1	Research to Reduce & Eliminate Health Disparities Experienced by Asian Americans and Pacific Islanders Testimony of the Asian & Pacific Islander American Health Forum to the Institute of Medicine Committee on the Review and Assessment of the NIH’s Strategic Research Plan To Reduce and Ultimately Eliminate Health Disparities Gem P. Daus, MA Director of Policy May 11, 2005
2	Objective APIAHF’s views of the Strategic Plan and whether there are significant omissions in the content or indicated approaches to the objectives set forth under the three goal areas [research; research infrastructure; public information and community outreach] Perspectives on the overall approach and other factors bearing upon the attainment of the mission of the NIH minority health and health disparities effort.
3	APIAHF = “Health Forum” National Advocates for Asian & Pacific Islander Health
4	"1985 – Report on Black..." 1985 – Report on Black and Minority Health 1986 – First Asian American Health Forum in New York City
5	"The mission of the Health..." The mission of the Health Forum is to enable Asian Americans and Pacific Islanders to attain the highest possible level of health and well being.
6	Background Four themes: Asian Americans and Pacific Islanders have been “Missing in History” Native Hawaiians and Pacific Islanders are often overlooked Asian Americans are stereotyped as a “model minority” Asian Americans continue to be viewed as foreigners
7	Who are Asian Americans and Pacific Islanders? Diverse Communities, Diverse Experiences: A review of six socioeconomic indicators and their impact on health Language Income and poverty Educational attainment Immigration and citizenship Healthcare workforce Other household indicators
8	Who are Asian Americans and Pacific Islanders? 13.5 million - The estimated number of U.S. residents who say they are Asian or Asian in combination with one or more other races (2003). 1.5 MILLION MORE THAN CENSUS 2000 8.7 million - The number of U.S. residents who were born in Asia. 959,603- The estimated number of U.S. residents who say they are native Hawaiian and other Pacific islander or native Hawaiian and other Pacific islander in combination with one or more other races (2003). 60,000 MORE THAN CENSUS 2000
9	Who are Asian Americans and Pacific Islanders? Diverse: nearly 50 national/ethnic origins and over 100 languages and dialects Among the top 10 most frequently spoken languages: 2.2 million – Chinese 1.3 million – Tagalog 1.1 million – Vietnamese 966,959 – Korean 27,160 people speak Hawaiian at home. 25% of AAPIs live in linguistically isolated households
10	Examples of Health Disparities among Asian Americans and Pacific Islanders CANCER Young Asian women have lower participation in breast self examination (BSE) and pap tests Cervical cancer incidence rates are 5 times higher among Vietnamese American women than White women. Native Hawaiians have the third highest breast cancer mortality rate in the nation and the state of Hawaii.
11	Examples of Health Disparities among Asian Americans and Pacific Islanders LIVER DISEASE Asian Americans and Pacific Islanders account for more than half of 1.3 million chronic hepatitis B cases and half of the deaths resulting from chronic hepatitis B infection in the US. Liver cancer is the third leading cancer among Asian Americans.
12	Examples of Health Disparities among Asian Americans and Pacific Islanders AAPIs have the highest TB case rate: ten times more than that of Whites Smoking rates are high among Southeast Asian American men (over 70% for Laotian American and Cambodian American men) Native Hawaiians have high rates of hypertension and obesity Elderly Chinese women have high rates of suicide
13	Healthy People 2010 When there is no Asian or Pacific Islander data, specify whether Asian or Pacific Islander data has not been collected at all (DNC) Asian or Pacific Islander data has been collected but has not yet been analyzed (DNA) Asian or Pacific Islander data has been analyzed but is not reported due to small sample size (DSU)
14	Healthy People 2010 Of 22 objectives (as of 2003): Only 3 currently comply with OMB 6 only have aggregated A&PI data 5 have both aggregated data and data for Asians but not for NHOPI 8 do not have statistically reliable aggregated A&PI data
15	[Lack of] Quality and Quantity of Data is Well-Documented Government funding for AAPI-specific health projects from 1997-2000 was less than 2% of 1% of government grants (grants, not funds) Out of millions of citations in MEDLINE, fewer than 400 had data relevant to the health of AAPIs in the US Ghosh, 2002
16	[Lack of] Quality and Quantity of Data is Well-Documented President’s Advisory Commission on Asian Americans and Pacific Islanders, Interim Report (2001) www.aapi.gov/resources.htm DHHS Policy Statement on Inclusion of Race and Ethnicity in HHS Data Collection Activities (1997) aspe.hhs.gov/datacncl/inclusion.htm DHHS Data Council, Improving the Collection and Use of Racial and Ethnic Data in HHS (1999) aspe.hhs.gov/datacncl/racerpt/index.htm
17	Reports and Recommendations on Racial and Ethnic Data Westat, Assessment of Major Federal Data Sets for Analysis of Hispanic and Asian or Pacific Islander Subgroups and Native Americans (Task Force 2 and Task Force 3 Reports) (2000) aspe.hhs.gov/hsp/hspother.htm#race National Committee on Vital and Health Statistics, Health Data Needs of the Pacific Insular Areas, Puerto Rico and the U.S. Virgin Islands (1999) ncvhs.hhs.gov/9912islandreport.pdf
18	Research To understand specific health conditions in specific populations Redefine populations – ethnic, refugee, generation, language group, US geographic There is no recognition of Hepatitis B in the NIDDK plan Specific: cancers, cardiovascular disease, diabetes, tuberculosis, mental health, drug use, sexually transmitted diseases Not just prevalence, but also access and quality of care
19	Research + BEHAVIORAL & BIOMEDICAL + MULTIFACTORIAL To understand health seeking behavior → prevention To understand acculturation → healthy immigrant paradox To understand environment (global and local) To discover effective community/social interventions To discover effective D_x/T_x interventions (cultural competence and language concordance)
20	Research infrastructure Increase the capacity for Asian American and Pacific Islander researchers and organizations to conduct health disparities research. EXPORT – NYU and UH CBPR ++
21	Research infrastructure Ensure that Asian Americans and Pacific Islanders are included in programs that target under-represented minorities, particularly at NIH. Not all Asian American subgroups are well-represented in the health professions. Native Hawaiians and other Pacific Islanders are under-represented. Recruit bilingual researchers Conduct research in language. Disseminate validated translations of survey questions and instruments. Collect primary language data more routinely.
22	Public information and community outreach APIAHF currently working with NLM Public health education programs need to be available in other languages (oral and written; people and paper) Need to partner with community organizations (not just PR firms) for public health education Need to validate already translated educational materials Analyze existing data
23	Approach Keep research focused on specific health disparities and specific populations (in addition to being inclusive in all research) Maintain coordination among NIH ICs and HHS (particularly CDC/NCHS, AHRQ)
24	Contact information Gem P. Daus, MA APIAHF 1001 Connecticut Ave, NW, Suite 835 Washington, DC 20036 www.apiahf.org gdaus@apiahf.org (202) 466-7772 phone (202) 466-6444 fax