For years, New York health-care providers treated Asian-Americans afflicted by serious, even life-threatening illnesses with ever-increasing frequency. Many doctors in the nation\u2019s largest city agreed that Asians seemed particularly at risk for specific health problems just like any other racial group, but there was neither research nor statistics supporting physician observations.<\/p>\n
Enter New York University\u2019s Center for the Study of Asian American Health (CSAAH), which emphasizes community-based participatory research and problem solving. Established in 2003, it is perhaps the only center of its kind at a U.S. academic medical center dedicated solely to evaluating public health issues of this racial group. Among other things, CSAAH:<\/p>\n
Develops and conducts research to address and eliminate health disparities.<\/p>\n
Builds and improves public and private partnerships to increase outreach and advocacy in response to social and other inequities faced by Asian-Americans.<\/p>\n
Trains health-care professionals about community-based approaches to addressing disparities.<\/p>\n
\u201cBefore 2003, doctors saw so many individuals suffering,\u201d says Dr. Chau Trinh-Shevrin, CSAAH director and co-founder. \u201cBut there was no infrastructure among community clinics, private hospitals and NYU. There needed to be a place to centralize community resources and support.\u201d<\/p>\n
Furthermore, New York doctors were uncomfortable using the limited data on health trends among California\u2019s Asians because the population in that state had substantial numbers of third- and fourth-generation Americans, whereas the more than 1 million Asians in New York tended to be first- and second-generation, says Trinh-Shevrin, also an assistant professor of research at NYU\u2019s Department of Medicine. She and others believe that advocates and activists at the older and better established Asian-American studies programs on the West Coast helped produce ad hoc research on race-based health matters.
\n\u201cHere in New York, it was frustrating not to see public health priorities benefiting Asians at the community level,\u201d says Dr. Simona Kwon, a CSAAH research scientist.<\/p>\n
Kwon and Trinh-Shevrin agree that stereotypes of Asians as uniformly \u201chealthy, wealthy and wise\u201d impede Asians\u2019 willingness to seek medical care. But based on surveys by CSAAH staff and community health workers, a long list of additional reasons emerged: language barriers, affordability among low-income Asians who were forced to choose between paying rent and buying medicine, and fear of discrimination by non-Asians.<\/p>\n
\u201cLike other minorities, Asians here fear being discriminated against,\u201d Trinh-Shevrin says. \u201cIf they\u2019re on welfare or public assistance, they\u2019re often stigmatized, so a disease would be another excuse for others to show prejudice. Some Asians have even feared that, if word got out that they were sick with something dire like Hepatitis B, they\u2019ll lose their jobs or automatically be deported.\u201d<\/p>\n
Soon after CSAAH\u2019s inception, which was financed by a National Institutes of Health grant, its scientific efforts began exploring the relationship between viral and bacterial infections and cancer, as well as the risk for cardiovascular disease, among different Asian ethnic groups. Before long, statistics emerged. For instance, three out of five Filipinos in New York had hypertension as recently as 2008, and two out of five lacked health insurance. Half were overweight or obese. More than any other Asian subgroup in New York, Filipino Americans were more likely to die of heart disease.<\/p>\n
Based on such findings, CSAAH staff launched education and awareness projects aimed at encouraging Asian-Americans to seek preventative medical care and help with problems before they become untreatable. CSAAH has periodically hosted seminars for local health-care professionals, community members and policymakers to disseminate data and discuss solutions. Among the topics are cardiovascular health, HIV prevention and women\u2019s health. CSAAH also disseminates literature in various languages about disease prevention at facilities frequented by local Asians, such as community centers and ethnic businesses.
\nCSAAH teaches local doctors and other community providers culturally appropriate ways to communicate with patients. \u201cSome Asian-Americans don\u2019t disclose use of complementary and alternative medicines to the doctors because they fear doctors will think less of them,\u201d Trinh-Shevrin says. \u201cSome Asians don\u2019t even consider alternatives like herbal treatments to be medicine, so that\u2019s something that can slip through the cracks, yet an M.D. can still find out about it if he knows he should specifically ask.\u201d <\/p>\n
Last year, Trinh-Shevrin and other CSAAH officials released a textbook called Asian American Communities and Health, which examines the political, economic and cultural factors that influence the distribution of disease among this racial group. While intended as a tool for teachers and students in public health programs around the country, Trinh-Shevrin and the CSAAH staff hope it also sparks discourse about social justice and other issues.<\/p>\n
As part of its local grassroots outreach, CSAAH employs four full-time community health workers who have extensive ties to various ethnic subgroups and have been active in organizing labor unions and legal advocacy \u2014 meaning they\u2019re experienced in communicating with the so-called common man.<\/p>\n
The CSAAH screening and treatment program that has arguably gained the most acclaim is the one aimed at eradicating Hepatitis B, a virus that can cause cirrhosis, liver failure and cancer. It is transmitted by infected blood or sexual fluids. Mothers carrying the virus can pass it on to infants during childbirth. Because the virus can remain dormant for many years, people are often unaware they\u2019re carriers until symptoms such as high fevers and jaundice appear. By then, treatment can sometimes be too late. Some 400 million people worldwide have chronic Hepatitis B infection \u2014 including one in 10 people of Asian descent, regardless of which continent they live. The prevalence of Hepatitis B among Asians makes it perhaps as sobering a health concern for them as sickle cell anemia is for Blacks.<\/p>\n
Despite CSAAH\u2019s focus on Asian-Americans, a citywide public awareness campaign on Hepatitis B also benefited Latinos, Africans, Caribbean Islanders and East Europeans. Many of the ads were multilingual. Indeed, CSAAH staff include fluent speakers in Spanish and Haitian Creole. Meanwhile, CSAAH staff has educated more than 11,000 local Asian-Americans about the disease through education workshops.<\/p>\n
Over the years, health-care workers affiliated with CSAAH have screened more than 8,900 individuals at drop-in community clinics and vaccinated 5,800 people susceptible to exposure and infection. Doctors have clinically evaluated 1,200 screening participants who were identified with the virus, which not only potentially improved their health, but also provided critical information about epidemiology as well as cost analysis for similar programs among non-Asians in New York. CSAAH is now one of more than 20 members of a local coalition of academic, health and community-oriented agencies that banded together to fight Hepatitis B.<\/p>\n
In recognition for such accomplishments, the Centers for Disease Control and Prevention designated CSAAH as a National Center of Excellence in the dissemination and training of evidence-based strategies in fighting Hepatitis B. The center is called \u201cB Free CEED.\u201d Among other things, it provides pilot project funding opportunities for Asian-American communities outside New York to initiate their own campaigns against the virus. Currently, fledgling programs are being developed in Houston, Philadelphia and in communities in Ohio.<\/p>\n
\u201cThis really validates the community coalition model,\u201d says Kwon, who\u2019s also director of B Free CEED. \u201cAn organization has to bring in individuals who know how to engage the grassroots level.\u201d <\/p>\n
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