Defining Hmong- Health Inequalities and Social Disparities among First Generation Hmong American Communities

by: Joseph R. Domingo

I. Introduction
Since the passage of the Immigration and Nationality Act of 1965, America has seen an influx of Asian immigrants in search of prosperity, good health, and opportunities to exercise freedoms and liberties. Taking into consideration the push theory of migration, the reasons why one may want to leave from their home country is due to the lack of opportunities that they may have. The Hmong have a unique place in the America‘s immigration history because of political turmoil, violent regimes, and a hostile environment has thrusted them to seek political asylum and refugee status in the United States. According to the 2000 U.S. Census analysis by Lee et al, the Hmong are the most impoverished groups among the Asian American population in regards to socioeconomic status, employment, and access to social resources. Factors of Hmong migration is founded on the Laotian Civil War and the retribution by communist leader Pathet Lao and plight of Hmong to Thailand before entering the United States as “refugees” (Tatman, 2004). Because of this factor in their history, a mass exodus of political asylumees and refugees settled in the United States for security and for their freedoms. However, after immigrating to the United States, economic opportunities and access to social and health resources became difficult to obtain especially during the financial crisis of the 1970s-80s (U.S. Department of Health and Human Services – The Refugee Act of 1980, 2002). The inability to attain these resources has caused Hmong Americans to have social disparities and health inequalities. This call for attention to Hmong Americans is important because of the economic and social developments since their arrival in the United States. Mainly, first and second generation Hmong Americans are of particular interest because of the environments and experiences they have lived in becoming a part of the American landscape and being counted in to the general population. As a rising Asian American sub-ethnic group it is important to understand their well-being and livelihood. According to Moore & Stricker (2010) in the Health Impact Assessment Report: Reducing Health Disparities in the Hmong Population of La Crosse County, they are most at risk to communicable and respiratory diseases, lack educational attainment, and are more likely to live below the poverty line. Economic disparities and health inequalities among Hmong American communities do exist and are prevalent due to their poor health status, low socioeconomics, and the barriers to seeking healthcare and health resources. First, I will discuss Hmong history and their origins. Second, I will discuss statistical and sociological background of Hmong Americans. Third, I will shed light on the status Hmong Americans in a review of collected literature. Fourth, I will discuss my research findings. Fifth, I will discuss my methods and qualitative data. Sixth, I will discuss my analysis of Hmong American social disparities and health inequalities and, conclude my findings and pose my recommendations and future study analysis.

History and Origins
The Hmong are a sub ethnic enclave of Miao ethnic group. The Hmong are specific to the regions of Southern China, Laos, Vietnam, and Thailand. However, for centuries they have been a nomadic group that settled into areas around South East Asia, most notably in Laos (Tatman, 2004). The Hmongs beliefs are animistic and are in tune with supernatural forces and spirits that control aspects of life, death, successes, and misfortune (Tatman, 2004). Their faith and faith practices are ritual and ceremony based in respect with spirits connection to body and other life forces. Health and wellbeing are essential to the spiritual wellbeing of an individual, and through the maintenance of both keep the person in tune with their life cycle (Tatman, 2004)

According to the book Hmong Means Free: Life in Laos and America by Sucheng Chan (2005) , One of the major causes of Hmong migration and relocation to the United States was the threat of genocide and mass murder by communist leader Pathet Lao beginning in 1975 (p.44). The Lao Communist Government discovered that the Hmong under the direction of General Vang Pao and the United States Central Intelligence Agency had covert operations in stopping the spread of communism and the hindrance of the Ho Chi Min Trail by the North Vietnamese Army which was also known as the “Secret War” which coincided with the Vietnam War (p. 30). In retaliation, the livelihood and security of the Hmong became an issue. As war and hostility raged in the part of South East Asia, the Hmong, along with Vietnamese refugees, started come as refugees and political asylum seekers and were ―scattered‖ about the United States in hopes of avoiding a massive impact on resources in particular region (Indochina Migration and Refugee Assistance Act, 1975). As the more Hmong refugees started coming in, the United States‘ economy and resources started to take a toll on the general population. Many of them experienced racism in form of “compassion fatigue”, the influx of South East Asian refugees, most especially the Hmong, had implications to the areas where they were highly concentrated (Chan, 1994, p.135). The strain on the regional entities and resources also had an impact on the United States Government financially, the late 1970s and 80s had a large impact on many social services and funding for government assistance programs.

The Hmong felt the strain of these implications with the resources they were given and conditions they were placed under. As a result, today the Hmong are one of impoverished, undeserved, and undereducated groups in the United States (p.51). The opportunity to naturalize came in the late 1980s and early 1990s as first generation Hmong immigrants population started surging (Lee et al, p.10 ,2001). Hmong Americans have become naturalized citizens rapidly since 2000 in addition to a growing population. (Lee et al, p.10, 2001)

II. Statistical and Sociological Background
Hmong American Population and Regional Distribution and Housing
According to the U.S Census (2000) and Lee et al (2001), the Hmong American population amounts to 186,310 persons. 51% of Hmong Americans reported that they were male while 49% reported that they were female. In comparison with the general population, the statistics were alike. Nearly 51% reported that they were male while 49% claimed that they were female.

Age distribution in the Hmong American community is diverse and relatively different to the general population in the 2000 U.S Census. The median age for Hmong Americans is twenty years old. This is also reflected in the enumerated data that reports that most Hmong Americans reported that that they were under the age of eighteen. Meanwhile, the general population reported a quarter of individuals who were under eighteen. This reflects a more youthful population compared to the general population who were at least thirty-five years old (U.S Census, 2000.).

Among household and family sizes in Hmong American communities, the 2000 U.S Census reports that there is an estimated 6.28 persons in a household compared to to the national average of 2.59 persons. This high number of individuals in a household unit is contributed to the large number of family size. The general population average for family size is an estimated 3.14 persons compared to Hmong Americans who average to be 6.51 persons.

Also reported was the housing data among Hmong Americans and their ability to own and or rent housing. 61.26% percent of Hmong Americans reported that they rent or lease a home while 38.74% reported that they own a home. The national average for home ownership was 2/3s of the population. The rate of Hmong American homeownership is growing at an exponential rate due to the growth of educational attainment and high levels of employment (U.S Census, 2000).

Citizenship Status and Nationality
Of the Hmong American population reported in the 2000 U.S Census and in Lee et al‘s report (2001), 56.6% of individuals reported being foreign-born while 30% of individuals said that they were permanent residents or naturalized citizens. Meanwhile, 11.1% of the general population that they were foreign-born and 59.1% of foreign-born individuals reported that they were not U.S. citizens. However, since 1990 Hmong refugees have been naturalizing at a rate of 9% per year. Predictions of the rate of naturalizing has risen because of the national issues surrounding immigration and the need to naturalize due to better access to social resources and economic opportunities (Lee et al, 2001).

Income
Hmong Americans are reported to make a median household income of $32,076 annually come pared to the national average at $41,994. Family income for Hmong Americans was $32,384 while the general population reported $50,046  annually. Hmong American per capita income was $6,600 compared to the U.S population who received $21,587.

Hmong American individuals and families do receive less income than the general population; many of them are impoverished and have financial hardships. According to the U.S Census (2000), 38% of Hmong Americans reported that they lived below the poverty line compared to 12% of the general population. The Hmong American poverty rates vary by state and by population density. The Hmong American communities in the west coast primarily California and Alaska reported that the nearly 50% of them were impoverished compared to Hmong Americans in the south and east coast states who reported 20-30% (U.S Census, 2000).

Furthermore, with the high rates of poverty and an income less than the national average, Hmong Americans have the highest rates of public assistance (U.S Census, 2000). Nationally, 30% of Hmong Americans report that they receive some sort public assistance. Among the states that had the highest amounts of Hmong Americans receiving public assistance were Alaska with 70%, California with 50%, and Rhode Island with 35% (U.S Census, 2000).

Employment Status and Educational Attainment
In the 2000 U.S Census, Hmong Americans that were ages sixteen years or older reported being employed at a 47% rate compared to 36% of Hmong Americans who were not employed. States such as California, Minnesota, Alaska, and Oklahoma reported that Hmong Americans were 50% underemployed while states such as Rhode Island, Washington, and Georgia reported only 1/3 of the Hmong American population being employed. Hmong American females over the age of sixteen reported being 54% employed while Hmong American males were 41% employed. Hmong American unemployment rates were approximately 10% for both genders.

Industries that Hmong Americans were employed in various industries and occupations, the most common industry that was most employed by Hmong Americans were manufacturing at 43% percent: arts and the entertainment were the next highest at 11% (U.S Census, 2000). Third highest were in industries such as retail trade, education, and health and human services at 9% in each industry prospectively (U.S Census, 2000).

Educational attainments among Hmong Americans have smallest percentages compared to the general population. Hmong Americans who were high school graduates reported at 27.2% while Hmong American Associate or Bachelor‘s degree holders were reported at a 11.7%. Masters Degree holders reported being at a 1.5% of those reporting. The increase educational attainment among Hmong Americans has grown since the 1990 census. Moreover, the increase in Hmong American education attainment is key to their success in thriving as an Asian American sub-ethnic group (U.S Census, 2000).

III. Literature Review
Health Status
According to the Rairdan & Higgs (1992), Hee Yun & Vang (2010), and Cobb (2010) say that the Hmong are most susceptible to having respiratory illnesses, some cancers, diabetes, and heart disease. The health status of Hmong Americans usually varies by the places they reside and the exposures they are most at risk of. For instance, air pollution in urban and rural living environment that has a high amount of particulate matter that is being exposed to Hmong Americans.

One of the common health ailments that most Hmong are exposed to are respiratory illnesses. Since a large majority of Hmong American communities inhabit California‘s Central Valley, their exposure to particulate matter is high which results in a high risk to developing asthma, restrictive lung disease, and other respirator tract infections (Senate Health & Human Services, 2004). The exposures that cause these respiratory illnesses are particulate matter from exhaust from farming equipment, semi-trailers trucks, automobiles, and diesel operated machinery (Yang & Mills 2008, Rairdan & Higgs 1992). Some of these producers of particulate matter are placed near or in low-income neighborhoods where Hmong American and other ethnic minorities reside. These environmental exposures cause environmental threat to their health and wellbeing, which keeps the Hmong American community in the Central Valley vulnerable to these respiratory illnesses.

Another common health risk in the Hmong American community is susceptibility to cancers, digestive diseases, and heart disease (An fu et al, 2006). The Hmong have the highest rates of diabetes (e.g. type one and type two) and also have a risk to nasopharyngeal, liver, stomach, and cervical cancers (An-Fu et al, 2006). The catalyst for cancers can be attributed to their diet and how their foods are prepared. Some foods that are a part of the Hmong American diet consist of the use of triglycerides, fatty oils, and the high amounts of sodium. Nutrition among the Hmong is also unbalanced with substitution and the lack of customary ingredients for in preparing the food (Yang & Mills, 2008). These are among the highest rates of cancer and digestive rates compared to other Asian American sub-groups, Hispanic, and non-Hispanic groups (An-Fu et al 2006, Helsel et al 2005).

Socioeconomics
Hmong Americans are one of the least wealthy sub-Asian American groups because of lack to a sufficient and well-rounded public education system, inability to attain better jobs and sufficient income. According to Sakamoto & Woo (2007) Hmong Americans were listed among the lowest in literacy level and academic achievement standards in grades seven through twelve. Furthermore, Lee (2001) reports that the causes of low levels in academic achievement are due to the lack of literacy in the English Language acquisition and comprehension in the early childhood. Their inability to comprehend the subject material lead many Hmong refugee children to later become uninterested in their education and this makes them less able to attain literacy and comprehension skills later on in their adult life (McNail et al 1994, Sakamoto & Woo 2007, Lee 2001). Also, the high school drop out rate for many Hmong Americans is high this is due to the discouragement by their peers and adults, as well as the lack of interest to pursue a college degree and the support they receive from their family, friends, or their academic or social environment (Lee & Madyn 2008).

Furthermore, the lack of a sufficient education among Hmong Americans disproportionately disadvantages them from attaining descent jobs and income. According to Lo, Pao -Chin Lu, Lee (1995, 2001, 2005) Hmong Americans are listed in low paying and entry level jobs that make below the national income level. Hein, Sakamoto, and Woo (2000 , 2007) also mention that many Hmong Americans face adversity within the workplace because of their lack of skills and experience. Sakamoto and Woo (2005) also add that many of Hmong Americans find difficulty in job performance and decision making skills, which therefore disadvantages them from attaining management and other administrative job positions. Moreover the studies by Pao-Chin Lu and the Asian Pacific Islander Legislative Caucus (1995, 2004) cite that the lack of sufficient wages and employee benefits contributes to their professional and economic disparities. With the lack of sufficient wages and mounting financial pressures many Hmong Americans find it hard to find the funding to pay for their living expenses. Many Hmong Americans rely on government assistance and welfare programs to get by (i.e.: Medicare, Temporary Assistance for Needy Families) (Asian Pacific Islander Legislative Caucus, 2004).

Barriers to Healthcare and Health Resources
An integral part of Hmong American livelihood and wellbeing is their access to healthcare and cultural health resources. Hmong Americans believe that optimal health and wellbeing is connected to the wellness of mind, body, and soul (Helsel et al, 2004, 2005). The maintenance and balance of these three internal entities are what keeps Hmong Americans balanced in their health and spiritual life. According Helsel et al (2004), shamans are a combination of priests and doctors, who help use faith and holistic and alternative medicine as a part of the healing and health process. In another study by Capps (1994) said that Hmong Americans beliefs of the interconnectedness with the body and the spirit is a means of physical and spiritual wholeness, the use of western and allopathic medicine is obsolete and sometimes unorthodox according to their traditional ways of healing (Rairdan & Higgs 1992). Also, western and allopathic medicine to Hmong Americans is considered expensive and unsympathetic to cultural healing because of the lack of spirituality in the treatment process (Cobb, 2010). Due to the increasing rates of illness and disease and the lack of adequate health insurance coverage, health inequalities and disparities between the Hmong Americans and the rest of the American population is becoming more apparent and severe.

According to Moore & Stricker (2010), Hmong Americans are more likely to be on Medicare or on some sort of state health insurance coverage that is known to not cover many of the medical procedures, treatments, and tests that one may need to be diagnosed properly. Furthermore, Author Capps (1994) cites that medical drugs and doctor visits are perceived to be expensive because of the high co-pays, where the decline of their health continues until a serious illness or injury occurs and is either ineffective or incurable to treat. The lack of health insurance coverage and health education among Hmong American community is becoming an epidemic due to the vast issues with attaining descent healthcare. Furthermore, the rates of illnesses, disease, and injury surpass the average rates of the American population as a whole (Moore & Stricker, 2010).

IV. Research Findings
Disparities
Hmong American disparities in the communities where they live in are a testament to the poor treatment and their inability to access resources. Such examples are: better housing, food and nutrition, and adequate access to healthcare and health resources.

The access to better housing is important for any Hmong American family or individual to thrive and to grow. In a study by Pao Chin, Capps, Stricker & Moore (1994, 1995, 2010) claim that most Hmong American individuals and families live in some of the most impoverished communities and neighborhoods. These impoverished areas do not include grocery stores or supermarkets, physical activity or recreation centers, hospitals nor health clinics. However, these areas have liquor stores, have high rates of crime and violence, and have exposures to harmful environmental pollution or poisonous or particulate matter.

Compared to other Asian American sub-groups, Hmong Americans do not have same access or ―privilege‖ to certain vital resources as Citizens or Permanent Residents do. Studies by Pao Chin, Capps, and Stricker & Mooore (1994, 1995, 2010) contend that out of the four Asian ethnic groups that entered the United States as refugees or political asylumeés, the Hmong do not have access to these resources, rights, liberties, and rights as American citizens or permanent residents therefore making them unable to attain a decent means to livelihood.

Social Inequalities
Despite that Hmong Americans have the ability to become naturalized as American Citizens, their ability to socially and economically develop themselves as been limited because of their status as refugees and the implications that it has had on their ability to attain social resources and public assistance. One aspect the treatment as refugees and the political perception of compassion fatigue against refugees and asylumés. Because of the turbulent political history with the United States and South East Asia over the last fifty years, South East Asian Americans have always been sought out as communist sympathizers, and unable to adapt, and assimilate to American culture. The perception has leaders in government and in local communities to create public policies that only benefit American Citizens and those who are here legally. For example, according to Hien and Lo (2000)(2009) Hmong Americans are not able to seek out better housing or living conditions because of their lack of access to higher income and jobs. So they reside in the communities and neighborhoods that deprive them of the access to healthier food choices, better schools, and areas of physical activity and recreation. Also, since Hmong Americans attend public schools in deprived neighborhoods, which are known not to encourage and provide adequate education, compared to other schools in more affluent neighborhoods. Being categorized as such and not able to attain resources because of their refugee status limits them to being treated that way. This discrimination and prejudice deprives them attaining the same social resources and opportunities as the rest of the population and therefore harms their prosperity and livelihood.

Health Implications
Due to the social inequalities and disparities that Hmong Americans are faced with, impacts to their health also affect them as well. As mentioned previously in this research paper, Hmong Americans have the highest rates of diabetes (e.g. type one and type two) and also have a risk to nasopharyngeal, liver, stomach, and cervical cancers. The exposure to harmful and poisonous materials, the lack of access to healthy and nutritious foods, and the lack of access to better schools, and physical activity/recreational areas create barriers for Hmong American communities which results them to living shorter lives.
Assessing the needs in Hmong American Communities, offering interventions and some long term and short term solutions would improve the health of the Hmong American community and change the cycle of health disparities and social inequities.

V. Methods and Data
Interviews
In collecting observational, statistical, and logistical information on Hmong Americans, finding qualitative date to support my research came in the form of interviews by two first generation Hmong Americans. Two of these interview subjects do not reflect the views and responses of the entire Hmong American community, however the qualitative data confirm the socioeconomic patters and achievement gap patterns that are observable in Hmong American Communities. First, a female twenty five years-old, mother and wife, an after school teacher came with her fourteen brothers and sisters in 1991 and lived in public housing during the early years in the her U.S. experience in the education system as trusted her into finishing with a Bachelors of Arts in Liberal Studies at San Francisco State University.

Second, a male twenty-two year-old, Asian American graduate student at San Francisco State discusses his arrival and immigration experiences in 1995 with his six siblings and his parents. The Hmong Male struggles in attaining higher education have resulted in him being a graduate student. He also accounts his personal story and shares into a larger narrative of Hmong Americans defying the odds with regard to the socioeconomic challenges and community issues that still are current today.

The following questions were posed to the two subjects to understand the context of which Hmong Americans are living and the personal accounts of their childhood experiences in relationship to early immigration and attaining resources.

1. Did you and your family come to the United States as refugees or political asylum seekers? If so, explain in brief about your experiences of arriving and assimilating/settling in America.

2. Have you or your family depended on public assistance programs or government welfare or Medicaid? If so, explain about your experiences with participating in those programs.

3. How were your experiences in school? Has it helped you achieve your professional goals? Where there any difficulties or hardships that you had to endure or experience?

4. Discuss your childhood experiences and the environment you were in. Where did you live? What was it like? Also, explain any events, situations, or circumstances of hardships and or difficulty.

5. How do you feel about the state of Hmomg Americans today? Have they risen above and beyond economically and professionally? Please discuss in brief.

6. What issues within the Hmong American community would like addressed? Please pick three issues and explain why.

In the Hmong Female‘s response discusses her story of plight to the U.S in 1991 with her fourteen brothers and sisters and her parents. Also, the living conditions that they were placed in as a result of their refugee status.

My family and I came to the USA of June 1991 when I was 5 years old. We came because my family and I were refugees. We started off living in a one- bedroom apartment with 9 people and worked our way to a five bedrooms house with 17 people (2010). (sic)

I grew up in Fresno CA. in an area near downtown and it was an area that had many low-income people. The neighborhood had many apartments and many of us were either Hmong or Hispanics. We lived in a 2 bedroom apartment and one bathroom with seventeen people. Space was a problem and I had to share everything with my family, which I did not enjoy much growing up. (sic)

The living conditions and the housing accommodations that she has experienced is a common issue of health and wellbeing since most Hmong families are usually large in number. The government and housing authorities did not provide adequate housing resources because of the large amounts of Hmong families who needed housing. During the financial crisis of the 1980s, the funding for public housing was limited. So the federal government in cohort with regional entities found it plausible to seek less than ideal housing for Hmong refugees. The conditions that she experienced are very similar to other first generation Hmong American who have gone through poverty and hardship and not being able to enjoy the same freedoms and privileges as others do in immigrating to this country. The Hmong Female‘s experiences with her family have enlightened her understanding of being Hmong American in relation to her family‘s circumstances.

She further went along to discuss her family‘s reliance of government aide and welfare but expressed frustration and anger with the government and the resources that they were given because of the lack of cultural understanding and translation services for them.

We depend on the government aid and still do. It is hard to communicate with the social worker who are suppose to help and provide you with assistant but instead demand for paper works to be fill and turn in. They want to know all the changes that go on in the household from financial status to how many ids there are to people that works and how much they make, etc. (sic) The Hmong Female‘s experience with the government‘s inclusionary efforts to assimilate the Hmong into American culture and ways proved to be a difficult situation since none of them were able to communicate with social workers and other resource providers. The lack of compassion and sympathy to their cultural proved to be detrimental to their livelihood and thus creating a gap in the way they attain resources for their benefit.

In analyzing the current state of Hmong Americans in educational and professional achievements, she responded that they “have come a long way and accomplished a lot.” Contextualizing her own experienced she ended her response as, “Just like any other immigrants into this country, you start off poor and had nothing and work your way up the ladder.”

Likewise in the same respects, she expressed concerned over the issues within the Hmong American community. Gang activity, community division, and closing the education gap were some of the important issues that were preventing the community from unifying.

In her response about community division, she noted that “I have never sense positivity and teamwork” lacking these kinds of behaviors and attitudes divide the Hmong American community and prevent them from addressing the problems in the community. Because of her disbelief in the community, “this pushed (her) to find others to associate with in other ethnic groups.”

Another issue that was mentioned was the rise of Hmong gangs and gang activity in the community. The Hmong Female believes that gangs and gang activity are counter productive and obstructive. “I truly dislike and wish that they would just leave innocence people alone. They always ruined all the social and gathering events that we have for the community.” The presence of gangs in Hmong American communities are result of the impoverished conditions that they were living in and the lack of strong social organization and the lack of resources or support.

Lastly, she emphasized the point on Hmong American educational attainment. The Hmong Female clearly put the subject, as “education is still a struggle for many Hmong families.” Most of the first generation parents are uneducated and cannot help their own children with education or communicating with their teachers”. She feels that providing educational resources and opportunities for Hmong American would better the livelihood and economic status individuals and families.

Similarly, The Hmong Male has had the same experiences that The Hmong Female had but in a different town in the same regional area; Stockton. The Hmong Male and his family arrived in the U.S in 1995 with his six siblings and parents. His upbringing was very traditional and valuistic, he mentions that he and his family had to “participate in ceremony rituals throughout because of the enclave community of the Hmong in Stockton; they were able to hold onto their culture”. However, he mentions that culture can have implications that can harm Hmong Americans academically and linguistically. “This enclave could be a reason to explain the low literacy rate as the children are growing up with their native tongues, attending underfunded schools, practicing their traditional cultures, etc…. may be a limitation to their educational achievements.”

He went on to discuss his family‘s receivership of government aid and welfare during the early years in the United States. “Without public assistance, our family would not have survived during the early years, given the fact that my father brought home $1,200 a month and my mother‘s SSI $700.” He also went on to say that there were limitations and restrictions along with receiving government aid, “you have to report these monthly incomes every month. If for some reasons, you make more than their required amount; your resources would be deducted accordingly. If for some reasons you have a saving account… let say above ($2000), they would use that again you as well.” The restrictions and limitations on family income made it impossible to support the members in a household or a family. “The problem with this is that when you save a little too much, they go about deducting your resources…I see these tactics as not supporting, but perpetuating someone to stay in their place –socioeconomically”. When questioned about the state of Hmong Americans, The Hmong Male felt that the Hmong American community still need to live up to its full potential and to develop themselves.

They are still at the bottom of the social class in America; education, poverty, income rates, and so forth. Obstacles and challenges, such as culture conflicts, structural and political barriers, racism and discrimination issues are still a real threat. One important solution to this is to have Hmong Americans work in political positions so that they could make the necessary changes. (sic)

The Hmong Male believes that the lack of these resources and opportunities in combination with the barriers that are pitted against Hmong Americans keep them from training the same successes and achievements as any other Asian American or ethnic minorities in the United States.

Related to the disparity, He has lived a life that was full of hardship especially going through the education system and his rough childhood in an undeserved neighborhood. He states that there were underfunded schools and overcrowding of classrooms. This contributed to the lack of care and support by his learning community. “Because of the language, educational, and cultural barriers from my parents, they could not help out academically. Thus, I look to teachers and professors as models and guidance.” His experiences have pushed him harder to become more intuitive and progressive about his academics.

Furthermore, The Hmong Male discussed his living environment and how it was unsafe because of the gang activity that went on. Much like how the Hmong Female assessed about gangs in her responses, He went on to say that “Gangs issues arise up all the time, and you hear gun shots frequently…sometimes it gets to the point where you feel that it is the norm.”

Lastly, when discussing issues that were prevalent in Hmong American communities the Hmong Male responded that cultural continuity and preservation, social assistance and outreach programs for Hmong Americans and closing of the achievement gap among Hmong Americans is necessary for the community‘s sustainability and growth in the future. Having these resources allow Hmong Americans to improve their livelihood and wellbeing. He believes that having a strong social foundation is key to developing programs and services that can improve the quality of lives for Hmong Americans.

Both Hmong Male and Female have lived through difficult situations in immigrating and becoming a part of the American landscape. Personal accounts of their upbringing and insight into community‘s issues are current with peer reviewed journal articles and published reports documenting inequalities and disparities that are present among individuals and families. Furthermore, their drive to improve themselves through education is vital to uplifting their communities and to instill hope to up and coming Hmong American students who are struggling to defy the odds.

VI. Analysis & Conclusion
The importance of examining the social disparities and health inequities among Hmong American communities it to show the extreme disadvantages and struggles that they face in attaining social resources and healthcare. Without access to theses opportunities and resources their ability to thrive and sustain wellbeing is thwarted. As a society that supposed to provide fair access of these resources, we must remember that we all are entitled as citizens. However, because of the barriers and the struggles that Hmong Americans violates their equal protections and civil liberties in becoming healthy and socially mobile.

Research Assessment & Factors of Inequality and Disparity
Contextualizing and understanding the Hmong American experience in assessing their part in American history and the current livelihood and wellbeing, Hmong American individuals are victims to the health disparities and social inequities that are caused by their living environment, health and living conditions, and the lack of social mobility.

Inequality among Hmong American is founded on the perception of Hmong Americans as inferior and unable to adapt to mainstream American society because of their “refugee” mentality. As previously stated earlier in this research paper, Hmong refugees were a result of the communist rule and retribution by Pathet Lao. The masses of displaced Hmong within Laos fled to neighboring Thailand before ultimately immigrating to the United States. Hmong

American refugee status has negatively impacted them because of their inability to attain the same constitutional access and civil liberties as American citizens due. For example, the institutionalized biases and prejudice that is embedded into our laws and public policy prevent the Hmong from attaining descent jobs and livable wages, the lack of language support for limited English learners, and inability to attain cultural competent and comprehensive medical care.

Refugees and other groups who do not have a permanent legal status in the United States are often placed in categories and conditions that prevent them from attaining the same resources as citizens do. Recalling the section on socioeconomic status and educational attainment among Hmong Americans, the route cause of their inability to attain higher amounts of education is the lack of support of English language skill building and the encouragement of their learning community. Also, establishing a need for English proficiency programs among Hmong American communities further reinforce skills and comprehension. Likewise, improving the educational level of Hmong Americans would give them a fair and equitable advantage to compete in the academic and employment opportunities for further personal and collective growth.

Limited opportunities and access to better health and financial growth for refugees deprives them from the ability to grow economically to attain livable means and optimal health and wellness. Most Hmong Americans are employed in entry level employment positions that often times does not include medical benefits or wage increases – namely retail/service sector jobs. The inability to attain better and higher wage jobs keeps Hmong Americans suppressed from becoming socially mobile and keeps them subjects them to wealth inequity. The suppression places barriers and limits to what and what they cannot achieve is a direct violation of their civil rights and personal freedoms.

Furthermore, these disparities that set forth by policies and laws affirmed by the discriminating attitudes and behaviors furthers the gap between ethnic minorities and social classes creates inequalities and tensions between groups. The circumstances of their plight to the United States and their living conditions and experiences in America are not the faults of the Hmong American community but by the larger lawmaking and policy enforcing bodies that keep them subordinate and underprivileged in society. By exposing these conditions of inequality and disparity within the Hmong American community, leaders and allies can assess the needs of community and provide short term and long term solutions to building Hmong American individuals and families.

Conclusion
Recommendations
The presence of banks, credit unions, supermarkets, and grocery stores in Hmong-populated areas. Furthermore, the removal of liquor stores and payday loan offices within those communities.

The building of physical activity/recreation center as well as cultural centers.

Interest based and culture based workshops, training classes, and community events.

Health clinics and medical facilities with risk prevention and health education programs.

Medical/Health insurance cooperatives among local and regional public/private health agencies.

Youth and young adult programs that cater to their grown and development interpersonally and intrapersonally.

The development of policies and ordinances that prevent pollution and particulate matter from entering low-income minority neighborhoods – most especially Hmong American communities.

Design infrastructure strategies and revise building codes that reduce the amount of community violence and exposures to pollution and atmospheric and particulate matter.

Future Study
In undertaking this study, there were many challenges and obstacles that I personally endured in attaining information about the Hmong. The task of writing about them and their living and social conditions was done in a manner that is respectful, inquisitive, and hopeful.

Because of time constraints and the limited availability of resources, I was not able to collect a larger sample size of Hmong American study subjects. Also, the collection of current census date on Hmong Americans was unavailable. The current data on Hmong Americans would have included current and up-to-date status on income, educational, attainment, employment, family, and household information. Furthermore, the data would have provided additional information on the social pattern of Hmong Americans and their growth and development since the last census was taken.

As Hmong Americans enter into the twenty-first century, economic development and social mobility has yet to be seen. As policies, entitlement programs, and service providers change, the need for community interventions and solutions has become more apparent. As the Hmong Americans begin to establish themselves and become more visible as sub-ethnic Asian American group, the importance reporting on their growth and wellbeing is vital to understanding their mobility as a whole. Research and study into the changes of community dynamics and health would be inclusive to the prior studies done in understanding Hmong American health needs and social inequities.

 

Work Cited
Lee, S., PhD et al. (2000). HMONG 2000 CENSUS PUBLICATION: DATA & ANALYSIS. Hmong National Development Inc. (HND) & Hmong Cultural and Resource Center, 1, 1-75.

U.S Census 2000. Hmong Americans Statistics & Data.

Senate Health & Human Services Committee, Asian Pacific Islander Legislative Caucus. (2004). Hmong refugee resettlement in california : joint informational hearing / commission on asian & pacific islander affairs. Sacramento, Ca: Senate Publications.

Cobb, T. (2010). Strategies for Providing Cultural Competent Health Care for Hmong Americans. Journal of Cultural Diversity, 17(3), 79-83.

Hee Yun, L., & Vang, S. (2010). Barriers to Cancer Screening in Hmong Americans: The Influence of Health Care Accessibility, Culture, and Cancer Literacy. Journal of Community Health, 35(3), 302-314.

Sakamoto, A., & Woo, H. (2007). The Socioeconomic Attainments of Second-Generation Cambodian, Hmong, Laotian, and Vietnamese Americans. Sociological Inquiry,
77(1), 44-75.

Helsel, D., Mochel, M., & Bauer, R. (2005). Chronic Illness and Hmong Shamans. Journal of Transcultural Nursing, 16(2), 150-154.
Helsel, D., Mochel, M., & Bauer, R. (2004). Shamans in a Hmong American Community. Journal of Alternative
& Complementary Medicine, 10(6), 933-938.

Lee, S. (2001). More than ‘Model Minorities’ or ‘Deliquents’: A Look at Hmong American
High School Students. Harvard Educational Review, 71(3), 505.

Vang, T., & Flores, J. (1999). The Hmong Americans: Identity, Conflict, and Opportunity. Multicultural Perspectives, 1(4), 9.

Rairdan, B., & Higgs, Z. (1992). When your patient is a Hmong refugee. American Journal of Nursing, 92(3), 52. Richard C. Yang & Paul K. Mills. (2008). Dietary and Lifestyle Practices of Hmong in California.Journal of Health Care for the Poor and Underserved 19(4), 1258-1269.

Lo, Bao. (2009). Between Two Worlds: Hmong Youth, Culture, and Socio-Structural Barriers to Integration. UC Berkeley: Institute for the Study of Social Change.

Moore, D., Stricker, K. La Crosse County Health Department, (2010). Health impact assessment report: reducing health disparities in the hmong population of la crosse county La Crosse, WI: La Crosse County Health Department.

Park, C. C. (2006). Learning in America: The Hmong American Experience. In C. C. Park, R. Endo, & A. L. Goodwin (Eds.). Asian and Pacific American education: learning, socialization, and identity (4-16). Greenwich, CT: Information Age Publishing.

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