Access to High-Quality Healthcare in the United States for Chinese-American Immigrants

Posted on by BUJPH

By Dylan Lai

As a child of two Chinese immigrants, I have had many first-hand experiences of the existence and persistence of health misinformation in the Chinese-American community. One of the most standout cases of this is my mother’s continued insistence on the danger and harms of monosodium glutamate (MSG), a common flavor enhancer, on human health. As some people may know, the myth of MSG being detrimental to heart health has a heavily racialized history, even being dubbed ‘Chinese restaurant syndrome.’ The fear, first started by a letter written to the NEJM by Dr. Ho Man Kwok in 1968, “resurrected the deep-rooted prejudice and xenophobia around Asian culture.”1 Letters flooded into the NEJM in response, all regarding people’s racialized symptoms, referring to “‘Chinese temples’ and ‘Chinese headaches.’”1 The fear grew so widespread that even Chinese restaurants and products began labeling themselves with ‘No MSG’ signs to attract American consumers despite the lack of scientific evidence of MSG’s so-called harmfulness. At the same time, American fast-food chains such as Wendy’s, KFC, and McDonald’s continued their use of MSG with no significant backlash.2 Despite all modern literature showing that MSG is safe for human consumption,1 fear surrounding the seasoning agent is still widespread. My mother believes in the myth of MSG causing heart problems, and she refuses to believe otherwise even when I present her with peer-reviewed scientific journal articles. She insists on trusting her own experience with headaches after MSG consumption and the word of unreliable, Chinese internet sources. What is incredibly troubling, beyond just misinformation, is the damage that health misinformation and cultural differences may have on people’s behavior in how and when they access healthcare. From childcare to adult healthcare, the impacts of language barriers, community structure and relationships, and cultural values mean fewer visits to the doctor, reliance on potentially misleading or outright false medical information, and poor or even dangerous healthcare treatment as a result.3  

The language barriers for immigrants into the United States have proven to be, and have continued to be, a significant challenge to healthcare-seeking Chinese Americans across the country. In an interview study done on 24 Chinese immigrants, “language problems caused so much anxiety and stress, most participants, even after spending many years in the United States, chose not to rely on information from their [healthcare provider] or any English printed materials in health clinics […].”4 The challenges associated with expressing oneself and understanding healthcare providers in terms of a complex topic such as healthcare is a massive barrier to entry. Additionally, outside of actual barriers in communicating with healthcare providers, even accessing printed materials becomes a massive challenge for those with struggles in language communication. As a result, many Chinese Americans with language barriers turn to relatively unreliable sources of health and healthcare information. In a study done in 2018 by Jang et. al.5, resource-scare groups and family-dominant groups rarely used reliable information sources such as their healthcare providers or health-specific websites. Not only is there a clear obstacle to accessing high-quality healthcare information for many Chinese-American immigrants, but those same obstacles cause people to turn to information sources of lower quality and credibility. As shown in Chen et. al.4, participants who did not have a complete understanding of their symptoms grabbed any information that they could from a variety of sources, including a heavy reliance on printed materials written in Chinese, and the advice of non-professionals such as family and friends, while showing less of a reliance on healthcare providers. Just as the rumors of ‘Chinese restaurant syndrome’ spread as a result of rampant misinformation and fear, information bubbles within the Chinese-American community could lead to a rapid spread of false healthcare information. This leads to the argument that hospitals and healthcare websites must work to provide greater accessibility to low-cost translation services to better service the Chinese-American community. However, the pattern of information grabbing is not solely caused by language barriers and inaccessible information. 

Although economic status and accessibility are major areas of concern in modern healthcare, Chinese-American immigrant cultural beliefs also play a large role in their access to healthcare and health information, indicating a need for greater cultural awareness in medical settings. In Huang et. al.6, a comparison of delayed or forgone healthcare between two groups of Chinese Americans is done: highly educated and well-employed immigrants recruited from a Chinese school, and lower-income bracket Chinese immigrants recruited for the study at a Chinatown Service Center or a Chinese restaurant. The researchers found that, despite differences in level of health insurance coverage and family income, both groups had similarly high prevalence rates (45%-60%) of delayed or forgone pediatric care. If economic reasons are not solely to blame for hesitation in accessing healthcare, culture – just as with healthcare misinformation – must be involved. The study by Chen et. al.4 shows the impact of Chinese culture and values on Chinese Americans’ healthcare choices. An intriguing mentality is described, in which avoiding an illness diagnosis is like avoiding the disease altogether – if nothing is diagnosed, there is no problem. Privacy concerns are also noted, as health concerns are generally seen to be deeply personal matters in Chinese culture. Without learning to address the specific hesitations that Chinese Americans may have in going to the clinic, delayed and forgone healthcare will continue at high rates regardless of how accessible healthcare may become. These cultural signs seem to fit into a broad range of mistrust for Western medicine, causing a fallback on traditional Chinese medicine (TCM). 

The use of traditional Chinese medicine in itself is not an issue, but as described in Leng et. al.3, reishi mushrooms are a relatively common herb used in TCM to support cancer patients’ immune systems but can have significant drug interactions with antineoplastics. This makes conventional cancer treatments much more dangerous for Chinese cancer patients who do not discuss such herb usage with their healthcare providers. In combination with the language barrier and cultural-caused hesitation in communication with healthcare providers, there becomes a clear danger for Chinese-American users of TCM. Accessibility to translation services and physician-patient cultural understanding are vital to the health and safety of Chinese Americans not only in their lives outside of the doctor’s office but in receiving treatment as well.

As a very observable pattern in healthcare that has tangible impacts on the Chinese-American community, the issue of language barriers and cultural-based hesitations to healthcare access must be addressed through accessible translation services and cultural awareness in clinics. It is important to note, however, that the impact of language barriers and cultural differences on healthcare are not solely experienced within the Chinese-American community, nor are they observable only in the United States.  From misinformation on a chemical compound used commonly in food service to potentially life-threatening drug reactions, emphasizing a culturally aware approach to medicine is crucial to the betterment of all communities’ health around the world.

References

  1. Wahlstedt A, Bradley E, Castillo J, Burt KG. MSG Is A-OK: Exploring the Xenophobic History of and Best Practices for Consuming Monosodium Glutamate. Journal of the Academy of Nutrition and Dietetics. 2022;122(1):25-29. doi:10.1016/j.jand.2021.01.020 
  2. Mosby I. “that won-ton soup headache”: The Chinese Restaurant Syndrome, MSG and the making of American Food, 1968-1980. Social History of Medicine. 2009;22(1):133-151. doi:10.1093/shm/hkn098 
  3. Leng J, Lei L, Lei SF, Zhu Z, Ocampo A, Gany F. Use of Traditional Chinese Herbal Medicine Concurrently with Conventional Cancer Treatment Among Chinese Cancer Patients. J Immigr Minor Health. 2020;22(6):1240-1247. doi:10.1007/s10903-020-01017-2
  4. Chen CJ, Kendall J, Shyu YI. Grabbing the rice straw: health information seeking in Chinese immigrants in the United States. Clin Nurs Res. 2010 Nov;19(4):335-53. doi: 10.1177/1054773810372542. PMID: 20601638.
  5. Jang Y, Yoon J, Park NS. Source of Health Information and Unmet Healthcare Needs in Asian Americans. J Health Commun. 2018;23(7):652-660. doi:10.1080/10810730.2018.1500660
  6. Huang ZJ, Yu SM, Liu XW, Young D, Wong FY. Beyond medical insurance: delayed or forgone care among children in Chinese immigrant families. J Health Care Poor Underserved. 2009;20(2):364-377. doi:10.1353/hpu.0.0137

 

Dylan Lai