Diabetes: A Global Crisis, A Challenge for AANHPI

Kenneth P. Moritsugu is an American physician and public health administrator. A Rear Admiral of the US Public Health Service, Dr. Moritsugu retired in 2007 as acting United States Surgeon General. He is a member of the National Council of Asian Pacific Islander Physicians (NCAPIP) Board of Directors. Originally presented at Campaign for Modern Medicines 05/01/14
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During APA Heritage Month, we honor the culture and celebrate the achievements of Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI). We also acknowledge the vast amount work that needs to be done to combat health disparities among minority populations. This May, physicians and patients must mark a change in how we view, talk about, and act on the epidemic of diabetes. Diabetes is a disease that millions of Americans and people across the globe live with, and that many millions more are at risk of developing. Fortunately, bringing attention to the diabetes disparity within AANHPI has real potential benefits for alleviating the diabetes burden overall.

The fastest growing population in America is that of Asian Americans, where the "model minority" myth includes the misperception that because Asians are skinnier, they are also healthier.

To that point, body mass index (BMI) has become the popular indicator of a person's risk for developing diabetes, hypertension, and other serious, obesity-related disorders. The Centers for Medicare and Medicaid Services (CMS) concurs with this line of thinking: if you have a BMI of 30 or more, you qualify for "free" obesity counseling from your primary health provider. Unfortunately, an Asian American who "looks healthy", but could still be at significant risk with a BMI of only 24, wouldn't qualify for coverage.

Native Hawaiians and Pacific Islanders, in particular, suffer some of the greatest diabetes disparities in the world. Samoans both in the USA and United States Associated Pacific Islands (USAPI), overweight and obesity rates can reach close to 90%, and rates of diabetes can reach 47%. Among the greatest needs for these populations are more definitive diabetes prevention and management guidelines, and community oriented outreach.

Too often, we focus on "The What"- the science/evidence/data - without giving enough attention to "The How" - how that science will be translated into benefits for the individual. Too often we paint with the same broad brush; translating national and regional data into efforts that don't help - and, as in the BMI case, are even detrimental - the individual.

It's clear that, especially for AANHPI (and all minority groups), a more nuanced approach is necessary. Besides supporting ongoing research targeting AANHPI populations, what can we do as physicians and advocates right now? It begins with arming ourselves with knowledge, and talking.

The National Council of Asian Pacific Islander Physicians (NCAPIP) believes that, as part of a new calling for physicians, an integral role that they must play is that of a communicator. It sounds like common sense, but a great many physicians remain siloed in their offices, hospitals, and academic institutions without effectively communicating the best science available to those we serve. We have failed if all we've done to communicate amounts to them hearing us but not understanding, embracing, and acting on that information. And a population as diverse AANHPI warrants extra attention in this realm precisely because of diversity in language, culture, and health status.

This May, let's talk about diabetes in AANHPI, and just how "The What" that we have can help populations, communities, and most of all, individuals achieve better health.
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