Health Care Disparities: Asian-American Edition
I sit in a classroom in Mount Sinai Hospital that has the air conditioning on way too high, but all my shivers are forgotten as I concentrate on the PowerPoint in front of me. I anticipated that I would start my schedule right away, which meant shadowing a doctor in the oncology department, but instead I’m with my fellow colleagues in a room on the 13th floor. This meeting is not in vain, however, as the young woman standing in front of me is talking about something I’ve heard thrown around in conversations but never solidified into a single term — health care disparities.
As I took the pretest given to me, that was the only phrase I could not recognize, but as the college student started to explain, I couldn’t help but realize how big of an issue it is today. With my interest in medicine, I found it odd that I never came across that term when I did more and more research about my potential career choice. While many of us do not hear this term on a day-to-day basis, it’s important to understand and discuss the ideas that are encompassed in those two simple words because health care disparities create various problems for minority groups, including Asian-Americans.
So, what exactly are health care disparities?
As defined by the Health Services Research Information Central (HSRIC), health care disparities are “differences in access to or availability of facilities and services, a variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups.”
What primarily perpetuates the existence of such disparities is the fact that health care workers lack cultural competence. In the research article “Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model,” authors Cindy Brach and Irene Fraserirector define cultural competence as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or amongst professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations.” A lack of cultural competence means that healthcare professionals either lack the ability to or are unwilling to understand the historical, cultural, or religious context of a patient being treated, rendering them irrelevant.
What does this have to do with being sick?
Even though cultural backgrounds may seem unrelated to medicine, on the grander scale, it is inextricably linked to health care. To break it down even further, there are two decisions that a doctor might consciously or unconsciously make that perpetuates cultural incompetence, with this article specifically focusing on the Asian-American experience.
- Lumping ethnic groups together
The term “Asian-American” refers to a vast range of ethnicities, given that there are 48 countries in the continent of Asia. Using this as an umbrella term to address people of Asian descent marginalizes the variety of health issues that could be apparent for certain nationalities as opposed to others.
On the whole, Asians are seen as the healthiest out of all racial groups. The National Center for Health Statistics states that 7.5% of Asians are in fair or poor health, while the Caucasian population has 9.5% and the Hispanic/Latino population boasts 10.4%. However, if we take a look at stroke incidences, for example, Indonesians have the highest risk for stroke. For breast cancer, Vietnamese women are most susceptible. Although these facts are out there, not only does it take time to find them, more importantly, they are not integrated into general data. Such information is therefore inaccessible to health care providers, and this is mostly because it is deemed unrelated.
By automatically associating Asians with the word “healthiest,” there could be incidences where patients of Asian descent will not receive the proper care they need. Agnes Constante of NBC News covered an example of this in her article “New Study Reveals Longer Follow-Up Time for Asian-American Women After Abnormal Mammogram.” Her article revealed that Asian-American women were less likely to receive appropriate follow-up appointments after receiving a mammogram with abnormalities than white women. Constante interviewed Kim Nguyen, a scientist at the UCSF Institute for Health Policy Studies, who had a major role in the study conducted.
Nguyen explained her findings, mentioning how population-based studies on breast cancer failed to include Asians in general. Her own study broke down the ethnic groups, noting how 18% of Filipino-American women did not get a follow up after an abnormal finding in their mammogram, even though Filipino-Americans tend to have higher English proficiency levels. In another part of her study, she found that Japanese have the highest rates of breast cancer amongst Asians while Laotians have the lowest.
It is clear that treating Asians as a monolithic group casts a veil over issues that may be apparent for certain ethnicities over others.
2. Unwillingness to address cultural, religious, or linguistic barriers
This is another main factor that sets the stage for cultural incompetence. The United States is a diverse country, with thousands of people coming from different places in the world. With such diversity, it is almost impossible to not meet someone who is not fluent in English or has a set of beliefs that differ significantly from the ones that white Americans have. While America is often dubbed as “the land of immigrants,” the ethnic differences among Americans could do more harm than good when it comes to seeing a doctor.
Language interpreters do exist in hospitals and clinics, but most are for Spanish or Mandarin. What about other languages, like Hindi and Japanese? The availability of those interpreters are significantly lower. It is understandable to an extent: After all, there are approximately 3.8 million Chinese-Americans in the United States. However, there are also 1.2 million Japanese-Americans. There is obviously a population gap, but that doesn’t mean one group is more deserving of language interpreting services than the other.
The lack of readily available interpreters could create a barrier between the doctor and the patient. The patient might not understand what medication to take or the doctor might be unwilling to explain everything because of the difficulty presented by language barriers.
Furthermore, some cultural backgrounds are associated with certain beliefs. The famous case of Lia Lee, daughter of Hmong refugees, is a prime example of the importance of understanding cultural beliefs when treating patients.
Lee suffered from epilepsy and life threatening seizures at the age of four. Her family, who lived in California, brought her to the hospital, where doctors prescribed medicine for Lee to take. According to Hmong culture, Lee was suffering from qaug dab peg and had lost her soul to an evil spirit. Believing that this was true, Lee’s family didn’t approve of the hospital’s procedures and there were no translators present to explain anything to them. Instead, Lee’s parents took her to a shaman for consultation.
If Lee was given her medications according to the doctor’s orders, she wouldn’t have suffered from the brain damage she had to live with until age 30, when she had passed away. While acting in accordance to the Lee family’s cultural beliefs would mean stopping treatment, simply understanding what the family believed would have prevented most of the communication barriers that existed between both parties. Lee’s family viewed the hospital as “invasive,” but maybe if the doctors took the time to bring translators and did basic research on Hmong culture, the Lee family would have known about the devastating consequences of refusing the prescribed medication and thus been more inclined to reach a consensus. This story sheds light on the importance of understanding people’s personal beliefs tied to their cultures and connecting with patients beyond just the technical aspects. In the field of health care, it is essential to not only practice effective communication but also prioritize the patients’ ethnic, cultural, and religious backgrounds when treating them.
These problems exist, but what can be done?
Healthcare disparities are preventable.
While creating a single, one-time solution is highly unrealistic, what is not unrealistic is putting in more effort. Hospitals and doctors need to do background research and compile it into something simple to read. This means noting how Asians might have a lower BMI but can still be at risk for Type 2 diabetes, and digging deeper, how Vietnamese women have a high risk for breast cancer, and more. A compilation of useful information should be made available for practitioners to reference.
As for language interpreting services, translators should be made available based on the population demographic of the community that surrounds each hospital. Assuming that only Spanish or Mandarin is required for all hospitals is not enough. If a community surrounding a hospital has a large population of Indians, then a translator for Hindi should be available at that hospital.
Thinking along these lines is a start to the road of cultural competency in health care, and taking this road will allow healthcare to evolve into what it’s supposed to be: accommodating, personalized, and inclusive.
This article was written by Rhema Matcha and edited by James Noh.
The views and opinions expressed in this article are the author’s own and do not necessarily reflect the views and opinions of Young Asian Leaders of America.
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