|
Health care issues are one of the most concerning
issues among the various social and economic issues
the world is facing today. There was a time when
health care was not provided in a modern and organized
form. Nonetheless, with the passage of time, not
only the health problems increased but also the
health care services developed and are provided
under various private as well as local organizations.
However, health issues vary from one country to
another due to their specific geographical setup
and environment. At the same time, immigration
extensively transfers various health issues from
one country to another, from one culture to another
due to the social interaction of people living
in the society as well as other personal and physical
contacts. For instance, many sexually transmitted
diseases are transferred from one place to another
with the migration of such patients and their
physical interaction to other people living in
the society. Moreover, there are many cultures
and societies where the ratio of specific diseases
and health issues are at a higher percentage then
other societies. For instance, the health issues
of teenage pregnancies, which includes parenting
issues, health of the baby as well as mother or
other related issues at a higher risk in America
then any other country. Similarly, in Japan among
the various health issues the percentage of diabetic
patients is higher then any other country. Where
many factors are jointly the causes for the high
risk of diabetes among the Japanese-Americans,
which specifically include the immigration influx
of Japanese to America during the 1800-1900 as
well as the religious and cultural differences
between both these nations as both inherit separate
cultures of health problems.
However, the Japanese started migrating to America
in search of a better and prosperous life. They
were influenced by the freedom of expression and
liberal and independent life style at America.
Basically many Japanese realized this with the
rapid urbanization and industrialization after
the period of Meiji Restoration in the mid of
1800. This rapid change of industrialization resulted
into immense social disruption with massive decline
in agricultural sector. (Japanese Immigration:
Introduction, accessed on 09-23-04.) Therefore
not only the farmers were forced to leave their
lands but also the labors and workers were expelled
out from their respective jobs. So foreign competition
and the search of a better life style motivated
them to migrate towards the economically as well
as politically and socially strong America. Therefore,
Japanese started immigrating to America from the
late 19th C to the early 20th C, which includes
3 complete generations. These are the Issei who
belong to the roots who were basically born in
Japan but migrated to USA and then settled there
forever. Where the second generation is known
as Nisei who were born in America and become American
nationals by birth. (Marriane, K. G. and Tanabe,
M.D. 2000.) Sansei and Kibbei are the latest generation
rooted to the Japanese culture living in America.
These are basically the actual Japanese Americans.
Though they are born in America but posses the
inherited cultural roots to Japan and earn their
higher education from Japan and then return back
to America for strengthening their career life.
(Fujimoto et al., 1987)
Japanese Health Issues and Life Style
Japanese basically are not much emotionally expressive
by nature therefore, they do not express about
their illness and have generally tolerate and
posses self-indulgence. (Caudill, 1976). Usually
the Japanese are not much inclined towards the
basic health care treatment, at the same time
they do not realize to bring any constructive
changes in their orthopedic and dental care as
present in the American society. However, in America
health care is taken more seriously so the immigrant
families fully enjoy the health care services
in America. Therefore the Japanese Americans benefit
a lot from the health care services provided to
them as compared to the Japanese living in Japan.
This is due to the difference in the cultural
background and the religious beliefs as Japanese
originally focus more on its religious philosophies
and traditional culture for providing health care.
However, due to the different life style and
impact of the dominant traditional religious culture
in Japan, many diseases and health issues are
in direct relation to the very life style in Japan.
For instance, health issues associated to stomach
cancer, hypertension, diabetes and other stress
related illness is due to the malnutrition, imbalanced
lifestyle and unhealthy dietary patterns. (Sharts
Engel, Kojima & Martinson, 1986). Therefore
their religious cultural impact was so intense
that the Japanese use to involve private investigators
to search the inherited cause for any disease
instead of focusing on their life style and dietary
problems. However, with the development and modernization
specifically due to the immigration influx of
Japanese to America brought steady change to their
traditional concepts and they have started adopting
the social health care trends practiced in America
from the Japanese Americans. (Fallows, 1990; Reischauer
& Jansen, 1995). Furthermore, people of Japan
are more inclined to the usage of drugs that disturbs
the metabolism and weakens the internal immune
system, which results into an easy effect of various
diseases like T.B. and other cardio-vascular diseases.
Nonetheless, children, women and men both married
and unmarried are dangerously associated to smoking
behavior. This not only affects the health of
the smokers but also spreads infection to the
whole environment. At the same time Japanese are
recognized for a higher intake of alcohol then
the Americans specifically during their traditional
ceremonies and marriage rituals. Therefore, this
not only spoils the whole atmosphere and increases
the risk of health issues but also results into
the inactive and unhealthy behavior of the students
and adolescents. (Lock, 1980). Moreover, any change
in the environment and climate has a direct impact
on the emotional, psychological as well as physical
health of the Japanese. Due to strong roots to
their religious culture, they strongly believe
on the five powers of fire, earth, wood, metal
and water that all together are directly related
to the seasons and affect their physical health
and working of different body parts. Therefore,
they have a different behavior in regard to health
care services and possessive an unhealthy lifestyle
that easily attracts various diseases to them.
So they mostly use herbal medicines, traditional
bathing techniques, massaging, resting and acupuncture
for their treatment. (Lock, 1980).
Health Lifestyle and overall health
Inadequate family and social support, hostile
atmosphere, poverty as well as the presence of
psycopathology has proved to be the basic elements
increasing the risk of diseases and illness in
the Japanese society. (Fisher & Weihs, 2000).
Though the challenges of health care services
are increasing day-by-day specifically with in
the industrialized part of the globe, but modernization
and educational development has made it easy to
discuss various diseases and health care problems
to the elder Japanese Americans. These specifically
include immunizations and maintaining healthy
habits of balanced diet and regular exercise.
Moreover, Japanese American who belongs to the
first generation is having a low risk of suffering
from dementia or cognitive declines as well as
mental declines. At the same time they are at
a higher risk to diseases related to hypertension
so they strongly need to watch their diets and
make exercise a part of their daily routine. They
should avoid foodstuff containing high salt like
pickled vegetable, soy sauce, preserved meat and
fish as well as few other substances. However,
as far as other dietary issues are concerned for
instance, calcium intake for prevention of osteoporosis,
it should be noted that the prevalence of lactose
intolerance is high which in future create sever
complications.
However, the quality of social support and family
support play a significant role in relation to
the health care issues. Many physical diseases
and illnes are cured by the family support as
they apply religious and spiritual techniques
for medication. Therefore, japanese strongly belive
on a healthy and strong relationship between the
society and the family as social support and interpersonal
relationship is connected to the physical health
of their elderly immune system. (Lebra.1976).
It also influences the reproductive health that
starts from puberty and then reaches to smoking
and drinking habbits that are directly related
to various diseases and illness in the society.
(Prigerson et al., 1999)
Moreover, recent research shows that the mortality
rate increases among the Japanese Americans, which
is caused due to lack of social and family support.
(Blazer.1982). Therefore, the interpersonal relationship
plays a leading role in shaping the health care
environment of the Japanese Americans. For instance,
various material problems experience an increase
in negative immuneological change and parental
divorce increases the chances of smoking. Similarly
men belonging to a family where they have experienced
divorces among their parents during their childhood
are more habitual of drinking and alcoholic since
their childhood and have a higher intake of other
tranquilizers as well. (Prigerson et al.1999).
Furthermore, women that are not into close relation
to their family get easily involved into physical
relations out side the family and are at a higher
risk of sexually transmitted diseases like HIV.
Therefore, many physical and health problems as
well as interpersonal affairs leading to STDs
are in a strong need to introduce awareness programs
and investigate various diseases in the society
that can spread due to social relations and physical
relations. At the same time, development of new
and technological ideas, preventive measure, and
more effective strategies are needed to support
all group of the society, which include individuals,
families, and communities in achieving physical
and mental health so that one must attain and
maintain healthy and good social relationships
with their family and community. Consequently
the Japanese Americans will possess an opportunity
to achieve complete physical, mental, and social
well being, where overall health and all basic
needs of life are accomplished (Parkerson et al.,
1988).
Role of Diabetes in Health Care
Basically diabetes mellitus is a group of diseases
characterized by high blood levels of glucose.
It develops when insulin secretion is not proper
from pancreas that in turn affects on the blood
glucose level, which becomes abnormal (Low or
high). Where the presence of diabetes can be associated
with serious complications and premature death,
but people suffering from this disease can take
measures to reduce the likelihood of these occurrences.
Therefore, there are 2 types of diabetes. Type
I diabetes in Asian children is relatively rare;
rates are significantly lower than those among
non-Hispanic whites. The occurrence of type 1
or 2 in a particular area or climate depends on
several factors like genetics, environmental factors,
climate, food uptake, life style etc.
However, data from one study suggested that in
Type I diabetes, environmental factors might be
involved. The ministry of health has carried out
a study in 2002 according which; rates of Type
I diabetes in Hawaii were higher than rates of
Type I diabetes in Japanese children in Tokyo.
A total of 16.2 million people in Japan suffer
from or are suspected of having diabetes. The
survey by the Ministry of Health, Labour and Welfare
said an estimated 7.4 million people are "suffering
from or strongly suspected of having diabetes,"
up by 500,000 from the ministry's previous survey
in 1997, and 8.8 million others, up by 2 million,
are generally suspected of having it.
As far as the case of Japanese Americans are
concerned, they have a higher has a higher prevalence
of Type II Diabetes among Japanese Americans than
their counterparts in either Japan or Caucasians
in the U.S. To check the percentage and occurrence
f this type 2 diabetes in different regions of
U.S, studies were done on In Seattle, 20% of Nisei
men between 45 and 74 were found to have diabetes,
half of which was not diagnosed, and 56% had abnormal
glucose tolerance. Those rates are over twice
as high as comparable samples of men in the U.S.
population in general (Fujimoto et al., 1987).
The effect of dietary uptake had a strong influence
on these people and it has been observed that
those persons with diabetes were found to consume
more fat and animal protein than their non-diabetic
Nisei counterparts, although both groups consumed
the same amount of calories.
However, majority of the Japanese- Americans with
diabetes have Type II diabetes. This type usually
develops in adults, but it can also develop in
children or adolescents. In this disease, the
body's resistance to the action of insulin and
by impaired insulin secretion. It can be managed
with healthy eating, physical activity, oral diabetes
medications, and/or injected insulin. Until recently,
type 2 diabetes was rarely diagnosed in children
and adolescents (Tomita, 1994).
Although there are many factors that increase
the chances of Type II diabetes but two categories
as risking factors are very important. The first
is genetics. The second is medical and lifestyle
factors, including obesity, diet, and physical
inactivity. Individuals who complain problems
in their body metabolism like impaired glucose
tolerance, impaired fasting glucose, or insulin
resistance are at higher risk of progressing to
diabetes. A person s Genetic background is a determining
factor in the prevalence of Type II diabetes.
Therefore, according to a study conducted by
David liao (sept. 2002) the endurance exercise
improved adiposityrelated measurements in Japanese
Americans with impaired glucose tolerance (IGT).
Where Type II diabetes has rapidly become a global
health problem. Though initially it was observed
as a diseses limited to the developed nations,
but presently it is more common in the developing
countries where the lifestyle has a stimulating
effect to increase the ratio of diebatic patiants.
So now now diabetes has become an economically
burdensome disease due to the increased morbidity
and mortality stemming from associated complications
such as coronary artery, cerebrovascular, retinal,
neurological, and renal diseases. The solution
to this growing problem may lie in preventing
or delaying the onset of disease in at-risk populations.
Thus, Type II diabetes is more prevalent in Japanese
Americans than in the general U.S. population
or in Japanese. Although generally not obese,
Japanese Americans are nonetheless heavier than
Japanese. It has been observed that due to the
differences between the Japanese and the American
lifestyles with respect to diet and physical activity,
with Japanese generally being more physically
active and consuming a diet with fewer calories
derived from fat, particularly saturated fat,
compared with Japanese Americans. As an impact
of such behavior and lifestyle, a lifestyle intervention
directed toward reducing dietary saturated fat
and increasing physical activity was selected
to examine whether prescription of this combination
improved adiposity and body fat distribution in
Japanese Americans with getrointestinal troubles.
Moreover, several metabolis disorders have been
found in Japanese Americans like hyperinsulinemia,
abnormal glucose tolerance, hypertension, dyslipidemia,
and cardiovascular disease. An increased body
weight play a very important role in the distribution
of body fat which in turn have a a risk factor
for diabetes. In this way, the central pattern
of body fat distribution, and in particular an
increased amount of intrabdominal or visceral
fat also count a big part and the observation
that visceral fat may be significantly reduced
even if total weight loss is not great. Therefore,
it must be noted that studies design to reduce
adiposity, especially visceral adiposity, in individuals
at risk for type 2 diabetes are of great interest
and cannot ne neglected (Warren King, 2003).
Furthermore, current epidemiological studies has
experimented and calculated the association between
diets with a high glycemic index and a greater
risk of Type II diabetes mellitus in Japanese-American
women, which is related with increased insulin
resistance. Therefore, an increased intake of
whole grains and a diet with a low glycemic index
may reduce the risk of diabetes mellitus because
of enhancement of insulin sensitivity and an improvement
in blood lipid concentrations, respectively. At
the same time, the thrifty gene theory that was
first proposed in 1962, suggests that population
groups that experienced alternating periods of
feast and famine gradually adapted by developing
a way to store fat more efficiently during periods
of plenty to better survive famines. Obesity is
a major risk factor for Type II diabetes among
all races and ethnic groups.
Besides obesity, an important factor which increases
the risk is not only the overall weight but also
depends on the location of the excess weight or
improper distribution of body weight. For instance,
if the central or upper-body part is obese then
there is a stronger risk for Type II diabetes
than excess weight carried below the waist. Nonetheless
according to a research conducted, in comparing
Japanese people in Japan with Japanese people
who had migrated to Hawaii, the Hawaiian Japanese
had a higher rate of obesity and double the prevalence
of Type II diabetes. The drastic increase in Type
II diabetes in youth has paralleled the dramatic
increase of obesity in youth (Carr-Hill, 1987).
Therefore, a proper and balance diet plays a
very important role in reducing obesity and excess
body weight. For instance, if we compare the dietary
content of similarly aged Japanese-American men
living in Seattle, Washington, with that of Japanese
men in Japan, we will observe a higher calorie
intake including protein, fat, and carbohydrates
in the Japanese-American diet so this shows that
the daily intake of fat in Japanese-American men
was 32.4 grams, in contrast to a mean intake of
only 16.7 grams of fat in Japanese men. On the
other hands, Asian Americans usually have a higher
diet intake with lower fats and much more fiber
food as an essential part of their diet.
Moreover, around 8,000 Japanese-American men living
in Hawaii in comparison to the Japanese lifestyle
was associated with a reduced prevalence of type
2 diabetes. Where the components of this lifestyle
included higher levels of physical activity and
consumption of more carbohydrates and less fat
and animal protein. Diabetes is a major risk factor
for cardiovascular disease means that people having
diabetes may also face some other serious life
threatening diseases like cardio-vascular problems
and coronary heart disease. Data suggest that
minorities in general have a rate of risk for
this disease similar to that of the non-Hispanic
white population. Both impaired glucose tolerance
and Type II diabetes were risk factors for coronary
artery disease among Japanese Americans in a Seattle
study. Although limited information is provided
in regard to the relationship of stroke and hypertension
to diabetes among the Japanese American population,
where ischemic heart disease is one of the leading
causes of death for both men and women (Jennifer
Holmes, 2001). However, lifestyle intervention,
proper dietary habits and regular physical exercise
successfully reduces the risk of getting type
II diabetes for both men and women as well as
among all the ethnic groups. It also helps reducing
the risk of diabetes in people of 60 years to
71 percent.
Role of Immigration
Japanese migrated to USA due to many reasons where
the basic reason lies in search for a better lifestyle
and prosperous future as Japan was experiencing
serious social as well as economic changes. This
was actually a transitional phase prior to the
industrialization and development of modern Japan.
Therefore, majority of the Japanese immigrated
to America for work and economic development.
Moreover, the Hawaiian sugar industry boom brought
many Japanese to Hawaii so that in 1910, Hawaii
had four times as many Japanese as the U.S. mainland.
150,000 Japanese moved to Hawaii and about 30,000
to California in between the year of 1882 and
1908. On the mainland, economic opportunity initially
came primarily in the form of domestic and unskilled
labor, for example work in logging or building
railroads. Initially they were working as contract
laborers but when they got some opportunities
and became settled with the passage of time, they
establish their business and got some area for
working and during this time, the native born
Japanese group was growing, and by 1930, native-born
Japanese Americans were said to exceed those born
in Japan by eighty percent. (Kramerow et al.,
1999).
Nonetheless these immigrant labors and their
families have started settling in America and
gradually adopted the very life style of America.
At the same time they did not leave their roots
and was practicing the same lifestyle in regard
to alcoholic drinking, smoking and physical intimacy
with out precautionary measures. So in this way
the level of STDs were increased as well as other
contagious diseases were spread all over the country.
Some were adopted by the Japanese Americans while
other were gifted to the Native Americans. Both
the Japanese Americans later started inter marriages
which resulted into inheritance of diabetes as
well as other such diseases where precautionary
steps in regard to health care was not taken seriously.
Therefore, with the passage of time, both adopted
each other’s life style and cultural trends,
where Americans were not influenced much about
the traditional culture of the Japanese but Japanese
Americans were strongly influenced by the American
culture thus adopted their life style with a modernized
approach to their traditional lifestyle. At the
same time they developed themselves economically
as well as socially living in America. So with
the passage of time, the life style of Japanese-Americans
has also been change as their economical status
has been improved and the government had given
them many Facilities to provide good health care
and ideal life style. (Sanae Fukuda, 2000).
|