The first wave of Vietnamese refugees came to the San Jose area in the 1980s, after the fall of Saigon. Now San Jose has the largest Vietnamese population of any city in the country. Santa Clara County is also second largest of any county in the U.S., after Orange County.
Today, Santa Clara released its first-ever Vietnamese health assessment to get a better understanding of this growing population's health needs.
Health Officer Martin Fenstersheib says Santa Clara County didn't have a good understanding of what the health needs of its Vietnamese community were prior to this report.
"We had a great interest in doing this because we tend to lump all of our statistics together, especially in the Asian, Pacific Island community. So things are reported that way also."
Three top health concerns are highlighted in the report: access to health care and health insurance, stigma related to getting mental health services, and cancer -- particularly liver cancer related to Hepatitis B. Fenstersheib says the report recommends creating a task force to focus on reducing these health disparities.
Health Access and Insurance
More than one in four Vietnamese residents in Santa Clara County doesn't have health insurance. That's lower than for the county as a whole, and lower than any other Asian or Pacific Islander group, says Fenstersheib.
Those who do have health insurance may not be utilizing it. Community leaders say their Vietnamese patients tend to view health care as necessary only when they're sick. That means no preventive care. Thinh Nguyen, a Vietnamese doctor in San Jose and a contributor to the report, wrote that self-diagnosing is very common. Nguyen adds that in Vietnam, medicine is available over the counter, not by prescription. In addition, may people prefer to use herbal and traditional medicines.
But the biggest barrier to accessing health care is cost. Twenty-four percent reported not getting medical care in the past year because it was too expensive.
The report highlighted a need for a centralized location in Santa Clara County for Vietnamese residents to get information about healthcare coverage.
Though Vietnamese adults have a lower cancer rate than other racial and ethnic groups in Santa Clara County, cancer is still one of the leading causes of death. Vietnamese adults have the highest mortality rates for liver cancer, more than four times higher than other county residents.
A major cause of liver cancer is Hepatitis B. More than half of Vietnamese young adults in the county reported being positive for Hepatitis B. Fenstersheib says Santa Clara County is already well aware that this population is highly at risk for Hepatitis B, pointing to the ongoing work with Hepatitis B Free campaign in the Bay Area. But he says it's a matter of doing even more screening and outreach.
"That means we have to educate the general community, but it also means we have to educate the provider community that see the Vietnamese population so that they understand who is at highest risk."
Mental Health Stigmas
Because people with mental health issues are often stigmatized in the Vietnamese community, many don't seek therapy. Fenstersheib says the community is less sympathetic to people with mental health problems. And if they do talk about it, it's usually not with a therapist.
"It's something that's just spoken about in the immediate family - if at all. People are not as trusting to talking to anybody on the outside."
Fenstersheib says Vietnamese refugees are affected by mental health problems ranging from Post Traumatic Stress Disorder to isolation and depression. He says outreach needs to be done to communicate that mental health problems are also diseases, and those affected need to be treated -- just like any other disease.
"Just given the history of where they come from and what they've gone through during their decades of immigration and the war, there is certainly a lot of reasons for people to affected by emotional stress and trauma."
The report recommends creating a group of Vietnamese patient advocates who have a history of mental health problems to share their experiences with other Vietnamese resident in hopes of reducing the stigma.