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The CHE blog features articles that address different aspects of working towards achieving Health Equity. Check out the blog for stories of success, learning from failure, recommendations, new ideas, and other perspectives of people contributing towards our common goal.

Stigma, Mental Health and the Asian Pacific Islander Community

A stigma toward mental illness in the Asian Pacific Islander community in California and other states keeps many individuals from seeking needed treatment, KPCC's "KPCC News" reports. California Healthline's website posted a discussion of the KPCC findings online here.

Asian Americans use mental health services about half as much as the general population, according to a report by the California Asian Pacific Islander Joint Legislative Caucus.

Meanwhile, a report by the National Alliance on Mental Illness found that Asian American women in certain age groups have the highest number of suicide mortality rates of any ethnicity.

Context is vitally important in understanding this complext issue. Michi Fu, director of prevention projects at Pacific Clinics throughout California, asserts that people in the Asian community "are willing to die" rather than seek care for mental illnesses because "There's a reflection, supposedly, on the entire family name."

Cultural considerations include using appropriate language to frame the issue. Young Ahn — mental health services coordinator for the Los Angeles County Department of Mental Health, is quoted in the article as saying that is is vital to use other methods when helping Asian individuals in need of mental health care. "Don't even mention mental illness. They're not going to come," Ahn said. She has had more success when introducing the concept as stress management.

In addition to the stigma, Rocco Cheng — project leader for the California Reducing Disparities Project's Asian Pacific Islander division — said individuals in the Asian community face several other challenges to obtaining mental health care services, including:

  • Language disparity
  • Access to transportation
  • Unfamiliarity with Western mental health services

He said that providers should focus on making mental health information available in languages that minority groups will understand (Kim, "KPCC News," KPCC, 10/16).

The article on California Healthline's website can be accessed here.

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Gender and Health – website and information sheets

In any given culture, according to accepted norms, gender differences can arise. Some of the differences may not automatically connate inequalities, but in most cases they do.

On the website of the Gender and Women's Health Department of the World Health Organization, there is a discussion of some of these inequalities and a link to several helpful information sheets on these issues. Some of the examples of how gender differences can lead to inequities in health status and access to care include: 

  • A woman cannot receive needed health care because norms in her community prevent her from travelling alone to a clinic.
  • A teenage boy dies in an accident because of trying to live up to his peers’ expectations that young men should be "bold" risk-takers.
  • A married woman contracts HIV because societal standards encourage her husband’s promiscuity while simultaneously preventing her from insisting on condom use.
  • A country's lung cancer mortality rate for men far outstrips the corresponding rate for women because smoking is considered an attractive marker of masculinity, while it is frowned upon in women.

In seeking to help "increase health professionals' awareness of the role of gender norms, values, and inequality in perpetuating disease, disability, and death, and to promote societal change with a view to eliminating gender as a barrier to good health," the Gender and Women's Health Department posts a number of helpful information sheets at this link HERE.

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Removing Obstacles to Care for Asian Americans and Pacific Islanders

Culturally competent health care, including communication in a language that individuals understand. Nearly 61 million people speak a language other than English at home.  Language barriers impact the ability of individuals to access health care and human services.  Individuals with limited ability to read, speak, write or understand English are less likely to have a regular source of primary care. Language assistance services help provide meaningful access to quality health care.  The health care law expands initiatives to increase  diversity in the health care professions and improve cultural competency of health care providers.

Ending insurance discrimination. In the past, insurance companies could deny coverage to children because of a pre-existing condition such as cancer, asthma, or diabetes.  This discrimination is no longer allowed, and beginning in 2014, insurers are banned from discriminating against anyone with a pre-existing condition.  This is important because, for example, in Hawaii, adult Asian Americans, Native Hawaiians and other Pacific Islanders have high rates of diabetes.

Secure health information. As the agency within the U.S. Department of Health and Human Services that ensures that the privacy practices of several million heath care providers, plans, and clearinghouses adhere to federal health information and privacy laws, my office, the Office for Civil Rights, works tirelessly to enforce the laws which safeguard the privacy and security of health information. Individuals have rights over their health information, including the right to get a copy of their medical record, make sure it’s correct and know who has seen it.  Studies have shown that consumers pay more attention to and become more engaged in their health care when they have access to their own medical information. The Office for Civil Rights will continue its outreach efforts to inform consumers about their privacy rights. 

Increased access, equity of care and patient confidence are major drivers in reducing disparities in all communities, including the Asian American and Pacific Islander community. 

Juliet K. Choi is Chief of Staff and Senior Advisor at the U.S. Department of Health and Human Services Office for Civil Rights.

 

 

 

 

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