GRSJ224/Challenges in healthcare among Asian Immigrants in the United States

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Asian immigrants in the United States

Immigrant arrivals in the U.S. from 2001 to 2017. Asians outnumber Hispanic

International migration refers to the movement of people across national borders.[1]The United States has more immigrants than any other country globally; they accounted for 13.6% of the United States population.[2] The immigrant population in the United is comprised of a very diverse group of people coming from different parts of regions. The most common ethnic group among immigrants is Mexican; they accounted for 25% of the immigrant population, followed by China(6%), India(6%), and the Philippine(5%).[2] Historically, there are more Hispanic immigrants than Asian immigrants arriving in the United States. However, this trend has reversed; Asian immigrants in the United States has experienced rapid growth in recent decades and expected to become the largest immigrant group in the United States by 2055.[2][3]

Health of Asian immigrants in the United states

Asian immigrants are healthier than their U.S. counterparts[3][4]. A common explanation for this phenomenon is that people who decided to migrate to the United States are often younger, healthier, and strongly motivated by their vision about a successful future.[3][4] However, research has found that the health of Asian immigrants decline as they increased the duration of stay in the U.S., which cannot be attributed only to an increase in age.[3] As immigrants stay longer in the United States, they are more likely to face discrimination and mental stress stemming from trying to fit into a new culture.[3] Moreover, Hepatitis B virus infection among Asian immigrants is high compared with the U.S. population as a whole,[3][5] and they have a higher risk of getting stomach and liver cancer.[3] While the prevalence of these conditions is high among Asian immigrants, the utilization of health care service is low.[3] Even if they do access the health care service, they are more likely to dissatisfied with their health care service experience than whites, blacks, Hispanics, or other ethnic groups.[6][7]This dissatisfaction could stem from the struggles that are unique to Asian immigrants who hold different cultural beliefs and speak different languages.

Barriers in health care

Difference in health belief

Traditional health practices

Elongated bruise resulting from coining

Traditional Asian medical beliefs and practices differ greatly from the modern western approach.[6] For example, Asian patients often use "coining" and "cupping" to treat their respiratory infection.[6] "Coining" involves rubbing a coin with oil along the back and limbs to release the "wind" or "cold" element.[3][6]This procedure often left bruises on patients' bodies, which has been considered a sign of balance, stimulates blood flow, and the restoration of health.[8] "Cupping" involves warming up the air inside the cup with flame and put it on the patient's skin; as the air inside the cup has cooled, the vacuum is created.[8]Then, by pulling the cup, cold air is "pulled out" from the body.[3]The suction could cause a bruise or hematoma on the patient's skin.[8] Asian patients often use these traditional practices before they were seeking western medical care.[6]However, the western clinician has little knowledge about their health beliefs and traditional methods,[6]and bruises on patients skin are often treated as maltreatment or sign of physical abuse.[3][8] Due to limited understanding and knowledge about these practices from care providers, Asian patients often experience delayed or inaccurate diagnosis.[3]

Cupping

Health Literacy

According to the World Health Organization(WHO), health literacy means the ability to access health information and services and use it effectively to improve personal and community health.[9] Asian Americans have been found to have limited health literacy,[4] this issue may be embedded in eastern health-seeking behavior and health belief. Asian immigrants reported that visiting the health care system is unnecessary unless the symptoms are very severe.[3][4] Moreover, there are false beliefs about diseases that prevent patients from visiting health care services.[4] For example, historically, the low rate of breast cancer incidence among Asian American women compared to other ethnic groups had made them believe that they are not at risk of getting breast cancer.[10] This belief had lead to a lower rate of screening tests among Asian immigrants. In the case of Korean American women aged 65 and older, they have lower screenings(14.8%) compared to Caucasian women(40.9%) who aged the same.[10]This had lead to a poorer health outcome among Asian Immigrants.

Language barriers

Language barriers have been identified as a significant barrier that Asian immigrants faced when accessing health care.[3][4][5][6] Asian immigrants, especially elders who are not proficient in English, struggle to locate health facilities and make appointments.[4] Making an appointment through the telephone is a common way for people to access the health care system.[7] However, Synder's research has found that Asians often have poor telephone access compared with other ethnic groups, resulting in not getting needed care, inadequate treatment, and not following with prescribed treatments.[7] Moreover, speaking in a different language, Asian immigrants who speak limited English struggle to communicate with health care providers and face more barriers to quality care than other Asian immigrants.[6] Miscommunication between them will increase the chance of inaccurate diagnosis, false treatment, and unnecessary health service visits.[3] Frequent visits to the health care system are very costly and time-consuming, which will discourage patients from seeking future health,[3] leading to poor health outcomes.

Interpreter service

Interpreter service is provided in the health care system to mitigate the negative effects of limited English proficiency from the patients. However, this service is scarce in health care.[11] Although patients often rely on their own language skills, family, and friends who speak English, they tend to make mistakes and omission, causing inaccurate translation.[11] It has been found in a study that 23% to 52% of words and phrases are falsely translated.[11] A Chinese patient involved in Ngo-Metzger and her colleges' study has stressed that "the doctor says so much, but the translator says only a few words."[6] Inaccurate translation can disrupt how physician evaluates symptoms leading to incorrect diagnosis and undermine care.[11] Even when the professional interpreters are present in the health care, Asian patients with limited English skills will refrain from asking questions about their health compared to other patients who speak better English as they fear interpreters will not respect their culture and identity.[4]

Discrimination from health providers

Asians in the U.S. may experience discrimination across areas of life, such as health care.[12] More than one in seven Asian adults reported being discriminated in clinical encounters.[12] Language discrimination is a major type of discrimination that Asian immigrant patients face from health care staff and providers. [13] Besides, negative attitudes towards delayed treatment and the use of traditional medical practices were also being reported.[3] Discrimination against Asian immigrant patients in the health care settings would result in avoidance of care. [12] Mcmurtry et al. found that Asians have a higher chance of avoiding health care than whites as they fear discrimination,[12] putting their health condition at risk. Discrimination could negatively impact Asian immigrants through providers not following the prescribed treatment to treat their patients and patients not trusting the health care system.[3] Many negative health consequences could be caused by discrimination against Asian patients, such as the increased risk of chronic conditions,[13]depression, cardiovascular diseases, pain disorder, and respiratory conditions.[12]

Recommendations

The struggles experienced by Asian immigrants in healthcare settings are caused by the difference in health practices, beliefs, and languages between them and the western healthcare setting. With little knowledge about Asian cultures and languages, care providers often make inaccurate diagnoses, express negative attitudes towards Asian traditional medical practices, and reinforce discrimination against Asian culture and their language ability. These will discourage Asian immigrants from revisiting the health care system, leading to a poor health outcome.

To mitigate and remove these barriers, health professionals need to expose to the diversity of traditions and beliefs contained by the U.S population to create a culturally sensitive health care environment.[3] Respecting and knowing patients' health beliefs and practices are crucial to prevent making inaccurate diagnoses, offend patients' cultures unintentionally, remove discrimination against Asian patients and their cultural beliefs. Health professionals should ask directly about their health beliefs and traditional practices before making assumptions.[6] Besides, it would be helpful if a health program can reach out to the patients with limited health literacy to remove the incorrect health beliefs and behaviors among them.[4] Moreover, while there is a need to train and recruit more professional interpreters to address the lack of interpreters in the U.S healthcare system, they must increase their understanding of Asian cultures and beliefs. The quality of the interpreters could be monitor by evaluation from patients and providers.[6]

References

  1. ↑ "Migration/ Geographic mobility". United States Census Bureau. December 21 2017. Retrieved August 3 2020. Check date values in: |access-date=, |date= (help)
  2. ↑ 2.0 2.1 2.2 Radford, Jynnah (June 17 2019). "Key findings about U.S. immigrants". Pew Research Center. Retrieved August 3 2020. Check date values in: |access-date=, |date= (help)
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 Clough, Juliana; Lee, Sunmin (2013). "Barriers to Health Care among Asian Immigrants in the United States: A Traditional Review". Journal of Health Care for the Poor and Underserved. 24: 384–403. line feed character in |title= at position 47 (help)
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 Kim, Wooksoo; Keefe, Robert. "Barriers to Healthcare Among Asian Americans". Social Work in Public Health. 25: 286–295.
  5. ↑ 5.0 5.1 Carey, William; Tran, Tram (May 2009). "Understanding cultural barriers in hepatitis B virus infection". Cleveland clinic journal of medicine. 76: 10–13.
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 Ngo-Metzger, Quyen; Massagli, Michael; Clarridge, Brian; Manocchia, Michael; Davis, Roger; Iezzoni, Lisa; Phillips, Russell. "Linguistic and cultural barriers to care". Journal of General Internal Medicine. 18: 44–52.
  7. ↑ 7.0 7.1 7.2 Snyder, Rani; Cunningham, William; Nakazono, Terry; Hays, Ron (June 2000). "Access to Medical Care Reported by Asians and Pacific Islanders in a West Coast Physician Group Association". Medical Care Research and Review. 57: 196–215.
  8. ↑ 8.0 8.1 8.2 8.3 Vitale, Susan; Prashad, Thaleshravi (July 2017). "Cultural Awareness: Coining and Cupping". International Archives of Nursing and Health Care. 3: 3.
  9. ↑ "Health promotion". World Health Organization. Retrieved August 6 2020. Check date values in: |access-date= (help)
  10. ↑ 10.0 10.1 Juon, Hee-Soon; Kim, Miyong; Shankar, Sharada; Han, Wolmi (September 2004). "Predictors of adherence to screening mammography among Korean American women". Preventive Medicine. 39: 474–481.
  11. ↑ 11.0 11.1 11.2 11.3 Woloshin, Steven (March 2005). "Language Barriers in Medicine in the United States". JAMA: The Journal of the American Medical Association. 273: 724.
  12. ↑ 12.0 12.1 12.2 12.3 12.4 Mcmurtry, Caitlin; Findling, Mary; Casey, Logan; Blendon, Robert; Benson, John; Sayde, Justin; Miller, Carolyn (October 2019). "Discrimination in the United States: Experiences of Asian Americans". Health Services Research. 54: 1419–1430.
  13. ↑ 13.0 13.1 Yoo, Hyung; Gee, Gilbert; Takeuchi, David (December 2008). "Discrimination and health among Asian American immigrants: Disentangling racial from language discrimination". Social Science & Medicine. 68: 726–732.
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