Starting Points: Native Hawaiians

Apr 5, 2010

Grouping All Asians Together Could Be Bad For Health - NAM

Image by Asian/Pacific American Heritage Festival via Flickr

New America Media, News Report, Paul Kleyman, Apr 05, 2010

Asian Americans as a group are half as likely as non-Hispanic whites to die from heart disease. But Native Hawaiians are 40 percent more apt to suffer from heart disease than whites. That’s just one example of a health threat that gets lost when all Asians are statistically blended into the category “Asian Americans, Native Hawaiians and Pacific Islanders (AA/NHPI).”

The May 2010 issue of the American Journal of Public Health is entirely devoted to health concerns for AA/NHPI populations and is being hailed as a milestone for showing that bundling statistics for all Asians projects, according to a University of Toronto study, an “inaccurate and misleading” picture, which “fails to identify particularly vulnerable groups.”

“We’re constantly being lumped together as the ‘model minority’ that has fewer health problems than other groups,” explained Marguerite J. Ro, deputy director of the Asian & Pacific Islander American Health Forum (APIAHF) in San Francisco.

Although many group differences seem obvious, the common practice of statistical blending in health studies tends to wash out critical differences that would give public health experts information they need to target research and community programs effectively.

For example, Ro said, aggregating so many groups masks Pacific Islander health disparities. “That makes them a minority within an already invisible minority,” she stated.

Among other sharp differences examined in the journal between “Asian” groups are that older Filipinos in the United States stand a far greater chance of being disabled than Japanese Americans, Vietnamese seniors are far more likely than Koreans and “Asians” in general to incur Alzheimer’s disease and other cognitive problems, and Hmong in California experience rates of liver and cervical cancer triple or quadruple those of other AA/NHPI groups.

One study by Scarlett Lin Gomez and colleagues at the Cancer Prevention Institute of California (CPIC) notes that past breast cancer research failed to consider differences in Asian ethnicity or immigrant status. Because group-specific data within Asian groups is unavailable, they wrote, “health disparities experienced within Asian communities in the U.S. have been largely overlooked.”

According to Gomez and her coauthors, Asian American women are the only ethnic group for which cancer is the leading cause of death, outweighing heart disease. Breast cancer is the second leading cause of cancer death in these women. Yet the lack of group-specific data has obscured especially vulnerable populations that health care professionals should target for screening and treatment. For instance, while Japanese-American women born in the United States have a lower incidence of breast cancer than non-Hispanic white women, Filipinas had poorer five-year survival rates and greater development of late stages of the cancer that were comparable to African American women. The study notes that "explanations for the ethnic differences in breast cancer survival in Asians have not been carefully studied."

Gomez’s study determined that Asian-born women in the United States, especially those from Vietnam, China and the Philippines, are at higher risk of dying of developing breast cancer than U.S.-born Asian Americans, with Vietnamese women being the most vulnerable. These findings contradict the popular perception that the burden of breast cancer is universally low among Asian women, Gomez said.

In fact, a University of Toronto study found that there was more variation in disability rates among elderly AA/NHPI groups than between the white and the aggregated Asian group.

For example, the prevalence of Alzheimer’s disease and other cognitive problems was very slight between whites and all Asians. But Vietnamese people 55 and older had significantly higher levels of cognitive difficulties and more than twice the prevalence rate of Koreans.

Unpacking the statistics pertaining to different groups subsumed into the Asian label could also mean more ethnic specific outreach. A report from CPIC revealed the public-health power of ethnic-specific media outreach. Better community education through targeted brochures and use of ethnic media dramatically increased life-saving tests for colorectal cancer (CRC) among Vietnamese Americans ages 50-74.

CPIC’s Bang H. Nguyen and his team focused on older Vietnamese Americans and worked with Vietnamese print, radio and television media in Santa Clara County to develop articles and place ads featuring Vietnamese media personalities, cancer survivors, health community members and health providers. They produced a professional bilingual booklet titled Kham Ruot Gia De Song Tho (For Long Life, Test Colon). They also staffed a bilingual telephone hotline and held programs to educate health providers.

During the two-year project and follow-up survey, the Institute’s researchers found that the California effort boosted CRC screenings by 40 percent more than in the large Vietnamese community of the Houston, Texas area, where there was no cancer-screening effort.

Nguyen concluded that outreach to Vietnamese Americans and other racial and ethnic, poor or immigrant communities “could be applied to other forms of cancer, cardiovascular disease, tobacco, diabetes and obesity control.”

One of the Toronto researchers, Sarah Brennenstuhl, advised in an interview that when AA/NHPI seniors and their family members see a doctor or other health care professional, they should make sure “the person is not making silly assumptions. They shouldn’t assume there’s no need to screen for certain conditions. People should discuss this variability among Asians with their health care professionals.”