How do I know? In 2008, the Asian Health Services’ Filipino Advocacy and Organizing for Health (FAOH) Project interviewed 328 Filipinos in Union City, California. The study found that 81 percent of those surveyed had health insurance either through their employers, private insurance or government programs like Medicaid (MediCal) or Medicare. The 18 percent without health insurance were low-income workers or young adults who were no longer covered under their parents’ health insurance plan.
In spite of these high insurance levels, many Filipinos do not see their doctor to get screened for critical health problems. Filipinos had lower screening rates compared with the general population in California, based on data from the California Health Interview Survey.
As for cervical cancer screening, among women 18-24 years of age, the age when they are most at risk of acquiring the HPV virus (associated with cervical cancer), 74 percent never had a pap smear. Half of all Filipinos 50 years and older never had a colonoscopy to screen for colon cancer.
Even though it is known that Filipinos are at high risk for diabetes, almost half (45 percent) never had a glucose test. Screening for infectious diseases were also low among the respondents; only 30 percent were screened for Hepatitis B and 28 percent were tested for HIV.
So if health insurance is not a problem, why don’t we see the doctor? There are several reasons for this. The majority of the 3.4 million Filipinos in the US were born in the Philippines (US Census 2010). As a predominantly immigrant community, our attitudes and behaviors in the Philippines have shaped our health-seeking behaviors here in the US.
In a developing country such as the Philippines where health insurance is not available to the majority, Filipinos have to pay out of pocket to see a doctor, purchase medicines or when hospitalized. The financial cost has led many to seek health care only when they are acutely ill.
To get by, some rely on advice from friends or family, especially those with medical training. Others self-medicate with over-the-counter drugs, utilize herbs or seek traditional healers (manghihilot, arbolario, etc. …). According to a study of Filipinos in Los Angeles, the concept of accessing health services is alien to many — even when the services are available at low or no cost (Historic Filipinotown Health Network, 2007).
Another issue is language congruence. In the FAOH study, many Filipinos indicated they spoke English well, yet they also claimed to have difficulty understanding their doctor. Language barriers seem to be experienced more by older Filipinos and those with less education. However, it was noted that besides language, there are also different communication styles, such as nonverbal cues and cultural nuances that impact the patient-doctor interaction (NYU: Center for the Study of Asian American Health, CHNRA, 2007).
Whatever the reasons for not seeking health care, the outcomes can be severe. Data from the California Cancer Registry show that Filipinas have the second highest incidence and the highest death rate for breast cancer compared with other Asian Americans.
Meanwhile, Filipino men have the highest incidence and death rate from prostate cancer. They also have the second highest incidence and highest death rate from lung cancer. These deaths might have been delayed with early and frequent cancer screenings. It was also noted that Filipinos have the lowest screening rates for colorectal cancer among Asian Americans. (McCracken, M et al, CA Cancer J Clin 2007:57:190-206).
Among over two million members of Northern California Kaiser, Filipinos have the second highest prevalence for diabetes after Pacific Islanders (Karter AJ et al; Diabetes Care 2013: 36; 574-9), and have higher diabetes rates than Native Americans, Blacks and Latinos.
In 2008, more than half of all tuberculosis cases in the US were from foreign-born individuals, with immigrants from the Philippines ranking second behind those from Mexico (CDC, 2008a. Tuberculosis Morbidity Trend Tables, Unites States).
These illnesses can be prevented and treated if they are detected early. Most of us have health insurance and those who don’t are mandated to get it through the Affordable Care Act. So, let’s resolve to be knowledgeable about health benefits; see the doctor when not feeling well and get screened on a regular basis. It’s a resolution we really can’t live without. Schedule your appointment now.
(For a copy of the AHS Filipino Advocacy and Outreach Project study, go to: http://www.asianhealthservices.org/docs/FAOH-Final-Report.pdf. (PDF download))
Susan Araneta, MPH, is a grant writer and health program consultant with CDK Consulting.