Community-specific data teasing helps to understand the impact of disease risk in Pacific Islander and South Asian populations: A case study of STD testing

Researchers began studying disease risk in specific AANHPI cohort such as Pacific Islander and South Asian populations to better understand the effect aggregated data had on health. They’re finding that teasing apart data in community-specific ways lets them use race and ethnicity information without conflating it with biology. Policymakers are using data specific to individual communities to better understand how to allocate resources and communicate more effectively.

Improving health equity requires rethinking our global health infrastructure, and we are still at the beginning. But each solution adds support and begins to build a path toward justice.

Financial and cultural stressors were felt by Kauh’s parents, which can affect her health. Language barriers, racism, changes in diet with the move to a new country, and the circumstances of that move can add up. None of these factors are related to the biological basis of disease, but they determine what resources a person or community might need to achieve good health.

The coalition worked to show that Asian American immigrants wouldn’t feel comfortable going for STD testing if they knew it was not the problem. The communities and the health priorities are different. Western social norms and biased perceptions had been unintentionally driving health outcomes for hepatitis B.

The Most Important Children in the United States: How We Need to Make the Most Out of Our Children and Their Unknown Roles, How We Should Treat Our Children

Fanning their energy, their passion, may be the greatest source of hope for all of humankind. Although their diagnosis is flawless, their ability to act is limited and we need to go beyond that. They’re not in power; they often are not voting. They are usually given two minutes to speak at the front of the meeting after the adults have made their big decisions. So how do we potentiate them to go beyond just sound bites or nice photo ops to action and give them empowered ways of doing things?

I feel like their moral clarity is the clearest because, unlike older people who already bought into something or were worried about their next paycheck or position or winning awards, young people are devastatingly clear in terms of what’s wrong. Their problem statements are spectacularly accurate and on point, and so they give me a huge amount of hope. That’s partly why I still teach global health to young people.

Young people are my biggest source of hope. It is the people who are shining a light on what has been obvious for many years and whyleaders are not acting on it. Even though they are getting killed in schools, young people are still doing great work on gun control. It’s the young people who are alarmed about the rollback of reproductive rights in the U.S., in Afghanistan, you name it.

There have to be a context of hope in justice work, says Maybank of the American Medical Association. “A hope and faith that we will all be able to have an experience of optimal health.”

I am doing work around measuring racism along with many other brilliant scholars across the country, and that gives me hope. In my work and within our research center, we have to be able to make the invisible visible. Racism is so often passed off as this insidious thing that is baked into the system, and it’s so hard to identify, especially when it’s not an explicit interaction with someone.

We need to change the way people are told about what they can do to make them ask, who gets to be trained? Who gets to have the knowledge? Who makes the decisions? Who gets to decide what to make and where it goes? All those decisions happen at some level of leadership. If you diversify that leadership, you will have a better, more balanced opinion about how things should be done. That’s how you start moving toward equity.

Four African American students did almost all the bench work that was needed to get the Moderna COVID vaccine into that first phase 1 trial in March 2020. They were very proud of getting the whole vaccine program launched.

Faith and belief in a way of evolving toward good leads to optimism. The moral arc of the universe bends toward the good. It may take a long time. Helping to diversify the public health workforce through creating more opportunities and knowledge for students is a multigenerational process.

When I think about what things looked like when I was a child, it is daytime and nighttime. Investments in health systems, largely driven by the HIV epidemic, have borne fruit in amazing ways. No services were available, or those that did exist were fractured. There were no resources; there was no access to medicines or lab tests. It’s just been an enormous transformation in only a couple of decades, so that gives me hope for the future.

In a lot of my work and in what I’m seeing across the country with other scholars—incredibly brilliant Black scholars in particular—is an investment and interest in figuring out how we leverage data to measure structural and other forms of racism and then how to use that to inform policy change. We’re coalescing around the need to understand that health policy and social policy go hand in hand. We can not talk about historic redlining and racial covenants without having the data in those communities, as well as what is happening currently. And then using that to inform housing policy just as much as we might use that evidence to inform health policy.

For example, if a person were to do a study in Nigeria and the people who are leading it come from london, they would rely on a lot of infrastructure in Nigeria but disregard that the local people know anything. Then they go home and write this paper and publish it in the BMJ or in the Lancet. The pushback on that has changed, for me, what has changed for me. That is the beginning of things to come. But that physically measurable, countable phenomenon of partnership research sits on a whole bed of assumptions and normalized practices that we took from the colonial experience.

One of the things that I am hopeful is that more and more global health professionals and academics in the Global South are starting to worry about how the field works and needs to change. The idea of the West having a right and a duty to impose itself on the rest of the world was a recurring thought in the field.

Efforts to improve health outcomes of AANHPI are being done by the New York University Langone Health epidemiologist. In the last few years, AANHPI data has helped health-care professionals identify ways to lower cholesterol and improve vaccine rates, as well as reduce the damage caused by COVID and wildfires in Hawaiian communities. Yi says that it’s been exciting to watch.

The N.Y.U. team helped city officials implement community-based programs and offer adult vaccinations at primary care clinics and through community-based organizations. The key to driving down the spread of the disease was understanding that people’s choices about care are related to social conventions.

But the infection was common among Asian American immigrants because of high endemic rates in their countries of origin. In families the virus passed between married partners, from person to person through household contact such as the sharing of utensils, and from mother to child during childbirth. Adults are unlikely to seek healthcare at a clinic for STIs. At the time, researchers reported rates of hepatitis B among Asian Americans that were about 50 times higher than those among non-Hispanic white people, as well as rates of liver cancer, a common consequence of infection, that were several times higher. The researchers at New York University worked with community organizers, politicians, and clinicians in the city to address the disparity.

A collaboration strategy to customize health care after the Maui wildfires to help reduce COVID pandemic disparities in the U.S.

The same approach helped the team customize care after the Maui wildfires by recognizing specific needs such as food, shelter and medicine. Its methods have since been highlighted by the World Health Organization as an effective way to reduce health disparities.

Researchers worked with each community to find the right requirements. Some people wanted a safe place to keep healthy family members away, while others needed more resources for food or medical care, and still others need a way to attend religious gatherings virtually while observing COVID precautions.

The team members didn’t just gather information—they shared it with the communities through hours of virtual visits and phone calls. As they talked, the carefully gathered and stored details helped communities see their own losses amid the sea of numbers. No one could deny the devastation they’d experienced, nor could their experiences be minimized by a database that didn’t represent them and their needs. Matagi says the strategy was effective among the three Pacific Islander communities that were most affected by the disease: the Samoan, Marshallese and Chuuk.

During the most severe stages of the COVID pandemic, getting granular with community data was a lifesaver in Hawaii. The state health department’s infectious disease team was heavily focused on controlling the spread of the virus at the start in 2020. But the scientists were “thinking of it in terms of a purely biological system versus understanding what puts people at risk,” says Joshua Quint, an epidemiologist at the Hawaii State Department of Health. It’s important to accurately measure social factors.

Kanaya points out that data such as these can help clinicians advise patients more effectively by offering solutions that are easier for them to follow rather than forcing a western lifestyle on them.

For the past decade Kanaya and other researchers have run a study of heart health among South Asians living in the U.S. called Mediators of Atherosclerosis in South Asians Living in America (MASALA). It includes a food-frequency questionnaire that lists many South Asian foods, such as dhokla (a savory cake), sambar (lentil stew), steamed fish, lamb curry and popular snacks. Last year the researchers analyzed the diets of nearly 900 people from the study and identified foods correlated with a “South Asian Mediterranean-style diet”—one rich in fresh vegetables, fruit, fish, beans and legumes. They found that people who ate more of these foods had a lower risk of heart disease and diabetes than other people in the cohort.

Source: How to Fix Health Data for People with Asian and Pacific Islander Heritage

How To Fix Health Data for People with Asian and Pacific Islander Heritage? A Case Study of a Philadelphia convenience store parent’s mother, J.P. Kauh, N. J., and K. S. Schubert

The convenience store that Kauh’s parents owned was in Philadelphia. Kauh could tell that the constant demands on their schedules and language problems took a toll on their physical and mental health. They were not like a model minority. “I could see the challenges they experienced on a daily basis, but no one ever really talked about that except to frame it as ‘look how hardworking they are,’” she says.

Kauh first bumped into that cycle in college during an undergraduate psychology class about how culture and ethnicity shape someone’s behaviors and perceptions of social norms. Fascinated, she tried to dig deeper into the experiences of Asian Americans, yet she couldn’t find the data. Kauh says she couldn’t get funders interested in the topic at graduate school. Since then, she says, “it’s been this mission of mine to try to push for collecting data about Asian Americans.”

When data are pooled, these nuances vanish. A physician at the University of Hawaii at Mnoa says that you can’t rely on the estimates anymore because one group looks better than the other. “It’s nonsense. It’s not good science, yet people have been doing this for decades.”

The efforts of advocates, researchers, and community organizers are paving the way to better health.

Source: How to Fix Health Data for People with Asian and Pacific Islander Heritage

Social Stress in Asian Subgroups: Evidence from Eugene Yang’s Cardiology Clinic in Seattle, China, Korea, and Manila, a tech hub

The same stressors are experienced differently by people of different ethnicities. People who experienced more social stress had worse sleep, struggled to exercise, and used more nicotine, all factors associated with higher rates of heart disease. The differences emerged between groups. In Chinese Americans high stress was associated with an increased risk of diabetes, whereas in Filipino adults it was linked to high blood pressure. When Asian Indians felt social stress, they were most likely to suffer from poor sleep and physical activity. “There are significant differences in how social determinants of health impact the different Asian subgroups,” Yang says. This variation is a first step in helping physicians tailor interventions.

Many of the patients who come to Eugene Yang’s cardiology clinic trace their origins back to India, China, Korea, and multiple parts of Southeast Asia. His clinic is in Seattle, a hub for the tech industry and home to thousands of immigrant workers. Yang had seen firsthand how people from each of these groups were at risk of heart disease and how their typical lifestyles differ.