Health and race in California

Asian/Pacific American Elderly: Mortality Differentials, Health Status, and Use of Health Services

Asian/Pacific Americans are the fastest growing segment of the U.S. population today. The purpose of this paper is two-fold: (1) to provide a description of the mortality differentials, health status, and health services utilization of these Asian/Pacific Islanders and elderly based on records maintained by the National Center for Health Statistics and other findings reported by individual researchers, and (2) to show that there is an urgent need to gather accurate and specific data so that their needs can be assessed realistically. A socio-demographic profile will be presented, followed by a discussion of health behavior and health services utilization. Thus far, the health needs and health services utilization relative to white and black Americans have been ignored. Studies of the Asian/Pacific Americans' needs have been unsystematic and fragmentary. Many of the existing findings come from sample and non-professional studies by service providers on conditions and services rather than from studies conducted by trained investigators. Thus, the cycle of 'no statistics, no problems' has been a persistent problem in dealing with their needs. The concommitant problems of housing congestion, language barriers, under- or non-utilization of medical services also need to be remedied. In addition, their medical systems, the role of culture in health care, and the impact of western medicine should be examined in detail.

Social inequalities in health within countries: not only an issue for affluent nations

While interest in social disparities in health within affluent nations has been growing, discussion of equity in health with regard to low- and middle-income countries has generally focused on north-south and between-country differences, rather than on gaps between social groups within the countries where most of the world's population lives. This paper aims to articulate a rationale for focusing on within- as well as between-country health disparities in nations of all per capita income levels, and to suggest relevant reference material, particularly for developing country researchers. Routine health information can obscure large inter-group disparities within a country. While appropriately disaggregated routine information is lacking, evidence from special studies reveals significant and in many cases widening disparities in health among more and less privileged social groups within low- and middle- as well as high-income countries: avoidable disparities are observed not only across socioeconomic groups but also by gender, ethnicity, and other markers of underlying social disadvantage. Globally, economic inequalities are widening and, where relevant information is available, generally accompanied by widening or stagnant health inequalities. Related global economic trends, including pressures to cut social spending and compete in global markets, are making it especially difficult for lower-income countries to implement and sustain equitable policies. For all of these reasons, explicit concerns about equity in health and its determinants need to be placed higher on the policy and research agendas of both international and national organizations in low-, middle-, and high-income countries. International agencies can strengthen or undermine national efforts to achieve greater equity. The Primary Health Care strategy is at least as relevant today as it was two decades ago: but equity needs to move from being largely implicit to becoming an explicit component of the strategy, and progress toward greater equity must be carefully monitored in countries of all per capita income levels. Particularly in the context of an increasingly globalized world, improvements in health for privileged groups should suggest what could, with political will, be possible for all.

Hypertension and related health issues among Asians and Pacific Islanders in California

The prevalence of controlled and uncontrolled hypertension in the United States is lower for persons ethnically classified as Asian, particularly Japanese and excepting Filipinos, than for the general population. In this study, measurements of blood pressure were taken of 8,353 adults living in California, including 1,757 Asians and Pacific Islanders, and the subjects were asked six questions concerning high blood pressure. The results show that Asians and Pacific Islanders with hypertension, in comparison with hypertensive persons of other races, were less likely to be aware of their hypertension, to be under treatment with medication, and to be controlling their blood pressure; similarly, they had their blood pressure measured less frequently and visited physicians less often. Compared with the general population, Asians and Pacific Islanders were less knowledgeable about hypertension. In relation to health care, they recorded lower frequencies of hospital stays, days of bed disabilities, and days of not feeling well than persons of other races. Asians and Pacific Islanders' lower treatment rates and knowledge level concerning hypertension may be related to the fact that a high percentage are foreign-born. Consequently, they have been taught less about hypertension, rely more on traditional methods of medicine, and are hampered by the lack of availability of health care providers of their own ethnic background. In addition, Filipinos have experienced high levels of poverty and lack of education. These factors require additional study as part of efforts to help improve health care for these ethnic groups in the United States.

Health services for Asian elderly

Between 1970 and 1980, there has been an increase of more than 140% of Asians in America, mainly through the influx of new immigrants as a result of the 1965 legislative amendment to the old national quota immigration law. Along with the increase of new immigrants and their families, we experienced a sudden awareness of the problems of the immigrant elderly in addition to those who came during the first decade of the present century as farm labor from China and the Philippines, as well as the very old Issei (first generation) and the aging Nisei (second generation) from Japan. Our data showed that not all elderly Asians are taken care of by their kin or the ethnic community facilities. Compared with the general American population, such elderly populations have problems associated with economic conditions, cultural mismatch, as well as the structural factors of ethnic communities that left many elderly living alone or with nonrelatives. The myths of the support group have not been rigorously investigated in such ethnic communities.

Hypertension-related mortality in California

Death rates in California for hypertension-related diseases during 1969-71 and 1979-81 are compared. During both periods, age-standardized rates for a composite hypertension-related mortality category are highest for blacks, followed by whites, and lowest for Asians and Pacific Islanders. Filipinos who have high prevalence rates of hypertension record low rates of hypertension-related mortality. After adjusting for the comparability ratio, the age-standardized hypertension-related death rate declined by more than 28 percent between 1969-71 and 1979-81. The decrease was greatest at age 15-44 years. Of all major hypertension-related diseases, cerebrovascular diseases registered consistently large percentage declines in mortality for all age and race groupings examined. Possible reasons for the considerable decline in hypertension-related mortality and low death rates for Asians and Pacific Islanders are discussed. The combined effects of improved population awareness, level of treatment, and control of hypertension; a greater knowledge of cardiovascular risk factors and associated modifications of behavior; and improved medical technology and care may have contributed to the decline.

Medical care and mortality: racial differences in preventable deaths

We analyzed deaths of blacks and whites in Alameda County, California where previous studies have documented consistent racial inequalities in health services. We classified each death during 1978 as due to preventable and manageable conditions or as "non-preventable" according to lists compiled by the Working Group on Preventable and Manageable Diseases chaired by Dr. David Rutstein. The total death rate for blacks 0-65 years of age exceeded that of whites by 58 percent (p less than .01). Rates of death due to preventable and manageable conditions for persons aged 0-65 years were 77 percent higher for blacks than for whites (p less than .01). More than one-third of the excess total death rate of blacks relative to whites could be explained by the excess of potentially preventable deaths. Our findings suggest that inequalities in health services reinforce broader social inequalities and are in part responsible for disparities in health status. Improvements in the health and longevity of blacks and other oppressed groups might be achieved by improved access to existing medical, public health, and other preventive measures.

Racial differences in hospitalization rates among navy enlisted men

Similarities and differences in hospitalization rates among five racial groups serving in the Navy during a 3-year period (1973-75) were examined, and the differences in terms of sociological and occupational factors were evaluated. Overall annual hospitalization rates per 10,000 men were blacks, 1,413; whites, 1,109; American Indians, 923; Asian-Americans, 683; and Malaysians (Filipinos), 508.Explanations for the low Malaysian hospitalization rate included selection of the fittest for service, age and job experience, and a low percentage of assignments to physically arduous occupations. Although blacks had the highest rates for many medical conditions, their rates for injuries, respiratory diseases, and infective disorders were comparable with those for whites. Blacks had the highest rates for several non-life-threatening conditions that required surgical procedures; this finding suggested that the Navy Medical Department had filled a longstanding need for corrective treatment.Although the results of this study should be useful to military medical planners responsible for the health care of all naval personnel, the authors conclude that detailed longitudinal studies are needed to establish more clearly the underlying biological and sociological factors associated with racial differences in morbidity.