1. Healthcare Needs of the Hmong: Following Through an Example Ilean Her Executive Director Council on Asian-Pacific Minnesotans 658 Cedar Street, Suite 160 St. Paul, Minnesota 55155 651.296.0538: 651.297.8735 fax www.state.mn.us/ebranch/capm Kao.ly.her@state.mn.us

2. 3 Things to Consider Cultural Overview Refugee Experience & Trauma Adaptation & Acculturation Health Status Heath Needs or Disparities Strategies Implementation

3. 4 What Constitute Health Status? Health status a description of the health of the total population, using information representative of most people living in this country. For relatively small population groups, however, it may not be possible to draw accurate conclusions about their health using current data collection methods. The goal of eliminating health disparities will necessitate improved collection and use of standardized data to identify correctly disparities among select population groups. Health status can be measured by birth and death rates, life expectancy, quality of life, morbidity from specific diseases, risk factors, use of ambulatory care and inpatient care, accessibility of health personnel and facilities, financing of health care, health insurance coverage, and many other factors. The information used to report health status comes from a variety of sources, including birth and death records; hospital discharge data; and health information collected from health care records, personal interviews, physical examinations, and telephone surveys.. Source: Healthy 2010

4. 5 Leading Health Indicators: Healthy People 2010 The Leading Health Indicators illuminate individual behaviors physical and social environmental factors, and important health system issues that greatly affect the health of individuals and communities Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to health care

5. 6 Source: Healthy People 2000 Final Review

6. 7 Identifying the Disparity Cancer in the Minnesota Hmong Population Study, 2003 1988-1999 cancer cases of Hmong were collected and looked at. 186 cases: 84 males and 102 females (<.1% of Hmong population) Age Distribution Under 20 6% 20 to 4023% 40 to 6030% 60 to 8033% Over 808%

7. 8 Cancer Decreased ratio for: Prostate cancer Breast cancer Hodgkin’s disease Melanoma Increased rates for Nasopharyngeal (area in back of nose & upper throat) Cancer (39.39%) Gastric (stomach) Cancer (8.70) Hepatic (liver) Cancer (8.08) Cervical Cancer (3.72) *rates=proportional incidence ratios and not direct incident rates due to lack of accurate census data

8. 9 Understand the Disparity Lack of trust and experience in Western medicinal practices Avoidance and low participation in screening programs Diagnosis of many cancer sites occurred at the advanced stage and grade of disease APIAHF: Health Briefs – Hmong in the United States

9. 10 Create Strategies Intervention: targeted culturally sensitive screening programs Education and outreach Campaign Cross cultural training for medical professionals

10. 11 Culturally Responsive Care A culturally sensitive approach requires demonstrating respect for a patient’s cultural beliefs and reaching across cultures with human intentions. Themes in Cross-cultural medicine Apprehension about the effects of invasion procedures Fear operations may impair spiritual health Concerns over effects of long-term medication, particularly when patient does not “feel” ill Need to maintain hot-cold balance Value of family-based decision making Source: Culturally Responsive Care for Hmong Patients, Cheng Her, MD, MS and Kathleen A. Culhane-Pera, MD, MA