Marguerite Ro

Methodological Issues in the Collection, Analysis, and Reporting of Granular Data in Asian American Populations: Historical Challenges and Potential Solutions

There are close to 15 million Asian Americans living in the United States, and they represent the fastest growing populations in the country. By the year 2050, there will be an estimated 33.4 million Asian Americans living in the country. However, their health needs remain poorly understood and there is a critical lack of data disaggregated by Asian American ethnic subgroups, primary language, and geography. This paper examines methodological issues, challenges, and potential solutions to addressing the collection, analysis, and reporting of disaggregated (or, granular) data on Asian Americans. The article explores emerging efforts to increase granular data through the use of innovative study design and analysis techniques. Concerted efforts to implement these techniques will be critical to the future development of sound research, health programs, and policy efforts targeting this and other minority populations.

Transforming the Delivery of Care in the Post–Health Reform Era: What Role Will Community Health Workers Play?

The Patient Protection and Affordable Care Act (PPACA) affords opportunities to sustain the role of community health workers (CHWs). Among myriad strategies encouraged by PPACA are prevention and care coordination, particularly for chronic diseases, chief drivers of increased health care costs. Prevention and care coordination are functions that have been performed by CHWs for decades, particularly among underserved populations. The two key delivery models promoted in the PPACA are accountable care organizations and health homes. Both stress the importance of interdisciplinary, interprofessional health care teams, the ideal context for integrating CHWs. Equally important, the payment structures encouraged by PPACA to support these delivery models offer the vehicles to sustain the role of these valued workers.

Poverty, Race, and the Invisible Men

Improving access to primary health care by the poor, the underserved, and those living at the economic and social margins of this nation’s social construct has been work that the W. K. Kellogg Foundation has pursued rigorously and with deep commitment. We have worked to lead and serve as we supported health clinics, as well as to define, refine, and implement pathways to improve health for many. But like most, we have neglected a significant part of the population most in need of health care. We were blind to the fact that when we visited clinics and worked with communities to address their health needs, there were few men in the waiting rooms of the clinics where primary health and prevention services were being provided. Virtually no health efforts were directed toward men. Poor men had become invisible and their health needs neglected.

Moving forward: Addressing the health of Asian American and Pacific Islander women

Little is known about the health of Asian American and Pacific Islander (AAPI) women, a rapidly growing population marked by diverse sociodemographic characteristics, health needs, and access to and use of health services. This commentary provides broad recommendations for research, program development, and policy development based on the first-ever White House Initiative report on AAPIs. These recommendations address the issues of data, access, civil rights, community capacity, and the need to recognize ethnic subgroups among the AAPI population. Reflecting on the events of the past year, the recommendations provide direction for public health to address the health and well-being of AAPI women.

Lack of Oral Health Care for Adults in Harlem: A Hidden Crisis

OBJECTIVES Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care. METHODS A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist. RESULTS Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than

Developing the Community Empowered Research Training Program: Building Research Capacity for Community-Initiated and Community-Driven Research

9000 (36%), were unemployed (34%), and lacked health insurance (34%). The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%). CONCLUSIONS There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism.

Out of the Shadows: Asian Americans, Native Hawaiians, and Pacific Islanders

Health promotion practice research conducted by or in partnership with community-based organizations (CBOs) serving Asian Americans, Native Hawaiians, and Pacific Islanders (AA and NHPI) can address health disparities. Few CBOs have the tools to integrate or initiate research into their programmatic agenda. The New York University (NYU) Center for the Study of Asian American Health (CSAAH) and the Asian & Pacific Islander American Health Forum (APIAHF) created a partnership with the goal to support CBO research infrastructure development by creating the Community Empowered Research Training (CERT) program. Methods: A survey was conducted and discussions held with CBO leaders representing AA and NHPI communities to inform the development of the CERT program. Results: The majority of participants are engaged in service-related research and reported interest in building their research capacity. CBOs may require help reframing how data can be collected and used to better inform programmatic activities and to address health disparities facing AA and NHPI communities. Conclusions: CBOs possess both an interest in and access to local knowledge that can inform health priorities. Findings have been applied to the CERT program to build capacity to support community-initiated/driven research to address health disparities affecting AAs and NHPIs.

Vulnerable Populations, Prison, and Federal and State Medicaid Policies: Avoiding the Loss of a Right to Care

The authors discuss the role of public health in building an evidence base for change regarding immigration and health care reform. They advocate the consistent disaggregation of data regarding immigrant populations including Asian Americans, Native Hawaiians and Pacific Islanders who are the focus of this issue. They support the use community-based participatory research (CBPR) methods.

Community-Based Oral Health Prevention Issues and Opportunities

Unknown numbers of incarcerated people are losing public benefits. Instead of suspending these until the prisoner or detainee is released into society, some states are simply terminating benefits upon incarceration. Although there is evidence to suggest that this policy is having negative consequences for those who are reentering society and on their communities and systems of care, the precise impact is not clear because a systematic monitoring of these actions is nonexistent. A more efficient system would (a) suspend benefits and automatically reinstate the same to those eligible upon release and (b) establish a monitoring mechanism that would provide an accurate accounting of how these benefits are being applied.

Role of Federal Policy in Building Research Infrastructure Among Emerging Minorities: The Asian American Experience

For too long the issue of oral health has been neglected and has been separated from issues of primary care and general health. As a result of this neglect, large disparities in oral health exist by race/ ethnicity and social class. Despite scientific and technologic advancements, basic oral health prevention and care elude many Americans, particularly the uninsured and underinsured, low-income populations, and communities of color. It is within these communities that we continue to see high rates of oral disease and low rates of utilization of oral health services. Children represent a special problem. Twenty-five percent of children, namely those who are poor or are children of color, experience 80% of all dental decay occurring in permanent teeth. 1 The problems of children are not the only crisis that the nation faces as the oral health status of poor adults, and their access to any care, including restorative care at the moment, appears to defy solution or priority in policy dialogue (Figure 1). While the oral health recommendations of the Task Force on Community Preventive Services (the Task Force) do not target any specific population, they are a starting point for the concomitant task of identifying community-based interventions along the continuum of addressing oral health disparities including disparities in access to care. The next step however is to identify where the needs are, factor in the economic and social impact of the oral health disparities, and design appropriate points of intervention and service to effectively address the oral health of underserved communities. The W.K. Kellogg Foundation through its Community Voices: Healthcare for the Underserved Initiative and other funded activities has focused on improving access to oral health for vulnerable populations as a way to improve oral health for all. A basic tenet underlying Kellogg’s investments is that oral health care must be integrated within a primary healthcare system that is accessible, acceptable, and available to all. While the Task Force has focused on three disease-oriented issues— dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries—the Kelloggfunded oral health activities focus on complementary issues related to the health delivery system and health policy. The Kellogg-funded work addresses the overarching issues of accessibility, finance, education, workforce, and infrastructure/organization. The work ultimately attempts to integrate activities that remove barriers in a manner that does not leave segmented and separate answers for different communities based on, for example, service gateway, payment, and willing provider availability. Kellogg’s Community Voices Initiative involves thirteen diverse communities— or learning laboratories— across the country that serve as working centers to identify and implement strategies and interventions that address the needs of those who currently receive inadequate or no health care. The lack of any, adequate, or appropriate oral health care has been a major focus of their overall work in addressing the need for a comprehensive primary care system. These learning laboratories serve some of the hardest-to-reach populations, including those living in poor rural and urban communities, immigrants, children of the poor, communities of color, women attempting to make the transition from welfare to work, adult men, and the homeless.