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Asian Americans: Not Necessarily a Model-Minority for Health

Sampan, News Report, M. Thang Posted: Nov 02, 2006

When a Harvard study on life expectancy made the news last month, headlines proclaimed that "Asians are the Most Healthy" and "Asian Women Live the Longest."

But those statements, while true in some cases, are also misleading. Asian Americans -- who number more than 10 million nationwide -- are not always a model-minority for health. Nor are they a homogeneous group to whom a label of "good health and long life" can be applied.

In the Harvard study, which the peer-reviewed journal, PLoS Medicine, published last month, researchers examined the death rates of Americans in the country's 3,141 counties. Titled "Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States," the researchers analyzed the counties for race, race-specific income, population density, and homicide rates. They divided the nation's population into the following "Eight Americas": (1) Asian (excluding Hawaiians and Alaskans); (2) Northland low-income rural white; (3) Middle America (Asians not in America 1 are in this category); (4) Low-income whites in Appalachia and the Mississippi Valley; (5) Western Native American; (6) Black Middle America; (7) Southern low-income rural black; and (8) High-risk urban black.

The researchers did note that Asian American women's life expectancy was 86.7 years -- and 91 years for those in Bergen, County, New Jersey. Additionally, the research team found that Asian Americans "have sustained extraordinary advantage over the other Americas for mortality.

But Asian Americans comprise several subgroups from many different countries. Some Asian Americans are poor; some are rich. Some have graduate degrees while others havent completed high school. Asian Americans include poor refugees and wealthy immigrants as well as those born in the U.S. Their level of English fluency, diet, and lifestyles vary. All of these factors can affect the health of Asian Americans, especially when it comes to accessing health care, risk of cancer and diabetes, and unhealthy habits such as smoking.

The Non-English Disadvantage

Non-English speakers are at a great disadvantage for good health in terms of quality of care and receiving medical services. This disadvantage applies not just to Asian immigrants, but to other linguistic minorities as well. In a study published in the July 20, 2006, edition of the New England Journal of Medicine, Latino patients who weren't proficient in English had difficulty getting healthcare. The study, as reported in HealthDay News, showed that they received fewer preventive services, and they were less likely to follow directions for medications. Children with asthma who had language barriers were more likely to require breathing tubes and be placed in intensive care.

The lack of cultural competencies among medical professionals -- which means more than just providing translated materials to patients -- is another barrier to better health and disease prevention for immigrants and their children. It can contribute to the continuation of risky behaviors, such as smoking and poor diet. But health professionals can improve the situation -- and avoid greater medical expenses -- by training doctors and medical staff to be more attuned to the cultures and needs of their limited English-speaking patients.

At the Fred Hutchinson Cancer Center in Seattle, for instance, researchers found that language- and culture-specific interventions could significantly raise the screening rates for colorectal cancer in low-income Chinese patients.

A clinic-based multilingual educator counseled the Chinese-speaking patients, who were six times more likely to be screened for colorectal cancer. The journal Cancer published the research, and HealthDay news reported it.

For Asian Americans, colorectal is the second most-common cancer and the third leading cause of cancer-related death, according to the Asian American Network for Cancer Awareness, Research and Training, or AANCART. For Chinese, colorectal cancer is the second leading cause of cancer deaths, says professor Moon S. Chen, PhD, MPH, principal investigator of AANCART.

Cancer Among Asians

Asians bear a heavy death burden for many cancers, not just colorectal. In fact, Asians and Pacific Islanders are the only group in the U.S. for which cancer is the leading cause of death, says Chen, who is also associate director of cancer disparities and research at the UC Davis Cancer Center in Sacramento, Calif. Chen was not involved in the "Eight Americas" study. Heart disease is the second-leading cause of death for Asian Americans.

Of all Asian American subgroups, Japanese have the highest incidence and death rates from colorectal cancer as well as uterine cancer, reports AANCART. Chinese have the second-highest death rates from colorectal cancer. Filipinos have the second-worst five-year survival rate of all ethnic groups in the U.S. for colon and rectal cancers (Native Americans have the worst).

Japanese women have the highest number of new cases of breast cancer, says Chen, but Asian Americans in general are developing more cases of cancer of the lung, prostate, and breast.

For lung and bronchial cancers, Vietnamese have the highest prevalence, but Chinese have the highest death rate; the two subgroups have high rates of smoking. For prostate cancer, Filipinos have the highest rate.

Cancers that are infectious in nature strike Asians in high numbers as well, especially cancers of the liver and cervix. Chronic hepatitis B infection usually is the cause of liver cancer in Asians. Transmission of the human papilloma virus, or HPV, through sex is the main cause of cervical cancer. Both cancers can be deadly if not detected and treated early enough. Of all Asian subgroups, Vietnamese have the highest death rate from liver cancer, but Hmong are being diagnosed with liver and cervical cancers at increasing rates -- and at advanced disease stages.

Similarly, cervical is the most common cancer in Vietnamese women -- who develop the cancer five times more frequently than do White American women -- making regular Pap tests mandatory for early detection and treatment of cervical cancer.

Diabetes High Among Asians

Diabetes -- which can lead to blindness, amputations of the feet or leg, kidney failure, and ultimately death -- is another disease that afflicts Asians disproportionately in the U.S. Asian Americans have type 2 diabetes at a rate that is 50% to 200% higher than for the general population in the U.S., says George L. King, MD, director of research at the Joslin Diabetes Center in Boston. Type 1 diabetes -- which affects children -- is rare in Asians. King, who is also founder of the Asian-American Diabetes Initiatives-Clinic at the Joslin, was not involved in the "Eight Americas" study.

What makes diabetes so insidious for Asians is that they can become diabetic even without the excess weight or obesity that usually is the precursor to diabetes in other groups. Japanese in Seattle develop type 2 diabetes at a rate that is 200% to 300% higher than for non-Hispanic whites, according to the federal National Diabetes Education Program.

As Asians eat more saturated and trans fats, they may have higher incidences of diabetes and cardiovascular disease in the next 10 to 20 years, predicts King. "Diet is critical," he says.

Social Smoking

Like diabetes, smoking is on the rise in Asian Americans. It is a major risk factor for the top three killers of Asian Americans: cancer, heart disease, and stroke. Diabetes is fifth; injuries, fourth.

Tobacco use by Southeast Asian immigrant men is relatively high, causing an epidemic of lung cancer among them, says Chen. It is high in Asian and Pacific Islander immigrant females as well -- with smoking rates higher for the English fluent than for the English limited.

Yet, the opposite appears to be true for Asian American males, notes Chen. The more English-fluent they are, the less likely they are to smoke. This exemplifies how acculturation could be either an unhealthy influence (for females) or a healthy influence (for males)," says Chen.

For Asian immigrants who smoke, cultural stigmas about not smoking -- and lack of culturally competent anti-smoking programs to reach them -- may influence their behavior. For instance, in some cultures, offering someone a cigarette is often a friendly way to start a conversation. Such were the findings of a study by Grace Ma of the Center for Asian Health at Temple University, which Addictive Behaviors journal published in June, according to HealthDay News. Public-health campaigns and other efforts must be culturally competent to reach minorities and improve their health.

Christopher Murray, the principal investigator for the "Eight Americas" study, was not available for an interview for this article. Majid Ezzati, who designed the study with Murray, could not be reached.

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