Its impact on the Hmong Community
When I asked Kevin, a former student at Fresno City College, to share his story about dealing with a family member who had diabetes, he declined, saying it was too personal. It was a story close to his heart which he was unwilling to share with just anybody. As with any major health condition, family members tend to bear the burden – because one person had diabetes, it felt like the whole family had it. His story of struggle may be familiar for those who are currently living with a loved one who has a chronic illness like diabetes.

Diabetes / Interventions
Diabetes is also a global health issue with 346 million people diagnosed with diabetes worldwide. (3) In Fresno County alone, nearly over 37,000 people are diabetic. Although Asian Americans are known to have good health, they also face very serious chronic health issues like diabetes. This includes our very own Hmong community.

Type I diabetes is a genetic disease that is insulin dependent, whereas the choice of becoming diabetic is known as Type II diabetes, which is insulin resistant. For the purpose of this article, we are going to focus on type II diabetes.

Type II diabetes is caused by being overweight and lack of exercise. It occurs when the “pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces.” (3) Insulin is a hormone in our body that encourages cells in our body to drain sugars from our blood and into the liver and muscles to be used as energy. When insulin is not available to manage the flow of sugars into our blood, it increases the risk of health outcomes such as gout, blindness, kidney failure, heart attacks, leg amputation, or death.

People at risk for Type II diabetes tend to be obese. Chao Vang, a nurse practitioner from Fresno’s Urology Association of Central California who did her master’s thesis on diabetes and its impact on the Hmong community says that many “try to starve themselves and that it is not the best idea.” Alternatively, “They can eat brown rice and sometimes they take fat out of their diet, but that’s not the right thing to do too. Fat is what makes your (blood sugar level) rise slowly. If you take it completely out of your diet, then whatever you eat, your sugar content will rise quickly. The fat in your body is what contains your sugar levels from going so high.”

Foods that contain healthy fats are saturated, unlike transfat or unsaturated fats. Most labeled food items can help you identify the type of fat that is in the food on the “Nutrition Facts” label, like a bag of Lays or a can of Campbell’s chicken noodle soup.

Another situation that arises is the ideology that being diabetic means eating fruits or meat is harmful for their body, therefore only eating rice. This shows that there are people who do not understand how to manage their diet.

“Sometimes diabetics become so skinny because they think it’s their weight that’s causing them to be diabetic.” (1) Accomplishing a new body mass index by fasting is an unhealthy choice because blood sugar levels are not controlled if they continue to eat the same things. One way to control sugar levels from rising so fast is by eating five meals a day, in small portions within proximity of three hours. Solid solutions for disease management that are effective and ethical can be delivered in a number of ways. Behavioral choices such as eating a balanced diet, exercising, making healthy choices, getting sufficient amount of sleep, and maintaining good relationships at home and work, are underlying determinants for prevention. Overall, a managed comfortable and enjoyable lifestyle is suitable for primary prevention. Along with this, it is necessary to be resourceful because we are increasingly being pushed to become more accountable for our own health and the services we receive. Evidence based data shows that poor diet, physical activity, and drinking are three risk factors that can be highly preventable-to which we should focus on specifically.

Social Costs
Long term care for diabetes can be stressful and very expensive, having a significant drain on family income, which could be spent on food, shelter, education, and clothing; therefore, having a huge opportunity cost.

Larger portion sizes and senile lifestyles are also damaging to our health outcomes. Nenick Vu, chair of the Hmong Health Collaborative, elaborates that “Sedentary lifestyles for elders have become a big issue, and several times, there is not a lot of opportunity to be healthy.” This also includes young people who are often playing video games or spend their lives indulged in social media.

“The social problems are why we have health issues.” (2) Of course, that does not mean giving up fatty foods or drinking, but creating an opportunity to regulate eating habits so that healthy years of life can be maintained. Additionally, we cannot force someone to change. Even if a law was made, people would not necessarily change right away until social rules enforce them the change.

We recognize diabetes as a health hazard, but why has the problem persisted? Within 40 years, there have been increasing socioeconomic and educational levels rising, but many still lack sufficient healthcare literacy. This is common across all ethnic groups. Many adults (including young adults) do not have formal knowledge of diabetes. Vu mentions that, “People often have misconceptions or fears with the kind of information they receive about diabetes.” (2)

Additionally, “Many have never had the concept of awareness, and the idea of being psychologically impacted is absent cause they don’t understand the process and likely won’t hold onto it; even if they learned it, only when {an issue arises}, they’ll try to deal with it.” (2) Hmong people have a huge tolerance level when it comes to health, and we should notice these things when they happen. A greater pressing issue would be the integration of health and our culture.

Cultural Clashes
People with similar value systems tend to react similarly to healthcare, thus when speaking about the Hmong community, the values we have also correspond with how we respond to society. Cultural differences have shown to be a huge limitation to getting proper care.

A situation Nurse Vang shares is that “Primary physicians need to focus on primary prevention and sometimes physicians can fail to provide primary care,” because they “don’t know how to manage a patient, {then} the patient’s blood sugar levels don’t get checked and doctors don’t diagnose properly until kidneys are dead.” (1).

This is an example that demands a physical need to have more culturally competent care to provide a positive experience for patients. The cultural value and perspective created barriers because psychological issues and behaviors were poorly understood. Inherently, people of color tend to lose some of their options when looking for proper care. This is ironic especially when there is an expectation to look beyond the color of a person’s skin.

Cultural problems between a patient and provider are an issue of social construction and the types of scripts we give each other.

We often use generalizations to make a judgment which guides our decision and the choices we make, but that does not properly reflect how we want to be treated. Things like this are directly related to stereotypes, language barriers, and navigation into the health care system.

Everyone brings their own challenges to the task, but we can all come together to make sure that cultural competent care is practiced. For a provider, this would mean that he/she is able to use the knowledge of culture to help people better understand each other. This skill is especially important in the workforce when approaching academic works in the Hmong experience. Although people have gained an interest and are increasingly making efforts to practice culturally competent care, it has been a slow process.

Understanding cultural differences and being able to work with new cultures is a valuable skill because culture is pervasive, influencing our choices and the social world we live in as it travels through generations. We establish expectations facilitated by cultural law and “Our culture has a way of reinforcing behaviors,” influencing our lives in ways most of us are completely unaware of: What people eat, how they dress, and what languages they speak are all cultural dimensions. (2) It is not genetic; rather, something we learn. It is what we see as acceptable from family and friends, and even that has the ability to transform. “Cultural competency has to be integrated completely into our approach to medicine, and we will have to create new structures for sustainable public health influences in our community.” (2)

Western Medicine
Another underlying issue would be the relationship our community has with western medicine. Traditional, complementary and alternative medicine, or anything related to holistic health have been well known methods for healing in the Hmong community before seeking care from western medicine, so routine doctor visits are not the norm. Therefore, breaking into the Hmong community to address healthcare needs would have to be done by taking a nontraditional approach in order to find “people who are willing to champion the value of western medicine.” (2).

“As proud independent people, it can be frustrating when someone tries to tell you what to do,” because people like to have ownership over their own health choices. (2) “If you don’t understand barriers, you get mad and don’t want to submit,” thus, by “figuring out what strengths of our community are to implement healthy lifestyles,” we can find more thoughtful ways to improve health and bad habits. (2) This can be done by taking “a communal, oral, and relational approach to how we deal with health {in order} to reach out to the Hmong community.” (2)

The Next Step
We are due to create an agenda to have upward mobility and fairness to alter the public culture of diet and exercise. The responsibility of the health status of a community belongs to everyone. Hmong people should not have to die because they are not informed about health risks. Medical evidence that prevents death from diabetes through exercise and diet is well established. We need to see more signs of progress where society wants to get ahead, where we practice preventative care and improve our relationship with healthcare.

Health is a society wide issue and we need to reduce inequities and find potential solutions. No one really knows when progress will proceed, but it can become a reality to have safe, attractive, and alternative lifestyles.

We are going to “need a lot of young people willing to change that social structure and create solutions that are very intentional and comprehensive.” (2) Given the value to protect public health of our Hmong community, there needs to be a paradigm shift. There is a huge demand for political motivation and solutions, concrete, manageable, and above all, measurable success to removing barriers towards good health across all populations.

People with diabetes “have to do a combination of medication and exercise.” (1) Though we can eliminate poor diet and lack of exercise, the effort in healing begins with having the willingness to do what it takes to change. As Vu advocates, “we need to make a commitment to the healthcare system to respond to what each person needs and have meaningful change. Although the science and policies in health care are standardized, everyone is different,” and we need to realize that one size does not fit all. Increased critical awareness for existing and potential diabetes is essential.

With that said, “When you have diabetes, you feel alone if you have the condition… It forces your lifestyle to change, but if you’re with others and are table to walk together, it is comforting.” Our next step is to get involved by making an effort to educate and empower our community. Diabetes is preventable and it is not a death sentence.

Interesting information about Diabetes:
November 14 is World Diabetes Day
1. Chao Vang, Urology Association of Central California
2. Nenick Vu, Hmong Health Collaborative
3. World Health Organization