Asian-Americans Confront Distinct Set of Challenges By U.S. Representative Michael Honda (CA-15) The Hill[WEBSITE VERSION] February 11, 2009
When it comes to reforming our nation's healthcare system, some consensus exists on the starting point. Most Americans support the idea of universal healthcare. This is unsurprising; the term "universal" was used by virtually every presidential candidate in 2008.
Most agree that the growing number of the uninsured -- a whopping 46 million -- is more than unsustainable; it is fiscally untenable. We spend more per person than any other nation, yet provide poorer service than countries spending less per capita. A more efficient path is necessary and, with political courage, possible.
What gets lost in the reform debate, however, is the critical importance of healthcare equity. Our system is simply not serving everyone equally. Providing quality and affordable healthcare is a step in the right direction, but accessing those services remains uniquely difficult for ethnically diverse Asian-Americans and Pacific Islanders (AAPI).
AAPI communities face daunting cultural and language barriers due to lack of multi-lingual healthcare services, limited prognostication and treatment due to poor data collection and unique health challenges such as Hepatitis B.
Since 2003, as chairman of the Congressional Asian Pacific American Caucus, I introduced and supported The National Hepatitis B Act and The Health Equity and Accountability Act in order to address the root causes of this crisis.
Take the need for cultural and linguistic competency as our first example. Within the AAPI community, the communication gaps are particularly unsustainable, with many living in near complete linguistic isolation.
Seventy-six percent of Hmong, 70 percent of Cambodians, 68 percent of Laotians, 61 percent of Vietnamese, 52 percent of Koreans and 51 percent of Chinese are significantly limited in their English proficiency. These individuals have little capacity to interact with healthcare providers and social service agencies. When they do, they face complicated diagnoses and prescription directions, which if misunderstood, result in poorer health and even death.
This is preventable with the provision of financially efficient and effective linguistic and cultural services. The Health Equity and Accountability Act ameliorates these barriers by assisting healthcare professionals in providing appropriate cultural and language services, increasing federal reimbursement for these services, and creating a clearinghouse for culturally and linguistically appropriate "best-practices."
The need for improved practices in data collection is equally profound. Despite former President Clinton's executive order in 1997 adding five categories, including Asian, to federal data collection standards, the community continues to face insufficient methods. While searching for data on diabetes, I found that the Center for Disease Control and Prevention had no information on AAPIs, citing only "Black, White, or Hispanic/Non-White." Diabetes, meanwhile, is pervasive and increasing in Asian-American communities.
Ethnically nuanced data collection is critical because categories for race are too general. When data on AAPI health is collected it is rarely disaggregated, and as a result, washes over health differences. For example, employer-sponsored health insurance coverage varies substantially, from 49 percent among Korean-Americans to 77 percent among Indian-Americans. The high uninsured rate is a consequence of small businesses not offering employer-sponsored plans. For these communities, access to federal and state safety net programs is particularly important.
Further disaggregation is needed to reflect the diversity of Asian groups. Only then will accurate data emerge and only then will our policies effectively attend to the needs of diverse populations. The Healthcare Equity and Accountability Act addresses this by improving data collection requirements.
The final example involves Hepatitis B's unique impact on AAPI communities, African-Americans and Native Americans. These populations suffer from higher rates of Hepatitis B than other ethnic groups. Most shocking is that Asian-Americans account for half of chronic Hepatitis B cases and half of deaths resulting from chronic Hepatitis B infection. Of the approximately 2 million people estimated to be infected, only 200,000 patients have been diagnosed. Most infections remain undiagnosed until the late stages of the disease. This late diagnosis often results in liver transplants, cirrhosis of the liver, liver cancer and frequently death.
The cause of AAPI vulnerability is unknown, thus the need for a National Hepatitis B Act to develop a comprehensive prevention, education, research and management program. With existing vaccines, immunization and management strategies can help reduce the deadly reach of Hepatitis B. This disparity is unconscionable for us to ignore and I will champion this issue again in the 111th Congress.
There is no question that America's healthcare system falls short for all, and in providing adequate care to ethnic minorities. Our recession exacerbates this trend as service providers cut costs and patients afford less. President Obama's drive for healthcare reform is an excellent opportunity to end the persistent health disparities that leave millions in poorer health. The task is not small and demands strategies on all fronts, including a more diverse workforce, strengthened ethnic institutions, and improved evaluation and accountability measures. But we must do it quickly; the health of our nation and our economy depends on it.
Honda is chairman of the Congressional Asian Pacific American Caucus.