1. A NATIONAL HEALTH AGENDA FOR ASIAN AMERICANS AND PACIFIC ISLANDERS (…and helping health care leaders learn to work with communities)
Throughout much of American history, research specific to the health of AA’s has been sporadic and without much financial support
All data has usually been lumped into AAPI, so useless when determining health guidelines
Now that AA’s are among the fastest growing ethnicities, this lack of data has been hindering efforts to determine and follow health objectives
This talk charts major efforts to understand and improve the health of Asian Americans through research and data collection, the state of grant funding, and ultimately the essential elements to establish, fund, nurture, and promote an Asian American Health Agenda.
Chandak Ghosh, MD, MPH
Senior Medical Consultant for Federal Policy
HHS, Health Resources and Services Administration

2. Executive: President Barack Obama
Department of Health & Human Services (HHS): Secretary Kathleen Sebelius

3. Federal Reports on Health Disparities
Heckler Report
Initiative on Race
Healthy People 2010
Institute of Medicine (IOM):
Unequal Treatment
In 1985, Secretary’s Task Force on Black and Minority Health—The Heckler Report., called for more data collection.
In 1998,. Infant Mortality, Immunizations, Diabetes, Cardiovascular Disease, HIV/AIDS, and Cancer These six were codified into Healthy People 2010 as the areas needing specific emphasis to eliminate health disparities for ethnic minority populations. These disparities are believed to be the result of the complex interaction among genetic variations, environmental factors, and specific heath behaviors.”
2002, the Institute of Medicine (IOM) produced Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, concluding that “racial and ethnic minorities tend to receive a lower quality and intensity of healthcare than non-minorities, even when access-related factors, such as patients’ insurance status and income, are controlled.” The authors analyzed the published evidence of health disparities up until that time and concluded that cultural bias can affect clinical decision-making, even to the point of not recommending clinically necessary procedures. Stereotyping, bias, and uncertainty on the part of healthcare providers, particularly under the pressurized circumstances of a medical encounter, can contribute to unequal treatment. These disparities remain unacceptable because “they are associated with worse outcomes in many cases.”

4. AAPI Data Dilemma Articles from the 1990’s Ghosh Study
President’s Advisory Commission on AAPI’s
Documenting health disparities, however, requires that health data exist for specific populations. Researchers expert in AAPI health called attention to the “AAPI Data Dilemma” in the 1990’s high burden of such preventable diseases as tuberculosis, hepatitis B, liver cancer, and lung cancer, and genetic conditions like thalassemia and lactase deficiency. They concluded that, far from a “Model Minority,” Asian Americans have been neglected with regards to health status surveillance, health services, and federal allocation of resources.
Ghosh, in the 2003 analysis of AAPI representation in Healthy People 2010, showed that the Federal Government had little significant data on AAPI’s. The 23 national federal health surveys, as cited as the data sources in Healthy People 2010, contain major gaps in results for AAPI’s. The vast majority of data for AAPI’s are listed as “Data Not Collected,” “Data Statistically Unreliable,” or “Data Not Analyzed.” The data which do exist usually are that aggregated for “Asian or Pacific Islander” as a group. overall, only 0.2% of federal grants involved AAPI health directly or tangentially. Looking at MEDLINE, overall, only 0.01% of published research involved AAPI health directly or tangentially.
Presidents Clinton and George W. Bush signed Executive Orders establishing the President’s Advisory Commission on AAPI’s. In 2003, The Commission released its report, the Commission synthesized the current data on the state of AAPI health and made recommendations to create a national “strategic plan for improving the health of AAPI populations (that reflects) the diversity of AAPI communities.” Before it could oversee the implementation of its plan, the Commission was moved from HHS to the Department of Commerce where it was assigned, instead, to study economic development for AAPI businesses.
Ghosh’s study and the President’s Advisory Commission on Asian Americans and Pacific Islanders Report have spurred the health community to spotlight the data and research gaps for AAPI’s, advocate for more public and private funding for research, train researchers on epidemiologic and statistical techniques to study various Asian subgroups, and translate this research into culturally-competent healthcare delivery and positive health outcomes. CBOs, Academia, took up charge for better data.

5. AAPI Health Disparities
Insurance
Cancer
Hepatitis B
Diabetes
Infant Mortality
Tuberculosis
Mental Health
Osteoporosis
Smoking Rates
INSURANCE RATES: 20% of Asian Americans report being uninsured during all or some part of the year
CANCER: Highest rates of Stomach and Liver Cancer; Asian American women are the least likely to get a PAP smear test among all other ethnicities
HEP B: AAPI’s are 2.5 times more likely to have chronic HEP B than non-hispanic whites; The Hep B-related death rate (liver cancer) is 6 times higher than among whites
DIABETES: Native Hawaiians have twice the rate of diabetes as whites and are 5.7 times more likely to die of a diabetes-related condition
INFANT MORTALITY: Native Hawaiians have an increased rate of infant mortality (9.6 per 1000) vs. all populations (7/1000)
TB: TB is 13 times more common among Asian subgroups like Cambodians, Chinese, Laotians, Koreans, Indians, Vietnamese, and Filipinos than among the full US population
MENTAL HEALTH: High rates of PTSD for South East Asian Refugee immigrating to US; Asian women aged 65 and higher have highest rate of suicide compared to other ethnic populations
OSTEOPOROSIS: Asian women have high rates of osteoporosis; The average calcium intake among Asian women is half that of other ethnicities.
SMOKING: Asian American youth (grades 7 to 12) have the highest increase in smoking rates of any other racial/ethnic group

6. Federal Funding for AAPI Health
National Institutes of Health (NIH)
Centers for Disease Control and Prevention (CDC)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Health Resources and Services Administration (HRSA)
Office of Minority Health (OMH)
Federal Government is the largest funder of health research in the country—with over $100 billion each including ways to treat, cure, and prevent disease and disability. With this funding power, the Federal Government sets the nation’s health agenda, which most private funders also follow.

7. Foundation Funding for AAPI Health
Asian Americans/Pacific Islanders in Philanthropy (AAPIP) Report
Asian American/Pacific Islanders in Philanthropy (AAPIP) study shows that from 1992 to 2004 foundation funding has hovered around 0.4% while the AAPI population has increased by 70%. (60 million or 32 billion)
In 2006, Kellogg committed $16.5 million over five years to work towards the elimination of health disparities for AAPIs. (the largest grant ever for asian american health) The effort is entitled, “The Health Through Action for Asian Americans, Native Hawaiians, and Pacific Islanders Program.” It’s being administered by The APIA Health Forum
The Commonwealth Fund has supported AAPI health research with its sponsorship of the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy since Similarly, the California Endowment has funded the Scholars in Health Policy Program at Harvard University since Both programs have produced many nationally prominent public health researchers and policymakers committed to AAPI health.

8. Total Grant Dollars to AAPI’s from all foundations, 1992 to 2004, per AAPIP’s 2007 report.

9. Foundation Funding for AAPI Health
Asian Americans/Pacific Islanders in Philanthropy (AAPIP) Report
W. K. Kellogg Foundation
Commonwealth Fund, California Endowment
Asian American/Pacific Islanders in Philanthropy (AAPIP) study shows that from 1992 to 2004 foundation funding has hovered around 0.4% while the AAPI population has increased by 70%. (60 million or 32 billion)
In 2006, Kellogg committed $16.5 million over five years to work towards the elimination of health disparities for AAPIs. (the largest grant ever for asian american health) The effort is entitled, “The Health Through Action for Asian Americans, Native Hawaiians, and Pacific Islanders Program.” It’s being administered by The APIA Health Forum
The Commonwealth Fund has supported AAPI health research with its sponsorship of the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy since Similarly, the California Endowment has funded the Scholars in Health Policy Program at Harvard University since Both programs have produced many nationally prominent public health researchers and policymakers committed to AAPI health.

10. The Future Federal Efforts
National Health Agenda for Asian Americans and Pacific Islanders
Research entities in the Federal Government are starting to understand the need for disaggregated data for AAPIs. The Census Bureau, which is continuously gathering statistics on American populations, is now collecting data more detailed than required by the 1997 OMB standard of “Asian” and “Native Hawaiian and other Pacific Islander.” However, Centers for Disease Control and Prevention (CDC), which administers the numerous national health surveys on which the Federal Government depends to make policy decisions, continues to collects data without a standard approach. Some have details, some as aggregated “Asian” and “Pacific Islander.”
Many have called for the need to create a national healthcare agenda and a financial investment strategy for the foundation, government, and research worlds to follow in order to increase the amount of needed data and use this data to improve care and decrease health disparities.
There have been some movement towards an agenda—A document from a number of different organizations was presented to HHS Secretary Levitt in APIAHF has created a general blue print. Native Hawaiian and Pacific Islander Alliance is considering an Agenda for those groups. South Asians have been developing their Agenda. What is missing is any sense of cohesion or bringing in the rest of the Asian American public health community

11. National AAPI Health Agenda
One Organization Oversees Agenda
Stress Collection of Subpopulation Data
Prioritize Largest Subgroups and Health Issues
Strengthen Capacity of Local Organizations
Publish Annual Health Status Report
Sponsor National Health Conferences
Any National Asian American Health Agenda must include certain provisions to be effective: 1) One organization must oversee the process; 2) Stress in the need to collect subpopulation data; 3) Prioritize largest subgroups and health issues; 4) Strengthen capacity of local organizations who work closely with these subpopulations; 5) Publish Annual Health Status Report; 6) Sponsor National Health Conferences; 7) Train in Community-Based Participatory Research Methods; 8) Develop Investment strategy for funders; 9) Partner with AAPI-Serving Institutions; 10) Collaborate with the Media; 11) Interact with medical provider training institutions; 12) Educate Professional Organizations; 13) Provide Input for Health People 2020.
As the Asian American population ranks among the fastest growing in the nation, researching the health status of the many subgroups remains imperative to eliminating healthcare disparities and maximizing health outcomes. Designing, implementing, and forwarding this National Asian American Health Agenda will lead to the collection of more useful health data, to the conversion of that data into improved access and effective preventive and medical care and, ultimately, to healthier lives

12. National AAPI Health Agenda
Train in Community-Based Participatory Research Methods
Develop Investment Strategy for Funders
Partner with AAPI-Serving Institutions
Collaborate with Media
Interact with Medical Provider Training Institutions
Educate Professional Organizations
Provide Input for Healthy People 2020
As the Asian American population ranks among the fastest growing in the nation, researching the health status of the many subgroups remains imperative to eliminating healthcare disparities and maximizing health outcomes. Designing, implementing, and forwarding this National Asian American Health Agenda will lead to the collection of more useful health data, to the conversion of that data into improved access and effective preventive and medical care and, ultimately, to healthier lives

13. PS…how to work with communities
Learn about public health-public health model vs. medical model. Medicine gets publicity, drugs/docs make money, docs push drugs. Drugs have side effects—for every $1 we spend for drugs we spend $1 to deal with sife effects. Public health knows how to control DM/HTN/70% of cancers (vegan); milk may cause not cure osteoporosis. Public health also determines health care systems. Social determinants of health (poverty, education, water quality, status of women, roads); health disparities.
Go to other countries to learn- Myths about healthcare “best health care system in world?”—ours is most expensive, most inequitable, least efficient, among most unpopular, have poor ourcomes, ration by ability to pay
Become an activist
Don’t compare to other communities and what they get
Get over yourself

14. Resources www.ncapip.org
NYU Center for the Study of Asian American Health:

15. Senior Medical Consultant for Federal Policy
CHANDAK GHOSH, MD, MPH
Senior Medical Consultant for Federal Policy
DHHS/HRSA
26 Federal Plaza, 3337
New York, NY 11201
(212)