dr. ronald e. mcnair acknowledgements - University of St. Thomas

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UST McNair Scholars Program Research Journal Thailand or Laos. This study concluded that acculturation of foods, store types, conveniences, and English fluency were just some of the factors that contributed to the surveyed Hmong individuals and their food access and shopping behavior. 2 Improvements in the Hmong community with health and food are problems that need to be tackled. While the Hmong are still struggling to become accustomed to Western medicine and food, the need for healthy living is a concern for all. This is directly associated with improving access to healthcare. According to the American Public Health Association, “while the United States spends more on health care than any other nation in the world, it lags behind so many developed nations in important health measures.” 3 This particular statement shows how health and wellness is such an important role in our lives. Although money is spent for health purposes, the health of the country is still poor. Healthy practices are obtained with the availability of good, quality healthcare. According to Lora Todovora, MPH, “people’s health is closely related to access to health care.” 4 As health and wellness become a larger issue in today’s society, there is a concern about equal access to quality health and promotion to wellness. In this particular study, the large Hmong community in the Twin Cities metropolitan area of Minnesota was studied to determine their access to opportunities of healthy living. This access to health and wellness was determined by locating and mapping four major aspects of the promotion of health: healthcare facilities, food sources, and public transportation. First, the Hmong community was mapped to identify their location in relation to the area. Access to healthcare was determined by locating and mapping hospitals, clinics, dentists, and other healthcare facilities in the Twin Cities. As being healthy includes having the choice of nutritional, affordable, and quality food, grocery stores were mapped. Public transportation, such as buses, light rail, and bikeways were also mapped to provide affordable transportation to healthcare facilities and food sources. All these features provide an understanding of whether the Hmong community is geographically limited to healthcare access in the Twin Cities. This research is based on the geographical access of healthcare in the community. Using the Geographical 62 Information System (GIS) in the University of St. Thomas Geography Department, I propose that the Hmong community in the Twin Cities metropolitan area lacks geographical access to the promotion of a healthy lifestyle due to the poor access of healthcare, food sources, and public transportation. LITERATURE REVIEW In this section, I discuss the many different background studies surrounding my research. Knowledge of who the Hmong people are is significant, but there is also an understanding of how complimentary geography and heath are. This can be seen throughout various researches being done on the Hmong community, the fields of geography and public health, and the use of applications in GIS. THE HMONG PEOPLE The Hmong have traveled across the world as refugees of war and oppression. The history of the Hmong people, whether direct immigrants or descendents of immigrants, is ingrained in their culture. Ancestry of the Hmong is uncertain because of their oral and nomadic traditions. From research, they are thought to come from China, although those who have migrated to the United States have come from Laos, Vietnam, and Thailand. 5 Many American people were (and still are) unaware of the Secret War of Laos that occurred at the same time as the Vietnam War in the mid-1900s. As American men were fighting against the Vietnamese, Hmong men and boys were recruited by the U.S. Central Intelligence Agency (CIA) in the 1960s to battle the emergence of communism in Laos, the Pathet Lao. The U.S. withdrew from Laos in 1975, abandoning the Hmong as communism took power. This created terror as “the Hmong became targets of retaliation and persecution.” 6 Re-education of the Hmong was ordered by the Pathet Lao through camps, and the Laos raged chemical warfare against the Hmong. Many Hmong fled to Thailand by crossing the Mekong River into the safety of refugee camps. Although out of the hands of the Pathet Lao, many did not leave until years after entering the refugee camps. Resettlement of the Hmong resulted in many moving to different parts of the world, such as France and the U.S., in the 1980s and years later. Many Hmong
Chia Lee Public Health Health care Accessibility in Hmong Community have returned to Laos due to the closure of refugee camps in Thailand, resulting in torture and abuse. 7 Today, large concentrations of the Hmong population outside of Asia reside in California, Wisconsin, and Minnesota. 8 Upon their arrival in America, the Hmong had a different culture, spoke a different language, and followed a different religious belief resulting in a struggle of acculturation. In the Hmong culture, the liver of a person regulates emotion and is the center of human emotion compared to the heart in Western beliefs. The liver plays an important role in the health and mental well-being of a person as well as their overall personality. The Hmong culture is dependent on spiritualism and herbal healing. A shaman is one who is able to travel between reality and the spiritual world to communicate with spirits for health purposes. 9 Ua neeb khu is the ceremonial healing practice used by shamans to treat health concerns involving spirits. 10 Along with shamans, herbalists are those who are knowledgeable of herbal medicine and their use for health conditions. As shamans and herbalists are important figures in the Hmong community, so are clan leaders. The social structure of the Hmong consists of a clan system (Xeem) of originally 12 clans but now ranging from fifteen to twentyone. 11 Clans are established through last names (paternal ancestry) and clan members are considered family. Birth, marriage, or adoption are the only ways of entering a clan. 12 Clan leaders, usually the elderly men of a clan, are held in high regard to leadership. 13 In specific rituals, the head of the clan is able to communicate with the deceased ancestors of clan members. 14 These clans are the different subgroups of the Hmong community. Rising numbers of health problems in the Hmong community include cancer, diabetes, hypertension, gout, and smoking today, which are only a few of Hmong health problems. 15 These various health concerns are due to the acculturation of Hmong and American culture. Healthcare is a concern to the Hmong community and health care professionals. The lack of medical physiology and anatomy terms in Hmong language has created a barrier between translating medical terms and diagnosis. Different beliefs between the Hmong and American culture also create misunderstandings and unreliability between the two sides. 16 For quality care in the Hmong community, there must be relationships built on trust and mutual respect of both cultures along with cultural awareness. 17 Sharon K. Johnson, Ph.D., suggests that negative health care experiences have caused many Hmong to mistrust and fear Western medical practice. 18 A study done by Dr. Hee Yun Lee and Suzanne Vang proposes that high mortality rate in the Hmong community in Minnesota is due to high prevalence of late stage cancer diagnosis. This study, through extensive literature review, concluded late stage diagnosis is because of barriers in the Hmong community. These barriers include healthcare accessibility, culture, and lack of cancer literacy. 19 HEALTHCARE ACCESSIBILITY Proper access to healthcare has become one of the biggest current public health problems today. 20 Health has become a big issue in lives today resulting in the trends of dieting and fitness, as well as eating disorders and obesity. There is a growing concern for health care access as populations continue to grow and health problems still exist. Improvements in health have allowed healthcare to evolve, but there is still a lack of healthcare access to one billion people in the world. 21 The life expectancy rates for Americans are not the highest in the world and according to Lawrence Jacobs of the University of Minnesota and James Monrone of Brown University the partial answer to longevity is unequal access to health care. Universal health care, health insurance guaranteed to citizens from the government, is present in many of the countries that have surpassed the U.S.’s life expectancy. Citizens in those countries are given access to vaccinations, annual checkups, and a range of medical screenings, improving their nation’s health and well-being. 22 Health disparities have become a large concern and some factors of this disparity could be linked to education, household income, health insurance coverage, and cost barriers. A study by the Centers for Disease Control helped raise awareness of health disparities in racial and minority populations in the United States. It suggests a need for community-based policies, systems, and environmental and individual-level changes while establishing prevention strategies accustomed to different communities. 23 This will allow healthcare access to expand to different populations. In Minnesota, some recent studies on healthcare access have addressed racial disparities as well as socioeconomic status. One particular study conducted in Hennepin County, MN examined perceived discrimination and 63
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DR. RONALD E. MCNAIR Ronald E. McNa
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ABSTRACT The purpose of the present
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Oluwademilade Adediran Psychology M
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