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National Harbor, MD -- At its December summit, the National Institutes of Health’s National Center on Minority Health and Health Disparities (NCMHD) made a call to arms to eliminate health inequities affecting individuals of all races and ethnicities living in poor or medically underserved communities. For Asian Americans in this country, that means more research and more targeted studies.  

            “Nationally, Asian subgroups – made up of 50 countries and 100 different languages – are lumped together,” said Dr. Sunmin Lee of the University of Maryland School of Public Health and the Asian American Health Initiative in Montgomery County. “This does not give accurate information on Asian groups and their specific health issues.”

            The Asian American Health Initiative in Montgomery County, Md. conducted a more focused study on the health concerns of 13 different Asian ethnic groups in the county. The study – presented during the conference -- included larger groups such as Chinese, Korean and Vietnamese as well as underreported groups such as Burmese, Thai, and Laosian.

            Diabetes and hypertension were mentioned in all 13 Asian communities as important health concerns. Next in line was weight and, interestingly, mental health.

            “It was surprising to see mental health ranked,” Lee said. “Depression and anxiety were related to the stress of language barriers, women in multiple roles, and academic success – all immigrant issues.”

            The initiative’s study also unveiled the barriers to health care access for Asians in this country, broken down by subgroups.  Language difficulties make it challenging to communicate and seek assistance; low-level of health literacy leads to lack of preventative care; and lack of resources and social capital for underrepresented communities means no health fairs or education programs for the smaller groups.

            Asian Americans are one of the fastest-growing populations in Montgomery County with increase from 11.3 percent in 2000 to 13.6 percent in 2005. Despite this growth on local and national levels, more needs to be done on the research front.

             “There are not enough studies (on Asian Americans) so we don’t even know what all the problems are,” Lee said. “Without the data, we can’t advocate.”

            Suhaila Kahn, program director for the Asian Pacific Islander America Health Form, also noted gaps in national data research funding for Asian-Pacific Islanders.
            “The API population makes up 4.5 percent of U.S. population and is one of the fastest-growing minority groups,” Kahn said. “However, in 2004 only .4 percent of all U.S. foundation dollars went to API groups. That is only a slight increase form .2 percent between 1983 and 1990.”

            What researchers, medical professionals, and public health officials do know about Asian American groups, though, were highlighted in various breakout sessions during the conference. Hepatitis B and cervical cancer were two areas of concern for Asian Americans.

            More than half of the 1.25 million people in this country with chronic Hepatitis B infection are API Americans, according to the Asian Liver Center at Stanford University School of Medicine. Regional assessments of the prevalence of HBV infection indicate that 10-15 percent of Asian Americans are chronic HBV carriers, which is significantly higher than the national average, according to the University of Michigan’s Healthy Asian Americans Project (HAAP).

            The group also conducted a 2007 study that looked at HBV prevalence and vaccination.

            “The prevalence rate in our study was a bit lower than published studies,” said Tsu-Yin Wu, director of HAAP. “We attribute that to the sample group being highly educated and not your traditional Chinatown immigrants. Most were working for academic institutions. Still only 9 percent had been vaccinated. It just shows we need to keep promoting the vaccine.”       

            Further, a survey study of Cambodian American women showed that only slightly more than half of the recruited population had heard of HBV infection and less than a quarter of the population were aware that HBV could be transmitted through contact. A primary factor contributing to the lack of knowledge about HBV infection is low education, according to HAAP.

            HAAP’s HBV screening and education program was initiated in 2006. Through annual health fairs, HAAP recruits Asian Americans to participate in the study of virus infection prevalence by providing free HBV screenings

Hepatitis B is transmitted through contaminated blood. Chronic infection can lead to liver cirrhosis, liver failure, and liver cancer. A vaccine is available to prevent infection.

            Cervical cancer was another health concern underscored during the conference. Vietnamese American women have the highest cervical cancer rate of any ethnic group in the United States. The last study, conducted from 1998-2002, showed that Vietnamese women had a rate of 16.8 percent – approximately two times higher than Caucasian women in this country.

            “Cervical cancer is the 2^nd highest disparity among Asians in the U.S.,” said Tung Nguyen, M.D. of the University of California San Francisco. “It is a socioeconomic disease.”

            Much like Hepatitis B, Nguyen pointed to lack of screening as the most significant stumbling block to prevention.
            “If you had screening, cervical cancer wouldn’t exist,” Nguyen said. “Or at least your numbers would be much lower.”

            Currently, there are number of community outreach initiatives that emphasize the importance of screening using methods that get the message across through cultural targeting and language.

            “We have had (Vietnamese) women tell us that a doctor treating you with respect is important,” he added. “A woman is more likely to be tested if she feels this. This is a cultural factor.”

            Other factors include lack of insurance and lack of access to medical care.

            Overall, researchers echoed similar recommendations throughout the three-day summit: increase awareness education, implement culturally and linguistically appropriate resources, and collect more data.

            Dr. Howard Koh of the Harvard School of Public Health and former commissioner of public health for the Commonwealth of Massachusetts summed up the need for the intersection of science, policy and practice to eradicate health inequities.

            “As an Asian American whose parents, like many of us here, journeyed to this country searching for the American Dream, the gift of health is part of that dream,
 he said. “We need to understand the social determinants that impact a person’s life, not just the biology of the disease.

            “Yesterday, Maya Angelou encouraged us to become composers. I would like to extend that metaphor and say we need to be conductors, maestros,” he continued. “We need to create the best public health symphony we can.  In public health terms, we need to collaborate to create a better health system.”

            The NIH Summit brought together nearly 4,000 of the nation's leading health disparity experts across multi-disciplines. Speakers included Maya Angelou, Governor Howard Dean and many Asian American public health researchers, practitioners, and policymakers in the field of health disparity.