Entering Asian American and Pacific Islander Heritage Month, a cutting-edge issue is addressing social determinants of health, which are especially critical among diverse Asian American ethnic groups that vary in education, income, and acculturation. For example, some Southeast Asian immigrants were forced to leave their countries because of the Vietnam War and have suffered piercing intergenerational trauma, socioeconomic deprivation as refugees, and major health disparities. Health care organizations are exploring ways to screen patients for social needs, refer them to community partners in fields such as housing and food security, and integrate their medical and social care.
Federally Qualified Health Centers are pioneers. The Association of Asian Pacific Community Health Organizations (AAPCHO), the National Association of Community Health Centers (NACHC), and the Oregon Primary Care Association (OPCA) have created the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) tool to screen for needs such as housing, employment, transportation, safety, and social support. AAPCHO, NACHC, and colleagues at the University of Chicago are currently investigating ways to score this screening instrument to identify high-risk patients for intervention, with support from the National Institute of Diabetes and Digestive and Kidney Diseases–funded Chicago Center for Diabetes Translation Research. Under global payment mechanisms and alternative payment models such as Accountable Care Organizations (ACOs), health systems have strong incentives to improve care for their most costly resource-intensive patients, who often have significant social needs.
Yet a deeper issue beyond caring for individual patients is inherent within social determinants of health: addressing the underlying structural drivers of inequities that faced my uncles and the many low-income Asian American immigrants I saw at the South Cove Community Health Center. We must have free, frank, and fearless discussions about structural racism and social privilege, the systems that insidiously drive many health disparities.
Read more at NIMHD.Blogs.gov.
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