Polina Mikhelzon

Professor Ida Susser

MHC 160-906

Health Care Issues and Resolutions in Chinatown

Arriving as immigrants to a foreign, well-established metropolis such as New York

City is never simple. The Asian population of Chinatown in New York knows first-hand about

the common challenges, the cultural and language barriers, which immigrants face in a new

environment. Aside from making it difficult to adapt to life in Chinatown, these barriers have

also negatively affected the physical and psychological health of Asian Americans. Their close

ties to their traditions and the lack of health and safety regulations at their workplace have taken

a toll on the wellbeing of this Asian American community. Fortunately, primary health care

services and research developments have been made to address the health concerns that have

plagued the inhabitants of Chinatown, New York.

Chinese traditional medicine has been a dominant medical remedy to common health

issues of Asian Americans in Chinatown, keeping them from considering modern approaches. As

evidence for this today, I noticed many more herbal shops selling piles of ginger roots and a huge

assortment of teas than health clinics or hospitals as I walked through Chinatown with the class

during out Chinatown walkabout. Aside from my personal experience, several studies have been

made to determine the role of Chinese medicine in the health care of New York’s Chinese

population. One popular study was conducted by C.W. Chan and J. K. Chang in 1976 on the

Chinese population of New York City to evaluate this role. They performed a survey, which

demonstrated that 83 percent of those surveyed had visited only Western physician, while the

remaining 17 percent had visited traditional practitioners in the 2 years previous to the study.
Furthermore, these researchers also discovered that Chinese medicine was much more frequently

used as a type of home treatment than they had predicted: about 93 percent of those surveyed had

used Chinese drugs as home remedies, while the residual 7 percent were not associated with

Chinese drugs. (Xueqin Ma 45).

Another study, made my Zibin Guo in 1994 about elderly Chinese and Asian Indians in

Flushing, New York yielded similar results. Guo discovered many reasons why the Chinese

elderly tended to avoid Western health care, such as high costs, language barriers, long waits in

hospitals, loads of paper work, and the requirement of making an appointment several weeks in

advance. They also assumed that Western-trained doctors are less experienced than doctors in

China, because they greatly rely on technologic diagnosis rather than patient experience (Guo

151). As for Chinatown residents, it has been generally difficult for them to acclimatize to a new

diet in hospitals or to visit health centers located outside of their home in Chinatown.

Additionally, oriental medicine represents and encourages emotional strength, and physical

sickness is considered a sign of moral weakness, so the Chinese could not acknowledge its

existence (Zinzius 111).

Guo noted the difference between two Asian populations that dominate Flushing: the

Taiwanese and the Chinese. The Taiwanese elderly have been in North America longer and

come from a capitalist society that accepted Western-style medicine and health insurance. The

Chinese, on the other hand, are from a communist society with no private health care and did not

arrive to America with a lot of money to make investments. As a result, they opt to use either

Chinese herbal medicine or Chinese-made Western medication, which do not require

prescriptions or health insurance, but simply a mail order for a package from relatives and

friends in China (Guo 152).

 Although the Asian population of both Flushing and Chinatown arrived with hostility and

reservations about foreign, Western medical practices, they have developed certain principles in

deciding how to deal with specific health problems and what health care methods to take

advantage of. The Chinese population of Flushing usually divides their health issues into two

categories: “big” or “small” problems. If they encounter a big, serious ailment or an acute illness,

most Chinese elderly will rely on powerful Western medicine. However, if the health concern is

minor or the illness is chronic, they will simply use herbal home remedies (Guo 155). The Asian

population of Chinatown is also more aware of its choices. Chinatown residents see a

professional doctor, rather than an acupuncture specialist. Nevertheless, they typically request

practitioners who are Chinese (Zinzius 111).

Various cultural and language barriers make up the origins of the dangerous health

problems that surround Asian Americans in Chinatown. Upon arriving as immigrants to New

York in the early 1900s, the Asian population formed many ethnic enclaves, which contain both

positive and negative aspects. On the one side, working in clothing and restaurant sweatshops

provided Asian American workers with employment opportunities, without the need to learn

sufficient English or have documents of immigration. On the other hand, the working conditions

were horrendous: working long hours and receiving below minimum wage, lack of labor laws,

tiny employment security, and poor light, health and safety that see no regulation (Lin 4). Louis

Joseph Beck wrote about the kitchen conditions in restaurants in Chinatown during the late

1800s: “A hen coop will be found adjacent to every restaurant kitchen, amply supplied with live

chickens, ducks and pigeons, ready for slaughter and cooking as required. The regulations of the

Board of Health in this regard do not seem to bother the Chinaman at all. The must have live

birds or none at all; this is the Chinaman’s idea of fitness for eating” (Beck 52). Government
investigations later led to the Factory Laws of 1912, which ensured safety and health standards

and set regulations on the length of the workweek (Lin 62).

Nowadays, street traders and vendors are a key feature of Chinatown’s community. These

jobs provide an easy access into the job market for new immigrants and have very few skill

requirements. Moreover, relatively little starting money is necessary to purchase the goods and a

table to display them. These vendors must register with the New York City Department of

Consumer Affairs and those selling the products must be licensed with the New York City

Health Department. However, many Chinatown vendors operate without licenses, which is why

public street vendors are viewed as a sanitary and public health hazard that must be efficiently

regulated (Lin 76). Socially, however, not much has changed in Chinatown; their residents still

face “linguistic isolation, low-wage employment, gentrification, inadequate healthcare, and lack

of housing” (Zinzius 108).

To further investigate the current health issues in Chinatown, I interviewed John Chin, a

professor in Urban Affair and Planning at Hunter College. As someone who has studied Asian

immigrant religious institutions and their potential role in HIV prevention for Asian immigrant

communities, Professor Chin knew about the current status of HIV in Chinatown, whose

existence in Asian Americans was generally low, he said, but it was, nonetheless, slowly

spreading and growing in the Asian population of Chinatown. He also mentioned some other

common health problems existing in Chinatown: hepatitis, tuberculosis, and diabetes. The

diabetes, he said, is ironically found at a low BMI (body mass index) in Asians, an uncommon

occurrence. When asked how Asian Americans in Chinatown solve their health problems,

Professor Chin said that most of them actually opt for help from professional doctors as opposed

to from herbal remedies, especially when they encounter more extreme forms of sickness, such
as HIV or heart problems, because they believe this advanced help will yield a quicker recovery.

He noted that the majority of the Asian population in Chinatown does not have health insurance,

with the exception of unionized garment workers (UNITE), whose jobs in factories pay for their

health insurance. Those who do not have health insurance simply visit a doctor for $20 or $25 a

visit for a shot or a prescription, which is cheaper than separately paying for health insurance.

Evidently, the medical help available to current Chinatown’s residents is very scarce, forcing

them to make the best of what they have.

Aside from physical health issues, living in Chinatown has created psychological side

effects for its inhabitants. In the early 1970s, the circumstances in the workplace eroded the

psychological health of Chinese Americans living in Chinatown; factory women stayed late at

work and restaurant waiters worked overnight, resulting in very little time spent at home with

family. This, in turn, significantly increased the “psychic pressure” on the Chinese worker.

During this time, “any Chinatown doctor will tell you that mental health is the neighborhood’s

number one medical problem” (Chernow 44).

Stanley Sue conducted a study in 1980 about the mental health care experiences and

service use of Asian American in the United States. He concluded that Asian Americans

underutilized the mental health services that they were provided with in nearby clinics, because

of the limited available resources they had and the cultural values of shame that were attached to

visiting Western doctors (Xueqin Ma 53).

To battle the ongoing health problems of the unchangeable working conditions of

Chinatown workers, several activist groups took matters into their own hands to help improve

lives in such demanding times. An organization called The Health Revolutionary Unity

Movement led street protests advocating better health programs for Chinatown residents, who
had among the highest rates of tuberculosis in the city. Nearby Gouverneur Hospital had only

twenty-five Chinese staff members out of eight hundred. Most people realized that language and

culture barriers were what prevented many Chinatown residents from getting the necessary

health care. Chinese medical students and staff joined with Lower East Side health-care activists

to push for the preservation of Gouverneur Hospital after municipal hospital officials began to

encourage its closing. The New York City Health and Hospital Corporation, however, was under

pressure due to a serious municipal fiscal crisis. To protest the closing of the Hospital, Lower

East Side associations staged a mass demonstration on May 7, 1976, and took over the executive

offices of Gouverneur Hospital. Eventually, the movement leaders were taken onto the board of

the hospital (Lin 128).

Another determined and powerful demonstration of activism to gain better health care for

Chinatown residents was seen in the establishment of the Chinatown Health Clinic. After

discovering that the Chinese population of Chinatown living in tenements had “a higher rate of

tuberculosis, hepatitis B, parasitic infections, and hypertension than the general New York

population”, young Asian Americans (mainly local youths, activists, writers, and artists looking

for something to do “in the ghetto that was Chinatown”) gathered in a damp basement of a

Chinatown tenement in the summer of 1971 and organized the first Chinatown Health Fair in

Chinatown of New York City: free health information and screening for conditions such as

tuberculosis, lead poisoning, and anemia (Wei 186). Community activists and “a large group of

community agencies including banks, the Golden Age Club for senior citizens, and the American

Cancer Society” focused on improving the access to health care services and confronted the

absence of a bilingual staff at local hospitals by setting up these health fairs as a way to “bring

the examining room into the community” (Wand 75). After witnessing an immensely positive
community response to the ten-day fair, volunteers worked together to set up “a permanent

program that could meet the community need for affordable and accessible health care services”

(Wei 186). In December 1971, the Chinatown Health Fair Committee opened the Chinatown

Health Clinic, which operated out of a space donated by the Episcopal Church of Our Savior,

located at 48 Henry Street in the Lower East Side, another underserved neighborhood east of

Chinatown. Right away, doctors, nurses, social workers, and students volunteered to offer free

services two evenings each week and on Sunday afternoons. In 1979, the Chinatown Health

Clinic received recognition as a “federally qualified community health center and funding from

the Public Health Service under the Urban Health Initiative Program.” This funding allows it to

charge uninsured patients a fee based on income (Trinh-Shevrin).

Since hypertension and smoking were two common factors of cardiovascular disease in

Chinatown in the 1980s, the clinic received support from the New York State Department of

Health to create and execute a hypertension control program. The clinic conducted worksite

screenings and monthly events for senior citizens. Those who took part in these tests and

revealed abnormal results were referred for follow up at the clinic, and those with evident

hypertension were enrolled in a program which “provided medication subsidies and workshops

in Chinese on the use of these medications,” as well as other treatment that did not involve

medication, such as diet and stress management. The American Cancer Society has also been

highly charitable in its support of Chinatown Health Clinic programs to reduce smoking among

teenagers. Prizes donated by local banks and Chinese language media coverage of a recent no-

smoking poster contest publicized the activity as well as a very important health message. Aside

from the services the Health Clinic provides, however, Chinatown residents have no hope in a

cure for heart disease; a survey at the Chinatown Health Clinic yielded results that showed that
over half of those interviewed felt there is nothing a person can do to prevent heart disease

(Wand 51).

The Chinatown Health Clinic was renamed the Charles B. Wang Community Health

Center (CBWCHC) in 1999, and it continues to increase its services to meet the growing

community demand. It has relocated several times in order to provide a large enough clinical

space capacity that could offer “bilingual and bicultural health care services to the underserved

Asian American community.” A non-profit clinic that is now open seven days a week,

CBWCHC generally serves “low-income, non-English-speaking, and uninsured and

underinsured Asian Americans.” The journey and roots of CBWCHC can be seen as a model for

strong community cooperation toward the development of a vital community health center.

CBWCHC is not simply a health clinic, but a “medical home” that is “patient centered and

provides outreach, education, advocacy, research, and training in addition to core medical

services” (Trinh-Shevrin). When I visited the Charles B. Wang Community Health Center, I

noticed a sign hanging by the receptionist’s desk in the lobby. It was truly representative of the

Health Center’s goals, because it read: “No patient will be denied services based solely on lack

of income.”

Some more modern breakthroughs have been made in the mission to solve the health

issues of Asian American in New York City. For many years now, NYU and its medical

partners, Bellevue Hospital Center and Gouverneur Healthcare Services, have provided direct

care services to a large part of NYC’s Asian American population. They are all located in Lower

Manhattan, within a few miles from each other, and these health care organizations offer a

variety of primary and tertiary care services to Asian American patients. NYU also has an

academic and clinical relationship with the Charles B. Wang Community Health Center.
Additionally, both NYU and its medical partners have continuing relationships with social

service and advocacy agencies serving various Asian American communities in NYC. During

the 1980 and 1990s, Chinese Americans represented a considerable number of the Asian

American patient populations seen at NYU, its medical partners, and the Charles B. Wang

Community Health Center. With changes in immigration trends, specifically the rise in the South

and Southeast Asian immigrant population in the 1990s, Bellevue Hospital Center and hospitals

located in Queens, NY have seen incredible rises in these populations (Trinh-Shevrin).

Academic faculty and community physicians representing each of these four health care

organizations gathered together in spring 2001 to suggest ways to improve their efforts in

tackling health concerns in New York City’s growing Asian American population, which

according to newly released 2010 Census figures, has grown by 32 percent ("Asian American

Federation Census Information Center”). They discussed the need to use their clinical

experiences to develop both “clinical and epidemiological research on this understudied, diverse,

and, often underserved community.” They came up with several research ideas after this

discussion: “investigating the connection between bacterial and viral infections with cancer,

chiefly with hepatitis B and liver cancer and Helicobacter pylori and gastric cancer; the risk

factors for cardiovascular disease, which the physicians and faculty believed vary among

different Asian American ethnic groups; and social and cultural factors of disease that may

contribute due to the large diversity of the Asian American population.” Researchers stated the

complexity of obtaining research grants on Asian American health issues and mentioned the little

data available on Asian Americans. They also said that stereotypes of Asians have been used as

the model minority as issues of concern. Collaboratively, the group sought to develop several
outreach plans in the Asian American community and strives for the same thing today (Trinh-

Shevrin).

In 2003, the National Center on Minority Health and Health Disparities (NCMHD)

awarded NYU a four-year Project EXPORT (Excellence in Partnerships, Outreach, Research,

and Training) grant, making official the efforts of the four health care organizations to create the

basis for the NYU Center for the Study of Asian American Health. This funding was highly

important in allowing faculty investigators and community partners to devote time and resources

to research on Asian American health issues. The Center for the Study of Asian American Health

also expanded outreach activities to aid “the performance of ethnic-specific community health

needs evaluations, capacity-building activities for the existing partners, hosting national and

local conferences on Asian American health issues, and partnership development with other

community partners.” The EXPORT grant also brought to light the issue of Asian American

health concerns as a national priority. The funding from the National Institutes of Health allowed

others to see the significance of Asian American health issues (Trinh-Shevrin).

As an area that has been plagued by social problems, including poor housing, poverty,

and high rates of disease and mental health problems, Chinatown has had immense trouble

dealing with its health issues. These struggles are mainly due to the inner battle of its inhabitants

in choosing between Western health care and traditional medicine. Nevertheless, the population

of Chinatown has seen some noteworthy transformations in the battle against the health problems

existing in its underserved Asian community, such as the Charles B. Wang Community Health

Center and its affiliation with other medical establishments. This progress has played a vital role

in reducing health disparities experienced by the Asian American population. It gives hope that

Chinatown will witness an even larger increase in the number of health providers, community-
based research, and health care that is culturally sensitive and relevant to the Asian community it

serves, with people from more than twenty countries and speaking thirty languages and dialects.
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Chernow, Ron. "Chinatown, Their Chinatown: The Truth Behind the Façade." New York

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