YOUR HEALTH: TAKE CHARGE!
NCAPIP RESPONSE TO THE PRESIDENT'S STATE OF THE UNION ADDRESS
By: Winston Wong, MD, Vice Chair- Policy,
National Council of Asian Pacific Islander Physicians
In the President's State of the Union message last night, President Obama reiterated the critical goals of the Patient Protection and Affordable Care Act (PPACA). The National Council of Asian Pacific Islander Physicians applauds features of the PPACA that have already been implemented, including provisions that allow children up to age 26 to be covered under their parents' health insurance policies, and increased federal support for elders' pharmacologic costs under Medicare Part B. These provisions are representative of PPACA's immediate and long term impact on the welfare of Asian and Pacific Islander families and communities.
The president's address also emphasized the importance of educating our children and the investment that is needed to train and develop our next generation. NCAPIP recognizes that the health of communities is inextricably linked to educational opportunities for young people, and we believe that educational opportunity should be available to all children regardless of their immigration status, nationality, and linguistic background. The NCAPIP believes that the future of health care in our communities is dependent on a strong and vibrant health care workforce that reflects our diversity and is afforded professional education and opportunity.
President Obama specifically mentioned the importance of addressing the crisis in medical malpractice. Many physicians serving the API community are hampered by the high cost of malpractice insurance, and fewer and fewer providers are able to afford to maintain practice in underserved communities. We are eager to work with this administration and lawmakers to address TORT reform and malpractice laws, and reverse the trend of physicians forced to abandon or contract their practices based on the cost of malpractice premiums.
NCAPIP applauds the President's call for investment in our infrastructure, particularly in information technology that will enable improved access and quality to vulnerable populations such as immigrant communities and those with low health literacy.
NCAPIP is anxious to support efforts by Congress and the President to improve health care access and quality to the underserved API community. We stand ready to marshal our resources, commitment, and experience to improve the health of all Americans.
CARDIOVASCULAR DISPARITIES IN ASIAN AMERICANS
By: Wilson Ko, M.D.
President Obama signed a 2009 Executive Order that calls for investigations on the health disparities among Asian Americans, highlighting the importance of understanding the differences among the Asian American subgroups.1 There has been essentially no representation of Asian Americans in clinical trials; there currently exists a significant lack of data on the health conditions of Asian Americans, and this is nowhere more apparent than with serious heart conditions among Asian Americans.
Thankfully, a few individuals have taken up the effort to reveal the disparities in question. The findings of some of these studies on cardiovascular diseases among Asian Americans include both negative and positive indications:
- Ischemic heart disease is caused by blockages in the arteries that supply blood and oxygen to the heart; these blockages are buildups of cholesterol and plaque. While the incidence of hospitalization related to ischemic heart disease for Chinese Americans is lower than the general population, South Asian Indians have a higher rate of hospitalization than the general population. 2
- Compared to the general population, South Asians in Canada have the worst 5 year cardiovascular outcome including more incidences of: death, non-fatal heart attack, strokes, and the need for heart surgery. 3
- Chinese Americans have a significantly lower amount of coronary artery calcium (calcified plaque that can narrow arteries and lead to heart attacks) despite a higher prevalence of diabetes when compared to the general population. 4
- The mortality rates from coronary artery bypass surgery was found to be higher among Asian Americans than the general population in the California registry. 5
- In a 2009 New York Chinatown survey, only 1/3 of the Chinese Americans were found to be overweight or obese when the World Health Organization standard was used. However, when the data was analyzed using the Pacific BMI standards (a body mass index appropriately designed for Asian Americans), 2/3 of the participants were found to be overweight or obese. 6
- In New York Downtown Hospital, the Chinese patients were found to have a significantly higher proportion of hemorrhagic strokes (caused by rupture of the blood vessel and bleeding) and lower proportion of ischemic strokes when compared to Caucasians. Normally, ischemic strokes are much more common than hemorrhagic. The difference here was due to a much higher rate of hypertension and stress among Chinese stroke victims. Hemorrhagic stroke is almost always more serious than ischemic stroke. 7
- Chinese American patients were found to have a high prevalence of non-responder to two of the major blood thinner drugs (Clopidogrel or Plavix) (70%) in one cardiology group study with unclear clinical ramification. 8
- ACE-inhibitors (medications that relieve blood pressure) are not prescribed by Chinese American physicians to Chinese patients because of the high incidence of the severe cough side effect.
Although the number of studies has been few, they have been enlightening and warrant future studies to improve the health of Asian Americans. When all cardiovascular diseases are taken together as a group, the cardiovascular disease group accounts for the most common causes of death among Asian Americans. For this reason, there is a great need to better define the cardiovascular risk profiles of different Asian American subgroups. It is vital that more research continues to be done to reveal the risks of cardiovascular disease in the many different Asian subgroups.
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