Hep B United Philadelphia was a representative giving testimony at the City of Philadelphia’s housing hearing on Thursday, November 17th. The testimony can be read below:
Thank you for providing a platform for this discussion and I appreciate the opportunity to be here. My name is Catherine Freeland and I am the Public Health Program Manager at the Hepatitis B Foundation.
The Hepatitis B Foundation is the only national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B. For the past 25 years, we have worked to ensure that hepatitis B, and those most affected by it, are not forgotten.
The HBF manages Hep B United Philadelphia and is the largest Asian-based community owned coalition in Philly – we have over 70 coalition partners, including the Philadelphia Department of Public Health, social service providers, health care professionals, nonprofit advocates, community organizations, and providers of human services to Philadelphia’s Asian, Pacific Islander, and African immigrant communities.
Since 2007, we have provided hepatitis B awareness messaging for over 10,000 Philadelphians; including in‐person education for over 5,000; offered free hepatitis B screening to 2,500; and administered over 500 free doses of hepatitis B vaccine. We have found a hepatitis B infection rate of 8% among local Asian Americans, which is higher than in most cities in the U.S. A total of 104,938 AAPIs reside in Philadelphia, PA (6.8% total pop), 66% of those are foreign-born – and largely have limited English proficiency. While approximately 70% are insured, they often face multiple social, linguistic and cultural barriers to accessing appropriate medical care. Since 2007, we have been working in the Philadelphia Asian American communities, and have witnessed first-hand the challenging obstacles these individuals face regarding health care access. An example occurred when we screened 2,500 people for hepatitis B between 2007 and 2015. Of these, 90% were less than proficient in English – 50% were uninsured, and only 45% had seen a doctor in the past 12 months.
We also did an in-depth study of barriers to health care access among Asian American residents of Philadelphia. AAPI face a significant number of barriers, including:
1) A lack of knowledge about navigating the local health care system – things that we think are simple, like making an appointment to see a doctor, are a foreign concept for people who are coming from countries where the medical system looks very different. And when you compound that with language barriers, you realize how difficult it becomes to call a provider’s office and make an appointment when you can’t understand the person on the other end of the phone.
2) Cultural barriers to health care access is a huge issue- for many Asian cultures, seeing a doctor is only done when a person is very sick – so taking advantage of preventive care services, like pap tests, colonoscopies, annual check-ups, and hepatitis B screening tests – is not done. Improving awareness about these preventive care options would be very beneficial for improving overall health among Asian Americans in Philadelphia. This would help to prevent end-stage disease – like cervical cancer and liver cancer – which disproportionally affect Asian Americans.
3) Financial constraints are a large barrier for many Asian Americans in Philadelphia – many are uninsured or underinsured – although the Affordable Care Act helped quite a bit in the past few years. However, many Asian Philadelphians are shift-workers, and often cannot make normal provider hours – it is a hardship for most to take off shifts and lose the salary that is needed to cover housing and food costs.
4) Transportation is also an issue for many Limited English Proficient Asian Philadelphians, who are unfamiliar with the public transportation system and fearful about leaving their neighborhoods and getting lost. This is true even if they can get themselves to a hospital, where all of the signs are written in English, and they have to navigate the mazes of hallways to get to their appointment.
5) Unfortunately, we have seen too many Asian Philadelphians die of liver cancer because they were unable to access appropriate medical care and treatment for their hepatitis B. These are vibrant individuals in their 40s and 50s who leave behind devastated families. And it could all be prevented with more awareness and services targeted at improving health care access for these underserved communities.
When Asian Americans in Philadelphia are not able to access health care, they face sickness and pain, isolation, loss of work, loss of productivity, lack of quality of life, and potentially shortened life span due to undiagnosed and untreated illnesses.
This is why places in Philadelphia, like Chinatown Medical Services, are playing such a critical role in keeping our 104,000 Asian Philadelphians healthy. Chinatown Medical Services provides linguistically and culturally competent health care to over 15,000 people each year. CMS staff are aware of the cultural nuances faced by Chinese, Vietnamese, and other ethnic patients – and they have staff that speak over 5 languages – and a state of the art Skype system that fills in the other languages, as necessary. CMS has social service providers that help patients enroll in health insurance, become educated about diseases – such as diabetes, high blood pressure, and hepatitis B – and they help navigate their patients through the daunting process of making appointments for specialty tests like MRIs and x-rays. Asian community members throughout Philadelphia know that they can go to CMS and get trusted care by specialty staff who understand them. Without places like CMS – and the other Federally Qualified Health Centers that treat our underserved ethnic communities in Philadelphia – thousands of local Philadelphians would see poorer health outcomes. And that leads to a weaker city.
For the future, we need to ensure that these organizations and clinics are given the support and infrastructure they need to keep making a difference in the lives of our local and diverse Asian American communities. But these organizations are strapped – and they can’t do it alone – the city of Philadelphia can help –
- The city can provide more supportive, multi-lingual services for newcomers to Philadelphia who are limited English proficient
- The city can help create and support multi-lingual health education efforts, to make both health care providers and community members more aware about preventive care
- The city can work with hospitals and medical providers in neighborhoods like Chinatown, Cambodiatown, and South Philadelphia, to create multi-lingual signs, educational literature, and health system navigation programs
- Very importantly – the city can work with local health systems to collect more disaggregated data on our diverse ethnic communities – we need to know more specifically about which illnesses affect which communities, so that we can address these issues in a more targeted way. Aggregating all Asians together does everyone a dis-service – there are more than 60 local Asian sub-groups, and they should be counted individually.
- provide very important and much needed services to those who need it most – however, they do not screen for hepatitis B, even among those who are likely to be infected – the city health centers can, and should, test their Asian patients for hepatitis B. Philadelphia has among the highest rates of hepatitis B in the entire country – but only 10-15% of local infected individuals know that they have hepatitis B. This puts them at serious risk of dying from cirrhosis or liver cancer. The city needs to prioritize hepatitis B, a disease that can be diagnosed with a simple $10 blood test.
Most importantly, working together, we can help to save lives and keep Philadelphia strong and healthy.
Hepatitis B Foundation,
Public Health Program Manager,