American Koreans and Healthcare – by Dr. Julia Wai-Yin  So

The nation is crying out for universal health care reform to provide adequate health insurance for the diverse citizens in the nation.  Yet, American diversity includes a group of individuals who remain silent as they continue to face limited access to health care because of their limited English proficiency (LEP).  A study released by the Kaiser Family Foundation in April, 2008 indicated that during 2004-2006 almost one third of non-elderly Korean Americans in the US do not have health insurance.

Of those who have health insurance, about half obtain health care benefits through their employers. By comparison, 77% of Asian Indians have employer-sponsored insurance. These data underscore the point that Asian Americans in the US vary considerably from one group to another and may surprise those who perceive Asian Americans, including Korean Americans, as an affluent group for whom health care is not an issue.

The same report also points to three explanations for the low subscription rate of health insurance of Korean Americans. These include their recent arrival in this country, the location of their residence, and the size of the firm where they work. The report further notes that this result is due, in part, to a lack of English proficiency among many Korean immigrants. Here I would like to elaborate on this point. According to the 2006 American Community Survey by the US Census Bureau, 75% of Korean Americans are foreign born. While 20% speak English only at home, almost half admitted that they do not speak English ‘very well.’ In fact, the 2000 Census indicated that 39% of Korean Americans are linguistically isolated. A lack of English proficiency may restrict their employment opportunities at corporations that offer health insurance benefits to employees. This leaves them little choice but to start a business or work for companies owned by Korean-speaking business owners who may not afford health insurance for employees. In either case, health insurance becomes an affordability issue rather than a benefit for the Korean American.

LEP also prevents Korean immigrants from seeking help at English-speaking medical clinics when needed. In 2004, Preventive Medicine reported that individuals with LEP tend not to practice preventive health measures such as mammography or routine check-ups. With respect to Korean American women, they are less likely than white American women to utilize mammography to detect breast cancer. The same report also states that a lack of English proficiency is the primary reason. A similar study by the National Institute of Health (NIH) in 2006 also found breast cancer to be the most common cancer among Korean Americans. Although early detection is possible through mammography and clinical breast examinations, the report cites these methods as underutilized by minority women. The NIH report also indicates that depression is more common among Koreans than it is for Chinese, Japanese, and Filipinos. However, the level of depression, in general, decreases with a more proficient use of English.

With a population of more than 1.3 million, Korean Americans make up the fifth largest Asian ethnic group in the nation. Because of political upheaval and economic downturn in Korea during the late 1800s, many Koreans left the country for China or Japan to seek better opportunities. Others chose Hawaii, in part, because many Hawaiians, like Koreans, are Christians. The first Koreans arrived in Hawaii in 1902 as plantation workers. Coming from a homogenous society, they suffered culture shock while having to work with a diverse population of native Hawaiians, Japanese, Chinese, and Portuguese. Ill-prepared for strenuous agricultural work, many Korean pioneers soon abandoned plantation work and moved to the cities. They opened sewing or shoe repair shops in hope of improving their financial situation. As their lives settled, many Korean bachelors began to seek wives from Korea; thus started the practice of ‘picture bride’ which was a version of arranged marriage. Through a marriage intermediary, each got a glimpse of the other from a photo and agreed to marry. The bride went to Hawaii for the wedding ceremony and stayed with her husband. Between 1907 and 1924, as many as 20,000 picture brides, primarily from Japan and Korea, arrived in the US. The practice ended abruptly in 1924 because of the Immigration Act of that year that stopped the immigration of all Asians.

Recent Korean immigrants arrived after the Immigration Act of 1965 that repealed the provisions of 1924. The majority came as families and settled primarily in California and in the New York/New Jersey area. Although well educated, many were unable to find employment because of their LEP. Others have turned to entrepreneurship and have become successful business owners but continue to struggle with the English language. Unlike their immigrant parents, many Korean American children, whether native- or foreign-born, do not face a similar language challenge because they are educated in this country. Consequently, a large majority of them are able to enjoy employer-provided health insurance. However, as many shed some aspects of their ethnic identity or culture while assimilating to the US, they tend to confront identity issues or clash with their parents.

As Korean immigrants strive to improve their English while learning the US culture and its health care system, they struggle to seek employment, especially one that offers insurance benefits. Because of their LEP, they may prefer Korean-speaking health providers over English-speaking ones when needed. Unfortunately, by doing so, they fall victim to their own limitations: an inability to speak English in an English-speaking country ultimately impacts all aspects of their lives.

Dr. Julia Wai-Yin So

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