(Original Title: Accessing Culturally Competent Health Care in the 21st Century)
According to the 2000 census, there were approximately 2.4 million Chinese in the United States, and about 152,000 of them resided in San Francisco. The 2000 census also revealed that about 59 percent (versus 25 percent nationwide) of the residents in the San Francisco Chinatown area who spoke Asian and Pacific Island languages spoke English "not well" or "not at all." (1) A recent study by Goel stated that there are disproportionately more foreign-born within the Asian American and Pacific Islanders group than non-Hispanic white Americans. Moreover, foreign-born individuals are at a greater risk for receiving poor quality health care due to lower participation in preventive services, lack of a regular health care provider, lack of lower rates of insurance coverage, cultural and language barriers, and lack of acculturation. (2) Even if Chinese-speaking patients have access to a Chinese-speaking physician, the limited time during the office visit is not sufficient to answer all of their health questions. As the trend of preventive health care gains momentum in the United States, the health care professionals' responsibility is to make health information accessible to community members in a linguistically and culturally sensitive manner.
Better access to reliable bilingual health information is especially important in San Francisco. According to the 2004 Chinese Community Health Report (data drawn from U.S. Census 2000), which is published by the NICOS Chinese Health Coalition, "70 percent of the Chinese population in San Francisco is foreign born, [and] in 44 percent of Chinese households, no one aged fourteen and over is able to speak English without difficulty." (3) Other Chinese, although bilingual, are more comfortable receiving information in their own language and cultural setting. In a 1999 survey of cancer beliefs and attitudes among Chinese in San Francisco, 66 percent of the respondents said they preferred reading or watching television in Chinese. (4) Moreover, a report of the 2005 Men's Health Day (a biennial health fair conducted by CCHRC) showed that 92 percent of the Chinese participants preferred to receive health information in Chinese. (5)
ESTABLISHMENT OF CCHRC
The Chinese Community Health Resource Center (CCHRC) is a nonprofit organization whose mission is to promote a healthier lifestyle through bilingual health education, programs, and services and to participate in community-based research related to health care. CCHRC is funded by Chinese Hospital, Chinese Community Health Care Association (CCHCA), Chinese Community Health Plan (CCHP), and grants. Prior to the establishment of CCHRC, there were limited culturally competent health education programs available for the Chinese immigrant community. The three local community healthcare leaders--Chinese Hospital, CCHCA, and CCHP--recognized this need and shared the vision and financial commitment to create a health education unit specially tailored for the community Since its founding in 1989, CCHRC has worked closely with physicians and national organizations such as the American Cancer Society and the Susan G. Komen Breast Cancer Foundation to provide the San Francisco Bay Area Chinese community with a multitude of programs and services.
Among CCHRC's many programs and services are health seminars and forums, disease management, individual nutrition counseling, cancer-related information and support, a bilingual wellness library, a bilingual website (www. cchrchealth.org), a friendly patient navigation program, and annual health day events. In recent years, CCHRC has also conducted and participated in several research projects related to the Chinese community. For example, over the past six years, CCHRC has been a partner of the AANCART special project of the National Cancer Institute, conducting education and research in cancer-related topics appropriate to the community As part of the AANCART Chinese Council, CCHRC played a leading role in the education of physicians on the new diagnosis and treatment for Hepatitis B, awareness programs for Hepatitis B in collaboration with NICOS Chinese Coalition, and in the development of local guidelines for follow up for Hepatitis B carriers and their families with CCHCA. This year, it will be the lead organization to recommend Chinese materials on cancer for the public website of AANCART and the American Cancer Society (www.aancart.org).
In designing and implementing programs and services, CCHRC seeks to include a wide range of suggestions. The topic selection process is an interactive one that brings together the input of community members, program participants, Chinese Community Health Plan, Chinese Community Health Care Association's physician members, and Chinese Hospital patients and staff. Suggestions are reviewed and program topics are identified at the advisory committee level, leading to implementation of programs (see Figure 1).
[FIGURE 1 OMITTED]
CCHRC provides approximately 15,000 services annually; 90 percent of the recipients are monolingual, over 65 percent are female, 30 percent are Medicaid (Medi-Cal in California) recipients, and approximately 15 percent have no insurance coverage.
Modes of program delivery include seminars and forums, individual nutrition counseling, our annual community health day (women's and men's), health screenings, printed material, our bilingual website, patient navigation program, and collaboration with local and...