Public Health Issues for Asian Communities in Christchurch: Challenges and Triumphs


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  • NEJM 2010, 21 authors
  • As examples use the male arrival; ME gentleman in phcyShould an Asian patient not understand – nor hear properly – medical instructions, he/she will often not ask for the treatment to be explained again. This is seen as a loss of face. Although many are able to speak English, comprehension is a concern. It cannot be assumed that even though a person may speak English, that person will understand what is being said; the ability to communicate not necessarily meaning an ability to comprehend. This assumption negates cultural sensitivity. Coupled with the English language must be the language of health. New Zealanders tend to speak too quickly; generally responding to a non-native English speaker by raising his/her voice rather than slowing speech down. Mutually communicable language is a vital – and often little regarded – factor in the delivery of health care. Many Korean mothers feel socially isolated in New Zealand due to poor language skills. This is compounded by the many Korean males returning to their home country for extended periods to work.
  • Cultural examples – face we have discussed; little housekeeping knowledge; sedentary lifestyleCulture plays an enormous – and often misunderstood – part in the ability to communicate. Many cultures – particularly in the East – are taught never to question anyone in authority - including medical professionals. Thus treatment regimes are accepted without question. Asians cultures view interpersonal relationships quite differently from those of western cultures. However, within Asian cultures yet more differences exist. For example, Koreans and Chinese value the input of the church far more so than the Japanese. For the Chinese this is a surprising factor given the lack of presence the church is allowed in China.Comments were made by Korean parents that “we get depression from our children!” The same statement could be made by any parent, but what is meant here is that when the children are depressed, mothers become depressed as they see neither answers nor support from absent husbands. Many young Koreans wish to assimilate with New Zealanders, especially at universities. However when they begin to act in a New Zealand way, parents object, believing they are Korean and should act that way. In other words, trying to assimilate into New Zealand by acting as a New Zealander is seen as negative by their parents. This results in family arguments, resulting in health issues.
  • Public Health Issues for Asian Communities in Christchurch: Challenges and Triumphs

    1. 1. Partnership Health Canterbury<br />Te Kei o Te Waka<br />
    2. 2. Christchurch<br />
    3. 3. Christchurch<br />Total Population: 398,801<br />European: 281,385<br />Asian: 27,438<br />Maori: 27,735<br />Pacific: 9,756<br />Others: 52,434<br />(Middle Eastern/African: 3,036)<br />Statistics NZ 2006<br />
    4. 4. Oriental Ethnic Breakdown<br />Statistics NZ 2006<br />
    5. 5. Partnership Health Canterbury – Capitated Age Bands<br />PHO: Dec 2009<br />
    6. 6. Family Health Issues<br />
    7. 7. Current Use of Medical Services<br />
    8. 8. Health-Related Risk Factors<br />
    9. 9. Health-Related Risk Factors<br />
    10. 10. Health-Related Risk Factors<br />
    11. 11. Health-Related Risk Factors<br />
    12. 12. Youth Sexual Health<br />Although the total under 21-year-old Asian group made up 5.9% (2008) and 6.7% (2009) of the total, it was only responsible for 1.5% and 1.6% of the total number of youth sexual health patient numbers. It was also responsible for only 1.3% and 1.4% of the total number of consultations. <br />PHO Data; on file<br />
    13. 13. Pregnancy Termination<br />Statistics New Zealand (December 2008)<br />Asian women have not previously been identified as an at-risk group in New Zealand—rates of chlamydia for Asian women were 14 times higher in this audit than<br />in the audit of completed pregnancies. [Done 12 months earlier]. NZMJ; March 2005<br />
    14. 14. End-of-Life Palliative Care<br />
    15. 15. The Art of Questioning<br />Current smoking, by ethnic group <br /><ul><li>Asian 11.2 (8.9−13.4) 31,200 </li></ul>Source: A Portrait of Health; New Zealand Health Survey: 2008<br />Source: Healthcare Needs of Asian People in the Wider Christchurch Area: 2008<br />Do you smoke?<br />Are you concerned about smoking?<br />
    16. 16. Diabetes<br />Prevalence of Diabetes among Men and Women in China<br />Wenying Yang, M.D., Juming Lu, M.D., JianpingWeng, M.D., WeipingJia, M.D., LinongJi, M.D., Jianzhong Xiao, M.D., Ph.D., Zhongyan Shan, M.D., Jie Liu, M.D., HaomingTian, M.D., QiuheJi, M.D., Dalong Zhu, M.D., JiapuGe, M.D., Lixiang Lin, M.D., Li Chen, M.D., XiaohuiGuo, M.D., Zhigang Zhao, M.D., Qiang Li, M.D., Zhiguang Zhou, M.D., Guangliang Shan, M.D., Ph.D., Jiang He, M.D., Ph.D., for the China National Diabetes and Metabolic Disorders Study Group <br />The New England Journal of Medicine; March 25, 2010<br />9.7% ---- 92,400,000<br />15.5% ---- 148, 200,000<br />
    17. 17. ANNUAL DIABETES CHECKS<br />PHO Data; on file<br />
    18. 18. BMI<br />In the 2006/07 New Zealand Health Survey, Asian males and females had almost 2.5 (males) and over 1.5 (females) times the prevalence of diagnosed diabetes than males and females in the total population. This placed the Asian adult group with the second highest incidence of diagnosed diabetes behind that of Pacific Islanders. <br />
    19. 19. Brief Intervention Counselling<br />In the 15 months ending June 2009, 1,497 new contacts for the Brief Intervention Counselling service. Only 1.7% were for Asian peoples.<br />
    20. 20. Immunisations<br />PHO Data; on file<br />
    21. 21. B4 Schools Checks<br />PHO Data; on file<br />At the end of December 2009, 508 4- and 5-year-old Asian children were enrolled with PHC. 17.5% of them had received a B4 School check. <br />
    22. 22. Language<br />Language is an ability which is difficult to measure. It is the single biggest issue facing migrants to Canterbury.<br />
    23. 23. Language<br />Language<br />
    24. 24. Use of Interpreters<br />Language Line<br />Face-to-Face<br />
    25. 25. Discussion<br />Culture<br />Culture plays an enormous – and often misunderstood – part in the ability to communicate.<br />
    26. 26. FACE<br />
    27. 27. FACE<br />“…pride of your parents, your immediate relatives, your extended relatives, and all your dead ancestors rolled up into this brand you will forever bear on your forehead for the rest of your life. Essentially, if you don’t excel …, then you will “lose face” and bring shame not just to yourself, but more importantly your parents, your relatives, your ancestors, and any being dead-or-alive that would bear the same last name as you.”<br />Dr Jane Chin<br />
    28. 28. The most recent Health Needs Analysis (HNA) published by the Canterbury District Health Board (CDHB) was carried out in 2004 using data from the 2001 census. At that time the Asian population totalled 18,000. Since then, the Asian population has grown by over10,000 people. The 2004 HNA is woefully out-of-date. <br />That HNA highlighted several areas:<br /><ul><li>Health-trained interpreters are essential
    29. 29. Increasing numbers of Chinese GPs and nurses in Christchurch have helped ease worries for non-English speaking Chinese new immigrants.
    30. 30. Instructions about taking medications are often not completely understood
    31. 31. Cultural difficulties in accepting Western medicine
    32. 32. The lack of English language skills
    33. 33. Discrimination</li></li></ul><li>Canterbury does not have an affordable, easily accessible interpreter service. <br />Worries for non-English speaking immigrants have not eased as stated<br />Miscommunication about medicine instructions is rife<br />The lack of understanding of our primary and secondary health care systems confuses most immigrants. <br />Discrimination continues to exist <br />The Brief Intervention Counselling Service is not culturally competent<br />