Asian American Culture and Health Status
Introduction and Objectives
This document is meant to serve as
a resource for researchers and health care professionals working with Asian and
Pacific Islander communities. This guide
is meant to give the basic introduction how different communities are organized
and defined by the U.S. Census and where these communities are located within
“Asian,” status and origin of major Asian populations in the
The terms “Asian” refers to
people having origins in parts of the
The US Census in 2000 showed that
living in the
Languages and Religion
Through all of the Far East,
practice of religion is similarly very diverse.
Though most Asians are Theravada or Mahayana Buddhists, there are also
significant populations practicing Islam, Hinduism, Christianity, Animism,
Taoism and Confucianism. Most Asians and
Asian American continue to practice the religion of their homeland by establishing
neighborhood temple or places of worship.
While, language and religion are two major challenges to assimilation in
Waves of Asian Immigration:
During the 19th century,
the two largest groups of Asians in the
War, the other major influence on Asian
immigration to the
There were two major waves of
immigration from Vietname. The first
wave followed collapse of the Thieu regime in 1975. Many fled by boat to neighboring countries in
Southeast Asia, eventually arriving in the
Japanese-Americans are a widely
recognized sub-group of Asians. Though
many perceive their numbers to be high, they are in fact only the 6th
largest group of Asians in the
Today, regardless of location, the
largest Asian sub-group is Chinese. In
the 2000 census, 2.7 million people reported being Chinese. The next largest
groups were the Filipinos (2.4 million), Asian Indians (1.9 million), Vietnamese
(1.2 million), Koreans (1.2 million) and Japanese (1.1 million). Asian Americans continue to be the fastest
growing population in the
The Model Minority and Access to Care
The reference to Asians as the “model minority” stems stereotypes that Asians and Asian Americans are hardworking, respectful, and place a high value on education, family and elders. Asians Americans are seen as passive, compliant, and without problems or needs. Asians are often times overlooked due to this “Myth of the Model Minority”. The myth has lead to neglect of the very real concerns of the population. Furthermore, the needs of the communities, particularly of newer refugee communities, can be nearly invisible.
Americans represent a wide variety of languages, dialects, and cultures here in
Asians and the Traditional View of Medicine:
The vast differences in traditions and culture make it difficult to comment on all traditional view of medicine. Many views for smaller isolated communities can be undocumented altogether. The Chinese however, have practiced a worldview on health for more than 3,000 years. Chinese medicine views the mind, body, and spirit as a holistically; each component influences the function of the others. A balance, therefore, is extremely important to good health.
Many Asian Americans believe that opposing elements must be held in balance. The Vietnamese call the balance am and duong. Most are more familiar with the Chinese terms yin and yang. In health these are translated as “hot” and “cold”. Each illness is caused from a force that is too hot or too cold. The cure, therefore, must be the opposing force, bringing balance to the body. When ailment present, the traditional cures rely on herbal medicines.
Herbal medicines were typically prescribed to bring the body back to equilibrium. Medications as a whole are thought of as bodily maintenance and repair, and not as longtterm answers. This concept can be a barrier for treatment of chronic diseases, particularly hypertension. For this reason, adherence can be a challenge for Asian populations. They believe that medication can be interrupted when one simply “feels better.”
Asian and Disease in
Diabetes – Persons of Asian backgrounds may share a common genetic factor that may affects their insulin secretion and insulin resistance. Asian Americans and Pacific Islanders may share a "thrifty gene" left over from their ancestors, which enabled them to survive during "feast and famine" cycles. However, with those cycles phasing out, that same gene may make a person more susceptible to developing type 2 diabetes. A study showed that Native Hawaiians were 2.5 times more likely to develop diabetes than non-Hispanic white Hawaiians. (4) Additional resources can be found at http://www.diabetes.org/communityprograms-and-localevents/asianamericans.jsp Diabetes management workbooks in Chinese, Korean, Hmong, Cambodian, Tagalog are available at the following site. http://www.ndep.nih.gov/diabetes/pubs/Tworeasons_tips_eng.pdf
Cancer - While
the leading killer of Asians in the
Hepatitis B –
While the rates of acute hepatitis B have been steadily decreasing, the
reported rate in 2001 was more than twice as high among Asians American and
Pacific Islander (2.95 cases per 100,000).
Non-Hispanic whites had infection rates of 1.31 per 100,000
individuals. Chronic Hepatitis B in
Asian population often goes un-noticed until the development of liver disease. It is known as a silent killer due to low
screening rates. The Stanford Liver
Foundation reports that among foreign born Asian immigrants 1 in 10 can is a
chronic Hepatitis B carrier. Hepatitis B
is also more prevalent in the Asian population, as mothers pass on the disease
to their children. If the children are
not immunized within 2 hours, they too will be infected. Though as many at two-thirds (2/3) of all
cases will recover, one-third (1/3) will become chronic carriers of the Hepatitis
B virus and could develop liver disease.
For more information on Hepatitis B contact the
Tuberculosis (TB) – Asians have the highest TB case rates among all racial/ethnic groups. In 2003 Asian accounted for 23 percent of all new TB cases. U.S.-born persons accounted for 2 percent, while 41 percent of the cases were among foreign-born persons. The TB case rate was 21 times greater in Asians than in non-Hispanic whites (29.7 vs. 1.4 per 100,000).
AIDS - Although Asians have the lowest diagnosis
rates (4.0 per 100,000), the percent of AIDS incidences had increased by 38
percent between 1998 and 2002, compared to a 2.4 percent increase among African
Americans and 12 percent decrease among whites.
Asians represent approximately 2 percent of all AIDS cases in the
Osteoporosis and Asian
American Women – According to the National Institutes of Health
Osteoporosis and Related Bone Diseases’
When being Asian American is protective:
Family is a concept of utmost importance to Asians. In almost any traditional Asian cultures, the individual puts the family’s needs above his or her own. Included in this concept of family is respect for parents and respect for elders. It is not uncommon for extended families to live together in homes or villages. These extended families may include uncles, aunts, cousins, grandparents, etc. Children are expected to obey elders without exception. This cohesive family structure in times of stress and illness creates becomes a natural source of social support. For chronic diseases, social support is a strong indicator of successful management.
Cardiovascular disease in Asians and Americans are the number one killer, generally Asians and Asian Americans do have lower body mass index (BMI), particularly Asian women. It is hypothesized that as diets become westernized BMI could also increase. In addition to cardiovascular disease BMI is a risk factor other chronic diseases like diabetes and hypertension to name a few.
First Steps to Culturally Competent Care:
The first and most basic step of providing culturally competent care is providing linguistically and culturally appropriate services. The lack of health care access for Asian-American groups is most commonly the result of language barriers (7). While developing and understanding of cultural norms takes time, seeking a translator or intermediary agency to assist, particularly with a language barrier, can often be the most beneficial step in bridging a gap in the short term. Families will often use younger children or friends who speak better English as interpreters. The caveat is that information can be lost or not understood at all without a proper interpreter.
Sensitivity to culturally appropriate behaviors is of the utmost important so as to not offend the patient. In many Asian cultures physical contact such as a handshake or a hug between a man and a woman may be interpreted as a sexual advance. Signs of disrespect may include a limp handshake. Even looking straight into the eyes of an elderly person can be seen as a challenge to authority. When in the presence of a group addressing the oldest male is often a safe practice (7).
The National Network of Libraries of Medicine’s website provides a complete list of links to language specific health information by organization and condition. References are for practitioners, clinicians, educators and trainers.
Selected Patient Information Resources in Asian Languages or SPIRAL is a collection of various health information assembled by the New England Region of National Network of Libraries of Medicine. Languages include Cambodian/Khmer, Chinese, Hmong, Korean, Vietnamese, Laotian and Thai with a pull down menu of health topics.
(1) Census Bureau, Census 2000 Brief: Overview fof Race and Hispanic Origin , 2000.
(2) Census Bureau, Census 2000 Brief. The Asian Population 2000. Issued February 2002
(3) Centers for Disease Control. HIV/AIDS Surveillance Report, Vol 14, 2003.
(4) Centers for Disease Control. Trends in Tuberculosis –
(5) http://en.wikipedia.org/wiki/Asian_Americans -Asian Americans
(6)http://www.cdc.gov/od/oc/media/pressrel/fs040402.htm CDC Racial/Ethnic Health Disparities
(7) http://www.erc.msh.org/quality&culture The Providers Guide to Quality and Culture
(8) http://asianamericanhealth.nlm.nih.gov/intro.html National Library of Medicine- Asian American Health
(9) http://www.nlm.nih.gov/medlineplus/osteoporosis.html Special Issue for Asian Women Regarding Bone Health