In a new health study, Connecticut’s Asian population fared quite well except in one eye-popping category: its tuberculosis (TB) rate is 23 times higher than whites’.
The data in the 2009 Connecticut Health Disparities Report, from 2000 and 2005, was compiled by the Connecticut Department of Public Health; the study was funded by the Connecticut Health Foundation. It’s the first report in a decade to look at whether or not the health of minorities in Connecticut has improved.
“Despite excellent overall health among Connecticut residents, we have documented the existence of a number of significant health disparities that present a formidable challenge to public health.” Thus begins the executive summary of the report, which considers socio-economic and demographic factors including race, ethnicity and income level, as well as vulnerable populations, such as homeless persons, sexual and gender minorities, and immigrants and refugees.
African-Americans fare the worst, as in the past. They have the highest death rate from all causes (1.2 times higher than whites), while Asian or Pacific Islander residents have the lowest death rate from all causes (approximately 0.4 times that of whites).
Black residents have the highest rates of cancer, heart disease and stroke among all racial or ethnic groups, while Asians have the lowest rates.
But for TB, 62 percent of cases in the state occurred among the foreign-born population from 2000 – 2004, with Asians having the highest rate.
TB is a highly contagious disease, and it must be reported to public health authorities, who initiate treatment. It can be fatal if not treated. Since the state’s Asian population has increased the most in the past few years — by 38 percent, compared to 25 percent for the Latino population — this is a big concern. (Still, in 2007, Asians in Connecticut comprised just 3.4 percent of the state’s population, while Latinos comprised 11.5 percent and African Americans, 9.3 percent.)
Dr. Saud Anwar (pictured at top of story), who chairs the Department of Pulmonary and Critical Care Medicine of the Eastern Connecticut Health Network, acknowledges the problem of TB among the state’s Asian residents. But she said it might be overstated simply because TB is a reportable disease and a TB test is required for immigration to the U.S.
“Tuberculosis in their home countries is higher, but there’s also a bias because we are looking for it more — when you look more, you find more,” he said. “In this study some of the sub-groups are very small, so the very high and very low numbers don’t mean much.”
The term “Asian” encompasses a huge number of countries, including the world’s two most populous, China and India. Anwar said other countries sending many immigrants to Connecticut include the Philippines, Pakistan and Bangladesh.
Anwar said that a person who tests positive for TB might be a carrier but does not have the disease and can’t infect others. Where TB has been identified, individuals are treated with Isoniazid — one pill a day for six to nine months. “The state TB control and local health departments work together,” he said. “I think they do a phenomenal job to make sure medicine is available to these people.” He added that DOT treatment (directly observed therapy, in which a provider gives a patient a pill and watches him or her take it) is available if health experts believe a person can’t be relied on to take a pill every day.
Anwar noted that subgroups in American society that are not Asian-American also have a high prevalence of TB and are at high risk for developing it — namely, those with compromised immune systems (drug users, alcohol users, the elderly, people with HIV/AIDS and poor people living in close quarters in unsanitary conditions).
He also cautioned against assuming that any group is immune from the disease. “We have to be careful that we don’t take it for granted that the indigenous [non-immigrant] community is somehow protected from TB,” because it is so infectious. But he said if TB isn’t tested for in less at-risk communities, it won’t be found.
Korean-American Elizabeth Krause is a senior program officer at CHF and the liaison with the team that produced the 2009 health disparities report. She also serves on the board of the Asian Pacific American Coalition of Connecticut, a non-partisan group of concerned citizens advocating for interests of Asian Americans in Connecticut across a broad spectrum, including immigration issues. (Anwar is also a member.)
Krause said that in public health reports, TB and hepatitis B are highlighted for the Asian community, “and while these are certainly issues of concern, I think the focus on them takes away from other important issues, like cancer, alcoholism or mental health.” She said many immigrants are refugees from oppressive regimes and suffer from post-traumatic stress disorder. She said China and the Philippines have high TB rates, so immigrants from those countries are likely to be disproportionately affected.
Krause said while the problem needs to be addressed, “It reinforces the notion that we are a community of immigrants and foreigners. We’re pushing for a more holistic understanding of the range of health issues.”
State Budget Implications
Pat Baker, president and CEO of the Connecticut Health Foundation, said, “The state of Connecticut has to be cognizant of the demographic shifts in our state. The Asian population is the fastest growing. It speaks to the growth of legal immigration in Connecticut. Tuberculosis continues to be a world-wide communicable disease that is being fought on many levels across the globe. We are a global nation, and our state is feeling the impact of that growth.”
She said the new data “must inform some of our public policy decisions. When you look at the Medicaid policy being proposed by our governor — where she proposes eliminating coverage for legal immigrants — think about the health ramifications if that immigrant happens to have TB and no health coverage. It puts at risk not just the individual, but the community. And that’s why you have to think of decisions not only from a medical model, but from a public health model. And we can’t let health coverage lapse when the cost to our community and our state could be so great.”
Anyone who is identified with TB — citizen, legal immigrant, or the undocumented — would be treated regardless of whether they have health insurance. Baker clarified in an email message that “research indicates those who lack insurance can delay seeking care, so if TB is active the potential of infection to others is increased.”
Baker also pointed to the struggle to provide medical interpretation, funding for which has gone in and out of state budgets like a ping pong ball. Gov. M. Jodi Rell has again cut it from her proposed two-year budget. “Medical interpretation improves efficiency and improves health outcomes,” Baker said, and it’s especially critical to recent immigrants.
Office of Policy and Management spokesman Jeff Beckham said Gov. Rell continues to support both those proposed budget cuts, “even though the Appropriations Committee of the General Assembly last week took a different view of both those matters.”
“It’s all subject to negotiation,” he said. “In this extraordinary budget year, the governor has looked at lower priority non-core function-type programs to achieve savings. The medical interpreter program hasn’t even started yet, so it’s an obvious candidate for savings.”