The National Institutes of Health (NIH) led a collaborative research team studying how cultural sensitivity of healthcare can make a difference in better health for individuals and groups within a community. They focused on Asian/Pacific Islander (e.g. Hawaiian, Samoan, Tongan, etc.) women living in America. The study data suggests that those living in ethnic enclaves—areas with high concentration of similar ancestry—are less likely to have pregnancy or birth complications than those living in other areas.
The team of investigators concluded that women living in enclaves were less likely to experience gestational diabetes, to deliver preterm, or to have an infant who was small for gestational age (a possible indicator of failure to growth adequately in the uterus). The operating theory is that living in ethnic enclaves possibly improves healthy by offering easier access to health professionals of similar ancestry, access to traditional diets that are healthier than typical U.S. diets, and less incentive to engage in unhealthy habits such as smoking and alcoholic abuse.
Pauline Mendola, PhD with the Epidemiology Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) commented “Our findings suggest that providing Asian/Pacific Islanders with culturally appropriate health care resources may be a key factor in overcoming disparities.”
More than 8,400 women of Asian/Pacific Islander heritage took part in the study on labor and delivery at 19 hospitals throughout the United States. Compared to Asian/Pacific Islander women who lived in other areas, those who lived in ethnic enclaves were 39% less likely to develop gestational diabetes, 26% less likely to deliver preterm, and 32% less likely to have an infant small for gestational age.
Why Culturally Directed Health Might Matter
The researchers posited that residents of ethnic enclaves often have stronger social networks than ethnic minorities that live elsewhere. Perhaps these social ties contribute to ease the stress of discrimination and reduce the likelihood of resorting to unhealthy coping mechanisms” such as smoking and alcohol use. Furthermore, those living in enclaves may have more access to health-relevant goods and services. For example, ethnic grocery stores often located in such enclaves offer the ingredients for traditional diets often at compelling price points. Moreover the probability of residents having a health care provider of the same ancestry may be higher—hence offering culturally relevant health care information in native language.
Implications for Clinical Investigators
Although this study applied to general health, it surely is relevant to clinical investigators and sponsors seeking to engage with diverse patient groups for clinical research initiatives. The Asian population in the United States is now around 20 million and nearly 6% of the population. It will continue to growth.
As medicine becomes more targeted and precise clinical research must be diversified to include underrepresented populations including Asians (category includes Pacific Islanders).
West coast cities such as San Francisco, Los Angeles, Seattle and San Diego have large Asian populations. For example, the San Francisco is nearly 35% Asian. But so does the east. In fact, with nearly 750,000 people, New York’s Chinese population is the largest ethnic Chinese enclave outside of Asia. Manhattan’s Chinatown has the highest concentration of Chinese people in the Western Hemisphere.
Presently there has been a national push to diversity clinical research participation. From NIH grants and initiatives to industry sponsor patient engagement programs, the race is on for meaningful engagement between healthcare system stakeholders, communities and individuals.
This research shines some light on strategies that the NIH or industry sponsors may consider for diversifying clinical trials—by identifying and engaging with health professionals within key Asian/Pacific Islander enclaves.
Pauline Mendola, PhD with the Epidemiology Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)