Authored by Emily Vo
Art by Angela Yuan
Southeast Asian American (SEA) communities have often been overlooked within conversations regarding public health and access to healthcare. And within these conversations, the topics of aging are significantly excluded. Understanding health disparities among aging populations is essential in delving deeper into the Southeast Asian American community’s growing relationship with aging health services, public institutions, and primary care.
A central pillar and issue within these complexities includes equitable access to healthcare for older Southeast Asian American men and women. Limited English language proficiency and poverty are barriers in preventing access to necessary healthcare and disease prevention methods, such as vaccinations and access to free clinics [1]. Many aging Southeast Asian American communities also consist of immigrants, refugees, and displaced peoples, which current public health systems are not adequately equipped to navigate– from few translation services to affordable transportation and local resources. And, as a result, a lack of communication evolves between many patients and communities, impacting health cases that involve long-term, continual care such as disease prevention, cancer treatment, or mental health services. Among the aging population of SEA individuals, Hmong and Vietnamese women are at a higher risk of being diagnosed with cervical cancer and, in general, Southeast Asian Americans suffer disproportionately from Hepatitis-B, which may lead to liver cancer or failure [2]. According to the CDC, if left untreated, up to ¼ of people with Hepatitis-B may develop liver cancer or other detrimental liver problems [3]. Many cases of untreated patients also reveal a lack of public health resources. For instance, high rates of hepatitis B infection among Hmong communities are attributed to vertical and horizontal transmission and are further exacerbated by low screening and vaccination rates [4]. Vertical transmission, from mother to child in utero, and horizontal transmission, from generation to generation, immensely contributes to the specific risk of community health with Hmong families at the most vulnerable, being at the lowest survival rate for liver cancer– a rate that is nearly two times lower than other Asian ethnic groups [3]. These cases contribute to the growing need for public health equity among aging Southeast Asian Americans as many of Hmong patients diagnosed with Hepatitis-B were foreign-born and had lived in the U.S. for nearly 30 years, suggesting that infection most likely occurred prior to immigrating to the U.S. [3]. Understanding these disparities and historical challenges may lead to better treatment and expansion of public health communications and services, and more importantly, a revitalized response to healthcare for aging populations within the Southeast Asian American community.
In addition to physical health, the mental well-being of many aging groups within the Southeast Asian diaspora have also been under addressed. These disproportionate experiences with mental health include higher rates of post-traumatic stress disorder (PTSD), major depression, and anxiety disorders [1]. Traumatic experiences of war, violence, and genocide negatively affect many aging Southeast Asian American’s physical health and mental well-being. In 2005, a study by RAND Health reported approximately two-thirds of Cambodian refugees suffered from post-traumatic stress disorder and anxiety [5].
Much of these underrepresented or “hidden” statistics can be attributed to the lack of resources allocated to focus on Southeast Asian American health centers or community, public initiatives. According to the Southeast Asia Resource Action Center (SEARAC), lack of evidence is also a consequence of “state and federal health systems [that] fail to tease out data on Southeast Asian Americans from “Asian Americans” overall, making it difficult to address and understand these disparities.” And, again, many of these disparities can be attributed to the severe lack of language and translation resources. It is important to further emphasize this point because universally accessible healthcare, including access to therapy, psychotherapists, and medications, and public health centers for non-english speakers are needed in order to bridge the gap of cultural differences and mutual understanding amongst physicians and aging SEA communities. Moreover, clinical and public-facing research must be expanded upon to provide inclusive language on the diverse subgroups within the Asian American and Pacific Islander communities, an issue that has been important in explicitly defining the needs and differing health concerns of Southeast Asian American communities specifically.
In understanding and delving deeper into the physical and mental health as well as aging of Southeast Asian Americans, public health resources and healthcare professions can better understand the treatment and care of all aging, diverse groups. Gerontology and the health of all aging populations is essential to building toward a more inclusive conversation around health equity, creating diverse venues of patient care and enabling the development of culturally competent and targeted healthcare strategies.
References
1. SEARAC. (2022, April 4). Health and Aging. https://www.searac.org/programming/national-state-policy-advocacy/health/#:~:text=Certain%20Southeast%20Asian%20American%20groups,PTSD%2C%20and%20other%20anxiety%20disorders.
2. Dinh, Quyen T.; Mariategue, Katrina D.; and Byon, Anna H. (2020) "COVID-19 - Revealing Unaddressed Systemic Barriers in the 45th Anniversary of the Southeast Asian American Experience," Journal of Southeast Asian American Education and Advancement: Vol. 15 : Iss. 2, Article 11.
3. Kwong SL, Stewart SL, Aoiki CA, Chen MS. Disparities in hepatocellular carcinoma survival among Californians of Asian ancestry, 1988–2007. Cancer Epidemiology, Biomarkers & Prevention. 2010;19(11):2747–2757.
4. Dinh, Quyen T. Southeast Asian Americans in 2020: 45 Years of Resilience and Resistance. – Asian American Policy Review. (2021, April 16). https://aapr.hkspublications.org/2021/04/16/southeast-asian-americans-in-2020-45-years-of-resilience-and-resistance/#_edn8
5. Nancy K. Herther et al., (2010) “Health Disparities Research in the Hmong American Community: Implications for Practice and Policy,” Hmong Studies Journal no. 13.2, 1-31.
6. Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, C. (2021, April 7). What should I know about hepatitis B?. Centers for Disease Control and Prevention. https://www.cdc.gov/knowhepatitisb/index.htm
7. National Institute of Health. (n.d.). Goal F: Understand health disparities related to aging and develop strategies to improve the health status of older adults in diverse populations. National Institute on Aging. https://www.nia.nih.gov/about/aging-strategic-directions-research/goal-health-disparities-adults
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