From a personal perspective, working in a community health center in the 1980s and providing health care for a primarily Asian American population was an extremely rewarding experience that was the culmination of an early professional and personal dream. However, as an American-born and -trained physician, I discovered that I was ill prepared to work in this setting in many ways. Despite receiving excellent medical school training, I lacked the knowledge and skills necessary to provide for the many and diverse needs of my primarily non-English-speaking patient population. There was much on-the-job learning in order to provide the best possible care and service for my patients. I had to learn to work with interpreters and to understand and deal with cultures that were vastly different from my own experiences growing up in the United States.

Working with underserved, primarily first-generation Asian American immigrants also made me realize that the health of my patients was intricately connected to the everyday realities of their lives. It was important to recognize how culture and beliefs affected patients’ perceptions of health and illness and influenced their willingness to agree to blood or x-ray tests and disease-prevention recommendations. One had to look vigilantly for the use of alternative and complementary remedies by some patients and recognize how this practice can affect their acceptance of and adherence to Western treatments. Being aware of the multitude of stresses associated with adjusting to living in a new and unfamiliar country, especially when many immigrants and refugees were ambivalent about leaving or were forced to leave lifelong homes, families, and friends, was critical to appreciating the major impact this experience had on the emotional and physical well-being of patients.

There were additional complexities to consider: many people did not have health insurance coverage, could not afford medicines, presented with late-stage disease, or had difficulties navigating through the health care system. In my experience, there were no teachers or mentors, and precious little information available in the research literature to inform and guide how best to address these and other social, cultural, and economic factors that greatly affected the clinical interactions and relationships with the patients. Asian American Communities and Health helps to fill this void for practitioners, programmers, researchers, and policymakers seeking to improve the health and well-being of this underserved and vulnerable population.

In the 1990s, after leaving the practice of serving primarily Asian Americans, I worked in various roles in the private nonprofit health sector, focusing on cost, quality, and access issues associated with the health care reform movement sweeping across America, mostly driven by market forces and managed care at the time. In this mainstream health care environment, it was clear that only limited attention was being paid to the health of minority populations and virtually none to the health of Asian Americans. The exceptions to this were the sparse but extremely dedicated work of researchers, providers, and advocates in parts of California, New York, and Hawaii.

Returning to the public sector at the turn of the century, I readily saw more emphasis on work related to racial and ethnic health disparities that was influenced greatly, but not exclusively, by the national health agenda promoted by Healthy People 2000 and Healthy People 2010, respectively. However, except in a few geographical areas or with special interest groups, conversations regarding health disparities largely do not include the health challenges plaguing many Asian Americans in this country. If they do arise, it is often mentioned as an afterthought, as token inclusion, or in the rare circumstance when there is an Asian American at the table who is knowledgeable about the issues and speaks up on behalf of this population. Many people, including key policymakers and decision makers, are unaware of the many health issues facing vulnerable segments of this population. However, for those working with Asian Americans, the health problems and challenges are obvious and tangible, and they require major attention. For most mainstream Americans, this population is virtually invisible, their problems are nonexistent or unknown, and information to raise awareness and facilitate engagement is not easily available. With my background of working closely for almost a decade with Asian Americans and then being equally immersed for years in various health issues facing Americans in general, seeing the stark contrast in the knowledge of Asian American health has been and remains remarkably striking to me.

Why is there this major dichotomy? What barriers prevent the ready exchange of knowledge across this apparent information divide? Understanding and addressing this phenomenon is particularly important because the Asian American population has grown tremendously over the past several decades and is projected to continue to grow rapidly in this century. Many new and emerging communities are springing up and expanding in areas across the country beyond the traditional Asian American population hubs of California, New York, and Hawaii. Providers and policymakers, especially in these emerging communities, are facing and grappling more and more with questions and challenges to serve this enlarging population better.

Many factors contribute to the invisibility of Asian Americans and their health issues to mainstream Americans—for example:

Asian American Communities and Health bridges the information divide by providing timely and useful information for those who work with Asian Americans or want to learn more about the health issues associated with this population. It does so in a highly comprehensive and engaging manner, providing a wealth of information across age groups, ethnicities, and health topics, and then going beyond the health care delivery system and integrating an understanding of social, economic, historical, and environmental contexts with health. This rich information contributes to a broader and deeper understanding of the many critical factors that influence the health and well-being of Asian Americans. Sections that highlight high-performing programs, the future needs of research, and the importance of advocacy also provide a valuable guide and a road map to advance an Asian American health agenda at local community, state, and national levels.

For providers, researchers, community advocates, and policymakers already working closely with Asian Americans, this book validates common experiences and knowledge and stimulates questions for deeper study, analysis, and understanding. For those with limited experience, the comprehensive and practical information provided here greatly contributes to the capability to serve and work with this population. For all champions of eliminating health disparities and improving the health and well-being of all Americans, this body of work provides the rationale and the guidance to include the Asian American population in all efforts to improve the health of vulnerable populations. Finally, students in the health professions benefit greatly from an in-depth and lesson-laden study of the manifold factors, including important sociocultural and economic determinants, that influence the lives of a unique and rapidly growing American population. Although the focus of this book is on Asian Americans, the knowledge and lessons are eminently transferable and can inform approaches to improve the health of other disenfranchised populations in the United States.

Healthy People 2010 set a bold and exemplary goal of eliminating racial and ethnic health disparities in the United States. Unfortunately, we are far from achieving the many objectives to reach this goal, and much work remains ahead for all of us. We must learn and understand the many factors that contribute to and perpetuate health disparities among all vulnerable populations and demonstrate unwavering commitment to advocate for and implement solutions to eliminate them. Asian American Communities and Health sheds light on a population that has heretofore received scant attention and contributes to the growing knowledge base to advance the work to eliminate health disparities in the United States. In doing so, it also highlights the importance of not only looking at problems associated with health care access and quality as major barriers to health equity, but also underscores the need to understand and appreciate the social and economic contexts within which health disparities exist.

American ideals are based on equality and opportunity—that everyone should have equal opportunity to achieve their dreams. Having good health and living in supportive and enabling environments is essential for this to happen. We must rally as a nation, across racial groups, political persuasions, religious preferences, and social and economic status, to come together and remove the barriers to good health for all vulnerable populations. In the process, especially as we continue to grow and evolve as a strong, multicultural nation, we are laying the groundwork and advancing the agenda to improve the health and well-being for all Americans.

She currently sits on several national and local boards, including the board of directors for the Public Health Association of New York City, the Asian American and Pacific Islander Health Forum Brain Trust, and the Nielsen Media Asian American Advisory Committee.

Prior to joining CSAAH, Trinh-Shevrin served as principal investigator of two National Cancer Institute-funded pilot projects aimed at breast, cervical, colorectal, and prostate cancer prevention in New York City’s Chinese, Haitian, and Mexican American communities. She received the Rising Star Award from the National Cancer Institute for her work in cancer prevention. She concurrently served as lead epidemiologist at the NYU Institute for Urban and Global Health.

Prior to 2000, Trinh-Shevrin’s career in research and public health included teaching and research at Columbia University, conducting research and analyses for American Express Corporation, and community intervention research at Beth Israel Medical Center.

Trinh-Shevrin received her bachelor of arts and master of science degrees in health policy and health behaviors at the State University of New York at Albany. She received her doctorate in public health from the Mailman School of Public Health at Columbia University. She received the prestigious Dissertation Fellowship Award from the Commonwealth Foundation of New York City.

While earning her master’s degree, Trinh-Shevrin conducted analyses and evaluation of a gender-sensitive drug treatment program at Lincoln Hospital that targeted women addicted to crack cocaine. Subsequently she coedited and contributed to the book Addiction and Pregnancy: Empowering Recovery through Peer Counseling, with coeditors Barry R. Sherman and Laura M. Sanders.

Prior to working at CSAAH, Islam directed the New York City site of AANCART, the Asian American Network for Cancer Awareness, Research, and Training, based at Columbia University’s Mailman School of Public Health. Islam has also worked as the linkage coordinator at the Asian Pacific Islander Coalition on HIV/AIDS (APICHA), where she was responsible for establishing formal linkages with providers and organizations around New York City that could serve as potential sites for referral of HIV/ AIDS patients of AAPI descent.

Islam received her doctorate in sociomedical sciences at Columbia University and a dissertation award from the National Science Foundation. For her dissertation, she conducted an ethnographic case study to understand how non-profit organizations serving immigrant workers in New York City engage in social movement strategies in the public health arena while simultaneously providing services to the community. Following completion of her doctorate, she was the recipient of the National Institute of Health Disparities Loan Repayment Program Award.

Islam served as the 2007-2008 chair of the Asian Pacific Islander Caucus in official relation with the American Public Health Association.

After receiving his undergraduate degree, Rey earned his MD from the NYU School of Medicine and completed a residency in internal medicine and a fellowship in cardiology at the NYU/Bellevue Medical Center. During his tenure at NYU, he held several positions, including director of the Bellevue Hospital Cardiology Clinic for over a decade and the director of the nuclear cardiology and exercise laboratories at both Bellevue and Tisch hospitals for twenty years. An expert in the field of cardiac physiology, currently he is the director of the Joan and Joel Smilow Center for Cardiac and Pulmonary Rehabilitation and Prevention at the NYU Medical Center, a position he has held since 1990, when he created that center.

Rey was a founding faculty member of NYU’s Institute for Urban and Global Health and served as its executive director between 2001 and 2003. He also created and was the director of the NYU Centers for Health Disparities Research between 2003 and 2006. Both of these entities are predecessors of the Institute of Community Health and Research, which was established in July 2006. From 2000 to 2006, Rey was the senior associate dean for student affairs. During that time, he established NYU’s International Health Program. Rey now serves as course director for the Annual Latino Health Conference and the Annual Asian American Health Conference.

As a cardiologist, Rey has been an investigator in four separate NIH-sponsored national multicenter trials, which have examined strategies to preserve cardiac muscle threatened by acute abnormal events. At the NYU School of Medicine, Rey now oversees several NIH, CDC, and privately supported programs and centers, which focus on addressing health disparities in Asian American, African American, and Latino communities. In addition, he serves as the director and principal investigator of the Community Engagement Core of the NYU Langone Medical Center’s Clinical and Translational Science Institute.

Rey is the administrative principal investigator and one of the founders of the NYU Center for the Study of Asian American Health, an NIH NCMHD P60 Project EXPORT Center that is a National Center of Excellence for Community Health Research. He is also the principal investigator of a CDC National Center of Excellence for the Elimination of Health Disparities, of the New York City Council-sponsored Asian American Hepatitis B Program, and of an NCMHD-supported R24 initiative on cardiovascular disease prevention in Filipino Americans.

Rey has been the recipient of many honors and has been recognized with awards for promoting humanism in medicine and gender equality in the health professions. In 2004, he was inducted in the National Humanism Honors Society of the Arnold B. Gold Foundation. In that same year, he received a City of New York Mayoral Proclamation for his substantial contributions to the Latino community.

Rey has published numerous articles and book chapters in the fields of cardiology and cardiovascular physiology, the interaction of the humanities with medical education, and the areas of health disparities, community health, and international health. He is currently developing a book on the health of Latinos.