Asian Americans and Pacific Islanders

In 2005, the Asian American and Pacific Islander population comprised 5% of the United States population (approximately 14.4 million people). This group is the fastest growing of all major racial/ethnic groups. California, New York, Hawaii, Texas, and New Jersey have the largest Asian American populations (Dossey et al., 2000; OMH, 2007b).

The Asian American culture involves individuals from more than 20 countries who speak more than 100 different languages and represent more than 60 ethnicities. (Dossey et al., 2000). Nearly three-fifths of Asian Americans are foreign-born and originate from the following countries (Luckmann, 1999; Management Sciences for Health, n.d.):

• China
• India
• Japan
• The Philippines
• Korea
• Laos
• Cambodia
• Vietnam
• Thailand

Pacific Islanders include people from Polynesia, Micronesia, and Melanesia. These land areas are comprised of thousands of islands with enormous differences in historical backgrounds, languages, cultural norms, and lifestyles. Micronesia alone has at least 12 different languages and as many cultural patterns (Management Sciences for Health, n.d.).

Cultural Issues

Traditional Asian values are based on traditional religious beliefs, greatly influenced by Buddhism, Taoism, Christianity, Confucianism, and Hinduism. These values place a higher worth on the interests of the family than on those of the individual. Education, a strong sense of community, and "keeping up appearances" are also extremely important (Luckmann, 1999).

The guiding values of Pacific Islanders include the following (Dossey, 1997; Management Sciences for Health, n.d.):

• an emphasis on the patrilineal family and the well-being of the community over that of the individual
• a definition of the family that includes both living and dead relatives related by blood, marriage, and adoption; spirituality and ancestral communication may involve immortals taking the form of animals or even rocks
• an emphasis on reciprocity and interdependence but with clearly defined roles and responsibilities for both gender and age; mutual obligations to others, working and living cooperatively, and group harmony are key elements
• holism and a multidimensional approach to life and health
• the concept of "right behavior" (group harmony, support, and well-being), which is connected to maintaining and sustaining friendships, familial bonds, community, and a life lived with interdependence and in perfect order
• rituals, such as storytelling, that are powerful therapeutic activities
• the use of food, alcohol, and kava/sakau for festive and ceremonial occasions (and particularly by men) to relax, bond, foster interdependence, or for medicinal purposes
• the use of food, alcohol, and kava/sakau for festive and ceremonial occasions (and particularly by men) to relax, bond, foster interdependence, or for medicinal purposes
• the strategy of seeking a knowledgeable patron or mentor/elder who protects the younger individual from misfortune or erroneous ways

 

Health Care Issues

The health care practices of Asian Americans are profoundly affected by the Buddhist philosophy of life. This philosophy encourages respect for elders and those in authority (such as health care providers) and it teaches that life is a cycle of suffering and rebirth. Therefore, suffering may be seen as something that must be endured and the Asian American may delay seeking health care remedies because of this belief. In the Buddhist philosophy, healing is spiritual as well as scientific and some individuals may believe that their illness is a result of karma as well as biology (Management Sciences for Health, n.d.).

Another profound influence on the health of the Asian American is the traditional health practice of Chinese medicine. Practiced for more than 3,000 years, Chinese medicine views the mind, body, and spirit as an integrated whole in which each component affects the other. Many Asian Americans believe that the universe is composed of opposing forces: yin and yang, or hot and cold. Health is achieved when each element is in balance (Management Sciences for Health, n.d.). Herbalists and shamans are considered healers, and they utilize specific foods to maintain harmony with natural forces. Massage, pinching, and cupping (the application of cups to the skin to create a vacuum and increase circulation to an area) are techniques used for healing.

Ayurveda (which means "knowledge or science of life") is also a traditional Asian approach to health care. This Indian system of holistic healing views the body as a combination of three forces, or doshas. The basic principle of Ayurveda is to prevent illness by maintaining a balance in the body, mind, and spirit through yoga, meditation, herbal medicine, and dietary recommendations specific for each individual. Ayurveda is based on ideas from Hinduism, one of the world's oldest and largest religions, as well as on ancient Persian beliefs (National Center for Complementary and Alternative Medicine [NCCAM], 2005/2006).

 

Return to the Beginning

Health risk factors for the Asian American can include the following (Dossey et al., 2000; HHS, 2000; Management Sciences for Health, n.d.; OMH, 2007b):

• There can be stress of acculturation by Asian immigrants and refugees, especially if the individual is elderly.
• The desire to "keep up appearances" may delay treatment for mental illness, drug abuse, and domestic violence.
• A lack of knowledge of risk factors exists for diseases such as high blood pressure or cancers or of the preventive behaviors for such diseases.
• Differing expectations of health visits may deter many Asian Americans from obtaining care (for example, 90% of the obstetricians and gynecologists in China are female).
• Common sites of cancers among Chinese men include the liver, colon, stomach, and nasopharynx.
• Newcomers to the United States may have hepatitis, intestinal parasites, malaria, and/or Hansen's disease.
• Asians are 20% less likely than non-Hispanic whites to die from diabetes.
• Overall, Asian/Pacific Islander adults are less likely than non-Hispanic white adults to have heart disease.
• Among Asian/Pacific Islanders, sudden infant death syndrome (SIDS) is the third leading cause of infant mortality.
• A higher rate of new cases of hepatitis and tuberculosis exists among Asian Americans and Pacific Islanders living in the United States than among whites.

When providing culturally competent health care for Asian Americans it is important to remember the following (Management Sciences for Health, n.d.):

• Looking straight into the eyes of some Asian elders may be equated with disrespect.
• A limp handshake may be a way of showing humility and respect.
• Physical contact (such as a handshake or hug) between a man and a woman may be viewed as a sexual overture or advance.
• Addressing the oldest male in a family or group first, before greeting other members, may be appropriate for some Asian subcultures.
• Observing facial expressions may provide little or no information; little emotion may be shown in the faces of some Asian groups, especially if they have experienced torture, genocide, war, slavery, or political oppression.
• Health care services may be more readily accepted if they involve community-based organizations or community leaders.
• Approaching health care from a holistic perspective may be more effective than the traditional western approach.
• When working with Asian American clients, observing nonverbal cues (such as body language) can often provide important information.
• Because of a cultural tradition that emphasizes self-humility, some Asian Americans are uncomfortable with giving and receiving compliments or saying "thank you" and may even ignore the compliment with silence or by turning their head away from the speaker.

Barriers to health for Pacific Islanders include the following (Management Sciences for Health, n.d.):

• lack of available facilities
• inadequate, untrained personnel
• health care systems that are not responsive to cultural norms
• spiritual despair and depression as a result of negative health, social, educational, and economic experiences
• desire to keep problems in the family and "take care of their own"
• loss of cultural identity and sense of place, since many have been displaced from their homelands or have experienced successive occupation by other cultures

For those interacting with Pacific Islanders, the following suggestions will help ensure that culturally competent care is provided (Management Sciences for Health, n.d.):

• Foster the individual's cultural identity and cultural pride.
• Promote and preserve cultural identity, values, and traditions.
• Include the family in intervention and treatment efforts.
• Recognize the importance of spirituality in their lives.
• Involve community and traditional leaders when improving accessibility and acceptability of services.
• Incorporate elements of rituals in the treatment process.