Shireen: We are in conversation with Dr. Jane Jih today. She shares the health risks that are more prevalent among Asian American communities, the impact of social determinants of health, and the influences of cultural beliefs on the health outcomes on this population, and what can be done from a research perspective to address Asian American needs better.

Stay tuned.

 Dr. Jane Jih is a practicing adult primary care physician and investigator in the division of general internal medicine at the University of California-San Francisco. Her health equity research focuses on the impact of social determinants of health, on chronic disease care and patient clinician communication, including the use of photos as a tool to communicate about health and social factors.

She’s a Taiwanese American, Chicago native and mama of two young kids. Welcome Dr. Jih.

Dr. Jih: Thanks for having me. So nice to see you today.

Shireen: An absolute pleasure having you on. So, Dr. Jih, your research lab at UCSF focuses on reducing health disparities among multiethnic and linguistically diverse adults. Now can you share with us how you arrived to wanting to do research around this critical topic?

And can you also share any current projects that you and your team were working on aligned with a similar topic?

Dr. Jih: Of course. So, I would say, you know, I had a couple of very formative experiences during my training and most of them were outside of the traditional academia medical school classroom.

And so, when I was in medical school, I was very active in the Asian Pacific American Medical Students Association chapter at my medical school. And we did a lot of community-based work working with the Chinese Vietnamese communities to work together to identify strategies to improve the health of these communities.

So, we did health fairs, educational sessions, and during that time I realized that the Filipino community, which is quite large in Chicago, and very significant population in the US had very little health-oriented work focused on them. And so, then I did a one year Albert Schweitzer Fellowship focused on health professional students to serve in the underserved Filipino community to address cardiovascular health disparities, which is very prevalent in that community.

And we had to collect our own data to really understand what was going on and to address it at different levels within the community. And this led us to start a nonprofit focused on that, that was very active for a number of years. And being involved in this community engaged process made me realize that I could pursue a career.

That there was a need to really have data equity, health equity in these communities. And so that was the first I say inspiration. That really led me to that. And I think the other thing was, growing up as an Asian American in the Midwest this wasn’t a big, this…our health wasn’t a big deal.

There was not enough data about it. I had close family friends that developed hepatitis C and then had liver cancer. And when I was a student looking into the data around it, there were just not that many Asian Americans included in a condition that was very prevalent among Asian Americans.

And so, I think from that drive always feeling that we wanted to be seen and recognized, especially as an Asian American, that really was a motivation to go and pursue a research career. And I think the reason I’ve brought in more to multiethnic, linguistically diverse adults is that I think in one specific group, many groups kind of have parallels and commonalities in their experience.

And so not only does my work focus on Asian Americans, but also, it’s important for us to include black African Americans, Latinx and other allies. Other groups are from racial, ethnic minority groups in our research. So that’s really the impetus for the career trajectory that I have.

Shireen: That is so interesting. Even when you’re talking about Asian Americans. So Asian Americans at large, really represent one of the fastest growing groups in the United States. Now, we’ve used the term Asians as really an umbrella term to describe people who are descendants from Asia.

But Asians itself have different cultural backgrounds, socioeconomic status different diets, cultures even within the Asian population that affects their health. Can you discuss some of the health risks that are more prevalent among Asian Americans? And then through your work, have you observed specific health disparities that disproportionately affect a particular group within sort of this Asian American umbrella term?

Dr. Jih: So, you’re absolutely right. Asian Americans can trace their heritage at over 30 different countries and ethnic groups and speak over 100 languages and dialects. And so, I would view this as a challenge. A challenge and a strength. A challenge, meaning that Asian Americans as a group are very heterogeneous, different immigration patterns, social economic status, even within the same subgroup depending on where you live in the US and what your immigration history is.

So, these are challenges that we see not only in clinical interactions like seeking healthcare, but also for data and also how we develop interventions for health. So, I think one thing that I think it’s great that you’re bringing up, bringing forward and having a podcast focuses on this, is that there’s just insufficient data focused on Asian Americans.

And so, some of the data and things I’ll discuss today are really based on a small segment of the population and Asian Americans will be much more part, one in nine Americans are estimated to be of Asian descent by 2060, which is not that far, right? So, if you want me to speak broadly about health risks, common things are common and less common things are also common.

And so pre pandemic in terms of Asian Americans, if you look at the aggregate group, leading causes of death are cancer and then heart disease. And so, for other groups it would be, it’s flipped around where heart disease is the leading cause followed by cancer. But then if you look at specific subgroups, right?

For example, south Asians cardiometabolic disease is the leading cause of cancer or leading cause of death for that group, unlike the other Asian subgroups where it’s cancer. And things that are less common compared to non-Asian Americans. For Asian American are excess of infectious disease related cancers.

So chronic Hepatitis B can lead to liver cancer. Chronic H or H Pylori infection can lead to stomach cancer. And then HPV infection can lead to cervical cancer. And so, these are prevalent among Asian Americans. And part of that some of these are very prevalent in Asia where many of them migrated from.

So, Hepatitis B is definitely one where universal screenings important. Getting vaccinated can protect you, especially if it runs in your family. Stomach cancer are higher in Asian immigrants and they’re actually even higher rates in Asia. Though, so relatively speaking in America, they’re lower. And then the other is tuberculosis, where there’s a large national, global burden of tuberculosis in Asia.

So, immigrants that come to this country also have to have been known to be higher. And so, I would also note, like if you look at different Asian subgroups, there’s different utilization of healthcare, different screening patterns, different receptiveness or use of preventive health practices. And so Asian Americans from Southeast Asia, for example, Cambodian Americans, Vietnamese Americans, there’s been evidence of higher cervical cancer incidents, right?

Lung cancer I think is another striking presentation where tobacco use is very much linked to it. But in some Asian subgroups, like female Asians that are never smokers also are seeing a lot of lung cancer. So, we’re seeing that there’s a lot of heterogeneity and differences across the different groups.

And so, for if someone that’s listening these are individualized to who you may be, you’re cultural upbringing, the things exposed to growing up. So definitely something to discuss with your clinician as you try to figure out what might you be at risk for.

Shireen: And we talked about socioeconomic status, in what ways SDOH or social determinants of health really affect the health outcomes of Asian Americans?

Dr. Jih: So social determinants of health are broad, right? They can include anything. We are born, grow, live, work, age, and then the social structures, the institutional structures where we live.

And so social difference health broadly are I think to be attributed as much as 80% of poor health outcomes. So, they are really a huge driver of what happens to Asian Americans. And so, I think this is again, goes back to sort of the immigration history by immigration cultural history for each Asian sub-group.

Also, social economic status and what are prevalent dietary and cultural practices. So, I would think one major area I want to highlight here is non-English language use. Which is a very significant challenge for many Asian Americans that do not speak English. And so, this is, I would view as an example of institutional racism where our healthcare system is designed for people that speak English.

And then you probably know, even though you’re literate in English, sometimes going to see the doctor or going to healthcare is so complicated. So, imagine doing that if you don’t speak English, and the healthcare system does not interface with you sufficiently in your language. So, there are so many barriers that can arise from that in terms of your health experiences, your willingness to engage and your health outcomes.

Especially if you don’t speak the same language with your provider and they’re not using an interpreter. There’s so much reduced quality and communication and so many misunderstandings and delays in care. So, the second thing I would say around social determinants of health is that there’s still, I view as insufficient data on a broad level about Asian Americans by subgroup.

A lot of the data that we are looking at are collected from national data sets, but oftentimes they only collect data in English. Which really limits the characterization for all these different groups and sometimes the harder to reach groups…I’m not saying harder. The smaller groups where there needs to be specific strategies to outreach to them.

Building trust to have them complete the surveys means as for some groups, we have less data around their health. And so that, I think itself is a structure that impacts. How Asian Americans experience health. And limits our ability to be able to conduct and do research and to create interventions that really address the needs of these groups.

One example I might share is the work that we did when we looked at body mass index and diabetes. It’s pretty well established that Asian Americans at lower body mass indexes, we experienced diabetes at a higher rate compared to other racial ethnic groups. And we use a data set called the California Health Interview Survey to look at this relationship.

And the reason we use this, unlike the other national data sets, is that they actually collected data in seven major languages. Not only English and Spanish, but five Asian languages. So Mandarin, Cantonese, Vietnamese, Korean, Tagalog. And if you look at the large data sets, our federal government invests in like they’re mostly skewed to English speakers and occasionally they might add some Asian Americans that speak languages.

And in this data set that we used, we found that certain Asian subgroups had higher rates of diabetes right at lower body mass index. And we wouldn’t have seen this if we looked at Asian Americans altogether. So, if we’re not collecting the data to look at this, we’re not going to be able to identify the different needs that different groups may have.

And then I think research often there’s a one size fits all sort of approach. And then I think that doesn’t work for Asian Americans. We’re all very different. We share a lot of similarities, but we also are different. And I think we need to on a national level, collect data that really reflects not only our health, but other things that are important in terms of education, engagement and civic engagement, all these different things, right? To really understand, to really be part of America and to really have efforts directed to us that are not just a one size fits all sort of approach.

Shireen: I absolutely like that you’re emphasizing sort of that diversity among sort of this umbrella term. And something that you said a second ago around, the language and I feel even that is so contextualized, right?

Because even if I think about it, and as you’re saying this, I’m thinking about my own family members and they speak English is fine but being in that room with your doctor and getting this ton of information come at you at once. Which the doctor’s probably used to saying this all day long, but being the patient, you know what I mean?

Especially when it’s bad news that you’re hearing from the doctor, it’s a lot to process. And even within that, sometimes I or another family member sort of accompany a family member going, there’s like, all right, one person’s just going to like write notes down and just try to digest everything the doctor’s saying so they can, sort of, again, digested later and just be able to jot nose down because it is so hard. And we may even speak the same language, but context is so much within that experience as well to understand what it really means for me.

Dr. Jih: Yes. I think as you said, right. Even as like an English speaker that is also a physician, going to that, navigating a healthcare system for yourself or a family member is absolutely very challenging for a native English speaker. So, imagine being someone that was born and raised in a different country. Or spent part of their significant part of their life in a different country and then immigrated here.

And interfacing with the healthcare system is all English based at a high level of literacy. I mean, some healthcare centers I think have signage in different languages, but not all healthcare centers have that. A lot of patients, when they see their doctor, they also followed up through a patient portal, right?

Which is very much English-based, I think some portals have Spanish, but few I’ve seen that have Asian languages. So, these are all structural barriers that there are social treatments of health. That affect the way people receive their healthcare, the way they experience health. And so, I think it’s all interconnected. So there needs to be changes on multiple levels. To really improve the health experience and the health status of Asian Americans.

Shireen: And speaking of sort of having that diverse background, to what extent do cultural beliefs influence the health outcomes or just have an impact on health outcomes of Asian Americans? And then how can healthcare providers like yourself address these barriers to really improve access to health for Asian Americans?

Dr. Jih: So, I think there was a period in time when there was like, they were very well intended resources to say Chinese Americans believe this, south Asians believe this.

And I think while they’re well intended at that time, they kind of perpetuate a lot of some stereotypes. And I think for Chinese Americans and maybe South Asians, in different Asian groups, there are multiple generations of them now in the US where many of them came early to help build the rail roads, help build America, right?

So, all these things where one of those sorts of one size fits all, where all Chinese Americans bully X. Potentially now, especially since we’re having all these more dialogue around this, could be potentially harmful. So, I think it’s important for clinicians and patients to find a good match where they feel like their clinician’s going to understand.

Is listening to what they’re saying, listening to how their cultural beliefs could be impacting their health. Adopting a strong communication style that involves active listening that’s patient-centered, that there’s really some humility and respect. Because patients are, you guys are experts of your health and your experience.

And our job as clinicians is really to offer advice, consultation and guidance and trying to offer in a way that It’s compatible with what is important to you. So, I think language one. First of all, if for some reason your clinician speaks a little bit of what you speak or you speak a little bit of English, that probably is not enough.

You should use the gold standard, which is an interpreter. And maybe not just a family member, but maybe someone that’s received training and or certification around providing you the technical expertise to help you understand what’s going on. I think sometimes your experiences that you’re bilingual, but maybe you’re not as strong and one language to understand the very technical things, have an interpreter help it or in is your legal right to have that.

So, your healthcare setting should really facilitate that. And if they not, that is a concern that others should be alerted of. And I think being, mutual, being open, curious. Treating each other with respect. I think the pandemic has created a lot of friction between healthcare work, a lot of friction about lots of things, right?

But I think coming to see your doctor, realizing they’re also a human being, also experiencing a lot of things and us doing the same to you, mutual respect is really important, right? And so, I think you should choose to show what you, what you wish to share with your doctor. Some of my work is focusing around photos as a way to help articulate or share some of the things that are important to you.

Sometimes it’s easier to share a photo of your family or what you eat as opposed to describing it, and so I think in the ways that you can to as comfortable as you are to share as much information about what’s important to you. And I think one thing that I can provide, an example is I’ve done some work around traditional Chinese medicine and developing nutritional counseling that blends traditional Chinese medicine and Western biomedical medicine.

And one issue is that some patients don’t feel comfortable disclosing that they use traditional Chinese medicine because of the perception that providers view that as wrong or not accepting of it. But we should respect that people are using in there, even though there might not be the same type of level of evidence that biomedicine demands for it to be used.

There are generations of history, belief, and That X, Y, and Z can help promote health. So, I think that disclosure or discussion and being open to it on both ends is really important because yes, there could be potential harms, but there could still be potential benefits. And I think that’s just one example where communication and being sharing that information is important.

The other aspect might be around that I could provide example about advanced care planning. I think there’s some beliefs for certain Asian American groups about how they want to go about that planning. If they’re end of life, would they want to pass away at home versus the hospital.

And there’s different preferences around this. And then I bring this up with a lot of my Asian American patients and they’re actually, I feel relieved when I bring it up because they want to do this planning and maybe there’s a perception out there that they don’t want to engage in this planning because of cultural beliefs. Or superstition and things like that.

So, I think we, we all have a lot to learn and approaching this with humility and respect, I think are key elements. And I think the last thing I will say, and I’ve touched upon this already, is that we need to see each other as human beings, right? Like person to person. I think with the pandemic, a lot of things have changed about how we perceive each other.

What is truth, right? What’s compassion and respect? So, I think for me, that’s really rebalanced that for me and. I’m okay with patients to see that I’m also human. I have children. I struggle with some of the things they’re struggling with too, and I think that’s okay. And I think, I hope patients over time we can build that relationship of trust and respect, that they feel comfortable to share that with their, not just their doctor, but the other members of the team. They’re helping take care of them.

Shireen: When we talk about Asian American populations, we automatically go to. Let’s compare with like an immigrant population specifically as well. In fact, we have another episode with Dr. Nilay Shah where we go into sort of the healthy immigrant effect. When we talk about Asian Americans and without mentioning immigrants who make up a large portion of Asians that are living in the United States today, what have you really recognized in your field of work that makes it challenging to address health disparities within the Asian community?

Dr. Jih: So, this goes back to data, and I call it the Asian-American Data fallacy. The absence of evidence is not evidence of absence, right? Just because you don’t have data that shows something, doesn’t mean it’s not there. And so, I might already mentioned one, right? Asian Americans are not also often identified in large national data sets where we’re lumped together, where we’re other people, right?

And then I think you can even point back to when the census was started, in the 1800’s was Chinese Americans, which came to this country to help build the rail roads. They were not included; they were not counted. And it wasn’t until 2000 that Asian Americans and Pacific Islanders were separated in the census.

There are now better national guidelines. And there’s recently they’ve been seeking input about how can they make it even better. And so, but if they’re not enforced, if they’re not used widely, you know, we still don’t collect data about Asian Americans.

And I mentioned the other one, not collecting data in Asian languages. Not all immigrants can speak English. And this narrows and skews our data to a different type of maybe social economically, education wise, different group than Asians that their predominant language is non-English.

So, it biases the data. And I think the other thing is administrative data. Especially if you go into a healthcare record, they can be really inaccurate for Asian Americans. So, it might not capture Asian Americans that are biracial or multiethnic. Sometimes when the administrative data is collecting, you go see the doctor, they don’t ask you when someone just looks at you and checks a box for you.

And so, these are really inconsistencies that are quite structural that are due to insufficient training. Resources to collect the type of data that we need because if everyone’s able to self-report and accurately collect that data, we would have a much better picture of what’s going on.

And the last thing is like, if we collect Asian-American data, we need to just aggregate by their sub-Asian-American subgroup, national origin language. And so, all these levels of data help conceal disparity. Sort of like with the body mass index and diabetes prevalence. If we look at Asian Americans as a whole, it doesn’t look like there’s a problem.

But when we disaggregate by Asian-American subgroup, you can see there’s a lot of granularities, a lot of differences based on subgroup. And that helps us better design interventions better, help understand and help people that are in different subgroups that have different needs.

Sometimes I would argue is the absence of evidence and evidence of neglect. Have we neglected just collect. We don’t see anything because we haven’t tried to. So, I would say a lot of researchers that are in this space, we have a good deal of doubt about the national and state data that’s available even during COVID.

Where we were grouped with other groups, or they weren’t collecting granular data. And so, I think these are huge issues in our work and this data fallacy is one example of anti-Asian institutional racism. We could do better to understand the health of Asian Americans if we collect better data systematically.

And I guess if there’s time I can comment on some other thing. So, Asian Americans, about six 7% of the US population in tax base. So National Institutes of Health is taxpayer funded money that focuses on research to affect the health of Americans and beyond. So, for 6%, would you guess that NIH would fund 6% of their budget would be for Asian Americans?

What do you guess they fund? How much they fund on Asian Americans?

Shireen: Oh goodness. Oh boy. I’m going to go with 2%.

Dr, Jih: Yeah. So, there was a study done by Lan Doan and her authors in 2019. So, they looked at data from 1992 to 2018 and they found that 0.17% of the NIH budget during that time period focused on Asian America’s native Hawaiians and Pacific Islanders.

So, it was 0.12% before 2000 and 0.18% after 2000. So, NIH is aware of this, and I think NIH has really mobilized recently around these topics. But really the question is, how are we supposed to understand and address the health of Asian Americans when so little funding is allocated to study and intervene?

The quality of the data that we collect is fair or poor. And the investment that we all contribute to the taxpayer base is not really coming back to us. So, I have to recognize there is much more visibility and acknowledgement of this. But I think and then one thing might be there’s a couple of grants that I was part of when they were submitted that are focusing on assembling large cohorts, following people over time of Asian Americans to follow for cancer risk, heart disease, lung disease.

And I think this would be a tremendous investment on Asian American health moving forward. And of course, there needs to be commitment when these grants are funded to recruit in multiple language, involve the community, involve key stakeholders to make sure the people that are included in the cohorts best represent our population.

Shireen: And coming back to talking about sort of the Asian American groups and looking at the sort of that immigrant population as well. Can you speak a little bit to the generational difference when it comes to health burden, immigrants by immigrants or first generation and then even later generation of Asian Americans?

Dr. Jih: So, I definitely think there are generational differences. Differences in diet, lifestyle practices, major historical societal events such as, the COVID Pandemic. Language use their experience of the immigration. And there’s a lot of heterogeneity, I think based on where your family immigrates to what part of the country and what was the context of that immigration, right?

Because some groups immigrated for, due to refugee status, a world event. Some immigrated to work in the US as a healthcare professional. Some immigrated for educational or some immigrated because other family members came too, and they were able to reunify and bring the family here.

And so, these little things translate. And there it’s not, I would say, it’s not very clear cut. They translate down to differential risks based on acculturation to lifestyles and diets that are common in the western countries compared to what it may be in the Asian country that they originally came from.

And so, there’s a lot of heterogeneity around here about cardiometabolic disease and risk factors in terms of heart disease, diabetes, high blood pressure, as well as cancer risks as we mentioned, right? Some of them, some cancers are lower in Asia, but then the risk increases as they spend more time here in the U.S. where some things are more common in Asia and then, persist and are more common here in the U.S. from some of those things.

I think one other thing that there’s a generational difference might be also mental and behavioral health. Where I think culturally it still remains very stigmatized. At multiple levels for many racial ethnic groups. But for earlier generation, the discussions they have around that versus discussions now we’re having that remain are different.

They’re more visibility and more open about those. And I think there’s a lot of societal pressures around the model minority myth about Asians. How we’re the model minority, high achieving good at math, earn a lot of money. And that’s not necessarily true across the board. And I think there’s also a relative feeling invisible in our data, as I mentioned.

But feeling invisible as Asian Americans in society, right? When Asian Americans were experiencing more and when it came to light that there was a significant amount of anti-Asian hate, during the ongoing pandemic. This was a surprise to many other non-Asians, for Asians this was something we felt internalized, or we were experiencing.

But there was no way to share and disseminate that. And so, I think it is a myth that Asian Americans do not experience racism, and the pandemic has helped uncover that. And I think by generation, there’s a lot of different coping feeling about this and contextualizing this in their experience in America.

Shireen: So then with that, Dr. Jih going back to what you mentioned around the research, how do you advise that research and interventions aimed at addressing health disparities among Asian American communities is culturally sensitive to the needs of this diverse population?

Dr. Jih: So, my own philosophy on this is that for us to develop, do the research and interventions that really address the needs of the Asian American community is that we need diverse perspectives and expertise. And so, I think the cornerstone of this is community, patient, family, other stakeholder engagement into the work that we do. It’s essential. We should compensate them for their time. This is their expertise.

Researchers can’t possibly have that, all that lived experience. So, people that have that li lived experience is so important to include in the research process from the beginning to the end. And then we also should hire key personnel and staff leading the research that have these lived experiences, shared language.

Cultural experiences to help conduct the research, because that is so important. Sometimes there’s people feel like their researcher is being done on them, but we should do research together not being done on someone. I think it’s really important also to conduct research that doesn’t just focus on English speakers, but those that are limited English proficient.

And we should, I think there’s some work that grant federal funding has funded as focused on one group versus another. And I personally have tried more now to include a lot of populations that study, that experience health disparities. Because I think there might be more shared commonality.

And I think that that what we learn can be more translatable into day-to-day real world, how we take care of patients in a clinical study. And I think there has to be adequate funding resources. Or adequate allocation of resources to support this research. So, making sure you have enough staff, time to recruit patients of different languages.

Avoiding the one size fits all, tailoring to different parts for each group. Recruitment how we deliver the intervention. Teamwork, I think takes precedent over individual glory and I think racial ethnic allyship. Thinking about what happens to Asian Americans, this is also cross over to black African Americans.

Latinx, I think there are a lot of. There are differences, but I think it’s stronger to work together because there’s some shared commonalities in our experience and how we interface with the healthcare. Of course, there are differences as well, but I think together that makes the work much more powerful and sustainable.

Shireen: I love that approach. And when we were talking about some of these approaches, how can we promote health literacy among Asian American communities, particularly for those who have limited access to healthcare resources? And then just a significant language barrier to what you mentioned earlier.

Dr. Jih: So, Title V of the Civil Rights Act of 1964. Requires recipients of federal funding to take reasonable steps to make sure that program services and activities are accessible by all people that have limited English proficiency, which basically means when you go to the healthcare facility, they should be taking steps to help you engage in your healthcare.

So, this is the use of in-person video or telephone-based interpreters for healthcare interactions. I think having your family help be there with you and help support your understanding and maybe help interpret a little bit is undoubtedly very valuable and helpful.

But using services that are that are provided by the healthcare institution can make sure you have that added level of nuanced understanding for your healthcare. So please advocate for yourself in that way. I also think some of the larger healthcare centers such as the one where I work in, may not deliver care, may not have as much staff that are language concordant.

And there are a lot of wonderful, excellent community-based clinics, federally qualified health centers that serve population, Asian American populations or local racial ethnic populations that really have staff that are hired from within the community, that are language concordant.

There are affiliated with larger medical centers or hospitals. So, I think, think of seeking care there, where you still have the connection to tertiary care or very comp, very highly specialized care, but receiving something. Care in a primary care clinic that’s community based, that you can really receive that high touch and more connection that’s important to you.

And I think other increasing resources. Increasing recognition of resources that are within your community. I think community-based organizations are the leaders in disseminate health information that’s in language and culturally relevant. One plug I might put in that I’m part of the Asian American Research Center on Health.

It’s a large collaborative community-based organizations and researchers focused on health of Asian Americans. And at our website, we have some in-language materials developed by different researchers and community-based organizations that focused on nutrition, physical activity, cancer prevention, tobacco use.

So, if you look in your community and do a Google search, there’s not one good aggregator, but there’s a lot of different resources out there that are potentially in language. And I think increasingly, NIH and large patient-oriented advocacy organizations are finding the need to develop these materials and make them more accessible to Asian Americans.

We’ve also worked, I mentioned on the integrative nutritional counseling guides. That focus on blending traditional Chinese medicine with biomedical principles. And so, I work worked on one specifically around high blood pressure and high cholesterol. And then one of my colleagues also worked on for diabetes.

And so, I’ve included the website that you could include with others that also are bilingual in Chinese and English. So, if they wanted to share this with their clinician and show them, this is what I mean, this is what I’m talking about. They could bring the guide, you can print it off online, download it, it’s completely free.

So those are some of the research. I think really advocating for yourself, for you. If you don’t understand it in English, you speak English, ask them to re-explain to you in a way that you understand. And if English is not your first language or is not your dominant or preferred language to use the interpreters that are available to you to help you understand what’s going on.

Shireen: And I really appreciate that perspective, especially coming from you because it’s the heart of it. What you’re saying is that this is your right. You need to understand your health information and get the resources and to what you said, advocate for yourself. Because if you’re not, I mean, who’s going to do it if you’re not going to do it for yourself?

Do not be intimidated because you’re sitting across from a doctor and the doctor has to either move on to the next thing or just assumes that you understood everything that they said. You have to be the person in the room who advocates for your health. With that Dr. Jih think there were so many brilliant nuggets in here in this episode, and I’m so excited that you came on.

From here, how can we continue the conversation with you? How can our listeners just connect with you and then just learn more about your work?

Dr. Jih: Yeah, so I’ll include a couple links where you can learn more about our work at UCSF, that our group and other team members, especially at the Asian American Resource Center on Health, they can take a look at that.

I say I use Twitter a little bit, so you could try to reach me there or also LinkedIn, but it’s always nice to receive an email, so feel free, if something resonates with you or you want you wish to collaborate or I’ll try my best to respond and connect with you that way. Well, thanks so much for inviting me for the podcast. It’s been fun chatting.

Shireen: An absolute pleasure. Thank you again, Dr. Jih. And to our listeners, thank you again for tuning to this episode with the Yumlish podcast. We encourage you, especially our Asian American listeners today to really reflect on their own healthcare experiences. Please share with us if you’ve ever encountered any cultural or language barriers that have made it difficult for you to communicate with your health needs to your provider.

And what you wish they would do differently next time for you in that healthcare for you. Head over to our Facebook, head over to our Instagram. We’ll continue the conversation there. Again, share with us if you’ve ever encountered any cultural or language barriers that just made it difficult for you to communicate your health needs to your provider.

We’ll continue the conversation there at Yumlish on Facebook, on Instagram. And with that, Dr. Jih, thank you so very much again.

Dr. Jih: Take care.

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