracy of SAPHA's findings, it is important to remember that a majority of information is collected under the larger umbrella of Asian and Asian Pacific American. The United States Census Bureau finally added Asian Indian as a racial option; little did they realize the national implications of such a narrow definition. In fact, in Washington State, it is almost impossible to determine the number of Pakistanis or Bangladeshis based on that particular racial identity. One has to look at religions and ancestry to create a plausible count.

Up till now health advocates have had little data to work with when developing public health initiatives, approaching major donors or creating ethnic-specific health education funds. It is difficult to guarantee accurate statistics when trying to gain the support of agencies and individuals. Quantitative data has been the 'gold standard' by which to develop health outreach. SAPHA combines results from populations in other countries like Britain to set the groundwork for the simplest of community needs assessments, many of the authors recommend taking into account similarities in immigrant diets, environmental and social changes, economic status and acculturation issues.

Having the 'brown paper' will do more for educating policy makers and funding organizations of the need to develope health services for South Asians. In terms of chronic illnesses alone, SAPHA authors have compiled the following data.

Cardiovascular Disease (CVD)

Authors Susan L. Levy, Meenakshi Khatta and Rajesh Vedanthan compiled their well documented statistical data on South Asian populations in the United States, United Kingdom and South Asia. In their findings, cardiovascular disease (CVD) is the primary cause of mortality among Asian Indians in the US. First generation Asian Indian immigrants to the US have a higher prevalence of CVD compared with other Asian populations. 38.7% of all deaths among Asian Indians attributed to diseases of the heart. The very identity of "South Asian ethnicity" itself remained a strong and independent predictor of CVD. For migrants, the combination of Westernization and genetic predisposition could explain this higher risk, even for those living healthier lifestyles. To be a bit more medical about the situation, South Asians have high rates of lipid abnormalities; low levels of HDL cholesterol, high levels of LDL cholesterol, elevated triglycerides and lipoprotein (a) levels. (In other words- HDL ='good cholesterol";LDL = 'the bad cholesterol', triglycerides = Bad; and lipoproteins are found to lead to myocardial infarction=Bad)

Cancer

Cancer rates increased at higher rates among Asian Americans than any other racial/ethnic group; females by 323% and males by 276%, according to Nadia Islam, of Asian American Network for Cancer Awareness Research and Training (AANCART), and her co-author Naseem Zojwalla , a National Cancer Institute Fellow at Columbia University. Breast cancer rates have increased about 15%., and Asian American women have the second highest risk of developing cervical cancer after Hispanic women. Chances of developing breast cancer increase by 80% after migrating to the US; 29% of women over the age of 50 have not had a mammogram in the past two years; 27% of women over 18 had not had a Pap smear in the last three years. They have found that screening for cancer among South Asian men and women is low, often due to lack of services, but also cultural issues. Common cancer sites within the body include lung, stomach, breast, cervical, pharynx, larynx and rectum.

Diabetes

According to the CDC 16 million Americans have diabetes, and as many as 5 million cases remain undiagnosed. Immigrant South Asian populations appear to be at a higher risk for developing diabetes, which poses a rapidly growing threat, according to authors Swapnil Rajpathak and Pinaki Mukherji. Contributing to the onset of insulin resistance is central adiposity ('big belly-ness"), a condition that may be higher among South Asian populations. They found that rates of diabetes differ among South Asian groups: Bangladeshis (26.6%) and Pakistanis (22.4%) versus Indians (15.2%). Environmental influences, diet and physical activity are key factors in the development of diabetes. That circulatory disease accounts for 77% of all deaths in diabetic South Asian populations as compared with 46% of Europeans should be ammunition enough when educating communities on health issues. Lastly, diabetic South Asians are more prone to organ damage, including kidney failure, even after controlling their sugar levels.

Alleviating the Burden: Doing the Work and Moving Forward

South Asians have their own set of social standards and 'positions' within families and communities. Going beyond the words of a doctor and receiving education on their illnesses is not something commonly done. In fact, more often than not, disease is a topic left unspoken. Add to that mix a lack of culturally accessible and relevant healthcare, 'English-only' medical services and a general distrust among South Asians for social services, and you have the challenge at hand.

The misconception that South Asian populations are wealthier and somehow removed from the ranks of other immigrants slows the move to provide services. All this could change if officials contend with the sobering facts detailed by SAPHA and other Asian American health associations. South Asians are prone to some of the most serious of illnesses, a situation that could change if the right proportion of intervention is mixed with the right amount of education. Outreach must be targeted to the public in general, particular ethnic communities, medical practitioners and policy makers. This last group has been all too willing to place social services and healthcare on the chopping block.

Some organizations around the United States do offer services, in-language and free of cost. Their work can serve as a model for other South Asian agencies advocating for better health within their communities. The South Asian Network, in Artesia California, has expanded its capacity in the last 13 years. The organization provides translated materials on domestic violence and other public health concerns in five South Asian languages. The staff prepares state insurance paperwork for low income families, offer referrals to county clinics and provide interpretations services when needed, all for free. They also run a legal clinic for immigrants and provide health agencies with cultural competency training.

The New York Taxi Worker's Alliance has teamed up with the Asian American Network for Cancer Awareness Research and Training (AANCART) to provide on-site blood sugar testing, Hepatitis B testing and other services at New York City taxi stands. AANCART, funded by the National Cancer Institute, has organized health fairs directed at South Asian communities. They pull in community health clinics and area medical personnel to offer educational services, screening and referrals to the public.

These programs offer states like Washington the opportunity to get creative. If the money is not out there from the federal or county government, perhaps there is support hidden within South Asian communities themselves. A number of individuals and organizations promote health clinics and hospitals in their countries of origin. Perhaps with the backing of SAPHA's 'brown paper' and results of other community health programs like REACH 2010, more individual and organizational donors will emerge. As with any campaign, potential resources must be convinced of the need.

We need community leaders who will step forward and begin this education process. The impact South Asians incur comes from external and internal sources. In one instance, an individual may be faced with bias or 'pressure' from work. When they return home, they are faced with the fact that they are ill, have cardiovascular problems, and the requirements of their familial role.

Out here on the frontier, the total costs to our communities in Washington State have yet to be determined. South Asians have to step forward and advocate for themselves, following the lead of other Asian American communities with long histories of organization and community service. Here in the Pacific Northwest it is possible to demand culturally competent and relevant healthcare, prevention and social services. There is a need, as the insurance coverage for low-income families disappears, and contract workers are left to pay in full for their own coverage. Where there have been successes there need to be more. It is a smarter move to develop community based healthcare networks for South Asians now, as the population still sits under two million rather than waiting until the costs have grown too high.

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