Pacific Islanders have the second highest infant death rate and some of the overall worst health outcomes in Alameda County, yet their vulnerability is too often overlooked, a recent county report revealed.
Explanations for the disparity vary. Some attribute it to longstanding barriers to care—poverty, unemployment, lack of health insurance—while others say cultural factors contribute. But experts and community advocates agree that for too long Pacific Islander health outcomes have been obscured by over-broad federal and state data collection techniques.
“It’s like we’re so unrecognized,” said Milika Funaki, a county maternal health consultant for Pacific Islanders. “We’re a minority in a large group.”
The Asian-Pacific Islander (API) designation includes people from east Asian countries like China and Japan, southeast Asia, including Indonesia and the Philippines, and south Asia, including India and Pakistan. Historically, information about Pacific Islanders has been aggregated within this group because the numbers would otherwise be too small to report, said Winston Tseng, assistant director for research with the UC Berkeley Health Research for Action center.
“The problem is, it diluted the health issues for Pacific Islanders,” Tseng said.
An important issue hidden in the Bay Area has been birth outcomes, such as birth weight or timing, which can indicate a baby’s current and future health risks.
Since 2015, Tseng has worked with the Regional Pacific Islander Task Force, which includes Alameda, San Francisco and San Mateo counties, to separate Pacific Islander data from the rest of the Asian population. Their work found that Pacific Islanders have the highest fertility rate in the region, the lowest rates of prenatal care, high rates of gestational diabetes, the second highest rate of low-birth weight babies, and the second highest infant death rate.
In 2016, only 76 percent of Pacific Islander mothers saw a doctor during the first trimester of their pregnancy, compared to 91 percent of white mothers. Nearly six percent of Pacific Islander babies were born underweight, compared to 4 percent of white babies and 8.4 percent of African American babies.
Health indicators such as these, Tseng said, can have an immediate or lifelong impact on the child’s health.
In fact, between 2010 and 2012, Pacific Islander babies in Alameda County were 1.7 times more likely to die in the first year of life than all other babies combined. Asians—the group Pacific Islanders are usually included in—had one of the lowest infant death rates in the county. African Americans had the highest rate and were twice as likely to die as all other infants combined.
Funaki, who has spent the past year and a half connecting mothers to county health services, said Pacific Island mothers aren’t usually accustomed to visiting a doctor regularly throughout their pregnancy, which could be a contributing factor to the poor health outcomes. “Back in the islands, we don’t see it as something important,” she said.
Funaki is Tongan, and she said Tonga has only one 200-bed hospital to serve a population of 107,000. That’s about half as many beds per capita as the world average, according to the Organisation for Economic Cooperation and Development (OECD). When they emigrate to the United States, most mothers from the Pacific Islands go to the hospital only when it’s time to give birth and don’t know how to navigate the health system, Funaki said.
Funaki helps mothers and families enroll in health insurance and sign up for CalFresh, the state food assistance program for low income residents. She also accompanies them to doctors’ appointments and nutrition classes. Often, her clients tell her that they wouldn’t have gone if she weren’t there.
“There’s a lot of need for more resources that have a direct impact on their health,” said Therese McCluskey, Funaki’s supervisor and perinatal services coordinator for the Alameda County Department of Public Health. For the past three years, McCluskey has spearheaded the local push to improve Pacific Islander health. Progress, however, has been slow, she said. A variety of strong cultural identities within the Pacific Islander group has made the work challenging.
“Pacific Islanders are many different kinds of people,” McCluskey said. “Fujians really identify as Fujians. Milika is Tongan, so our flyer gets interpreted as for Tongans only. Even Samoans might not know that the box they should check on the birth certificate is Pacific Islander.”
McCluskey said she was hopeful that a county child welfare bond measure would give her office the momentum it needs, however Measure A fell less than one-half percent short of the votes it needed to pass in June, and the county Board of Supervisors declined to place the bond on the November ballot. Had it passed, $250,000 would have been allocated to the Health Advancement for Pacific Islanders initiative, which provides incentives for health insurance enrollment, housing assistance, bus vouchers to get to appointments, and support for prenatal care visits.
A regional task force that works with Alameda County recommended that the statewide Black Infant Health Program be replicated for Pacific Islanders. The program offers black mothers group classes before and after they give birth to help them reduce stress, build a social support system and set health goals for themselves and their babies. The program also offers individual counseling and connects mothers to county services.
McCluskey said her department has begun to see small successes: former clients have referred new clients to the program, information about county resources has been passed around on social media, and more women are accessing early prenatal care.
But she’s only cautiously optimistic. “I don’t want to let up on this and in three years the numbers go back up,” she said.
Correction: This article has been updated to reflect that Measure A did not pass. Measure A received 66.2 percent of votes in the June election, but failed to receive the 66.67 percent needed to pass.