Hmong Americans' Residence: An Analysis of Public Health Factors

This essay examines the impact of place of residence on the public health of Hmong Americans, focusing on upstream, midstream, and downstream determinants. It discusses how government policies, socioeconomic factors, and individual behaviors, influenced by the place of residence, affect the health outcomes of this community. The essay also addresses the cultural aspects of Hmong healthcare practices, including the preference for traditional medicine and the challenges faced in accessing and trusting Western medical systems. Ultimately, the analysis highlights the complex interplay between residence, public health, and cultural factors in shaping the health experiences of Hmong Americans.

Running Head: PLACE OF RESIDENCE OF HMONG AMERICANS
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Place of Residence of Hmong Americans
Student’s Name
Institutional Affiliation
Table of Contents

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1.0 Introduction................................................................................................................................2
2.0 Influence of Place of Residence on Upstream, Midstream and Downstream determinants......3
2.1 Upstream Issues.....................................................................................................................3
2.2 Midstream Determinants........................................................................................................5
2.3 Downstream Factors..............................................................................................................7
3.0 Addressing Place of Residence in Hmong culture....................................................................8
4.0 Recommendations....................................................................................................................10
References......................................................................................................................................11

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Place of Residence of Hmong Americans
1.0 Introduction
Hmong Americans are U.S. citizens originating from Vietnam, Thailand or China. Most
of them resettled in the United States as war refugees following the Vietnam War. However,
some Lao Hmong escaped ethical violations, human rights violation and prosecution at their
homelands. Today, America offers safe asylum to thousands of Hmong groups in North
Carolina, Wisconsin, Minnesota, and California. According to (Yeng, 2010) majority of the Lao,
Vietnamese and Thai immigrated and settled along refugee camps, and were accepted as part of
the American community. Primarily, the Hmong Americans settling in Kansas, following their
migration during the 1980s. This paper examines the place of residence of Hmong Americans
concerning the public health framework.
The place of residence describes where a person or a group live. Notably, most people
live within homes; however, the dwelling place affects a person's access to public health care
based on the proximity to the healthcare facility; and surroundings to the residence. The effect of
place of residence on public health framework relies on determinants which can be upstream,
midstream or downstream. The factors are determining how Hmong families access healthcare
by outlining different structures. Prominent issues affecting the public health framework in the
United States are socioeconomic position and gender (Briain, 2013). However, the influence of
racism and place of residence is minimal – this is because primarily, the Hmong Americans
disregard western medication; and face discrimination in public health based on their race,
income or social status (Woodahl et al., 2014). Notably, urban areas relate better to general
health due to improved healthcare facilities. On the other hand, rural areas have poorly equipped

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medical centers with few medical professionals. Investigating the Hmong Americans place of
residence about the public health framework is vital because it lays the framework for policy
implementation. Further, it helps identify the health-related quality of life for the citizens living
in different areas.
From coursework, the public health framework entails upstream, midstream and
downstream determinants. The macro issues include government policy on health, housing,
transport, and welfare; while common factors are psychological and health behaviors. On the
other hand, downstream problems include physiological systems, health, and biological
reactions.
Figure 1: The Hmong People
Source: Briain
(2013)
2.0 Influence of Place
of Residence on Upstream, Midstream and Downstream determinants
The place of residence influences the determinants of health, and health outcomes in
many ways. Today, health issues are a fundamental social concern, with its coverage
increasingly becoming extensive with the advent of intensive media coverage on infectious and
terminal illnesses. The concept has resulted in development of complex procedures, and medical
inventions to prevent and treat illnesses. Depending on their place of residence, the Hmong

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residents are subject to different diseases. For instance, people living within Kansas suburbs are
likely to suffer from cholera from the waste disposal. Clearly, a variety of place-based issues
affect healthcare outcomes, including the physical altitudes, temperature patterns and pollutant.
Areas experiencing varying temperatures are prone to skin diseases resulting from ultraviolet
light (UV) rays. Economic factors relating to the place of residence, and health care outcomes
include access to health insurance, and quality of nutrition. Traditionally, the Hmong people diet
is meat, fish, noodles, rice and green vegetables; however, some groups cannot access this
balanced nutrition due to finances. In such cases, malnutrition takes place. The influence of place
of residence on health outcomes is vast, and can be evaluated from three perspectives: upstream,
midstream and downstream.
2.1 Upstream Issues
Macro factors mainly include global factors and government policies relating to health,
housing, welfare and transport. The Hmong Americans place of residence interacts with the
upstream determinants in different ways. One aspect is government policy on housing. Since
Hmong Americans are immigrants, their housing facilities in Minnesota and North Carolina are
generally poor. The poor living conditions subject the group to pollutants which lead to spread of
diseases (Hein, 2017). For instance, water pollutants lead to cholera, among other vector-borne
diseases. In some cases, tenants and landlords discriminate the Hmong people, denying them
proper places of residence. The federal governments have enacted policies which reduce
discrimination; and provide access to clean water, rudimentary sanitation and safe living
surroundings. The Immigration Act describes policies which promote access to healthcare
facilities, education and better places of residence. Further, it allows criminal prosecution for
landlords undertaking discriminatory practices when relating to immigrants.

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Government policy on health care allows access to immunization and primary health care
to Hmong citizens. Research shows that majority of the illnesses among immigrants arise from
lack of vaccination against specific diseases. Depending on the geographical location, the access
to health care differs. For instance, Hmong people living in the suburbs have inadequate access
to healthcare practices, such as immunization. The Immigration Act allows immigrants to access
health care in government hospitals freely or at low charges regardless of their place of
residence. According to (Dickert & Sugarman, 2010) access to immunization is perhaps the
most prominent issue affecting healthcare distribution in the United States. Notably, these
government policies on healthcare ensure access to preventive measures, and treatment practices
for Hmong people suffering from depression, anemia, tuberculosis, viral hepatitis and intestinal
parasites.
Government policy on education and working conditions is another upstream issue
affecting health outcomes. The place of residence impacts access to formal employment, and
education. Proper working conditions improve the finances of Hmong families. The concept
enhances the quality of nutrition and access to insurance. Primarily, these policies improve
health care equity, ensuring better health outcomes among Hmong Americans. In this case,
public policy describes federal or local laws governing housing. Garrison (2013) explains that
public policy affects education, income, education, and access to quality healthcare. Public
policies differ depending on the geographical location of residence. In some states, the dumping
in residential areas is prohibited, while in others, the areas surround transit lines such as subway,
bus or rail routes – this leads to noise pollution.
Depending on the location, Hmong people seek employment at different factories; and
engage in diverse economic activities. Their economic conditions influence the access to quality

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medical care. Research shows that a high percentage of immigrants lack health insurance; suffer
from malnutrition, and face the industrial waste chemicals. Top paying jobs allow people to
ingest balanced diets, while low-paying jobs reduce the quality of nutrition. The concept leaves
Hmong immigrants susceptible to certain food-related illnesses. Xiong, Meece & Pepperell
(2013) explains that the economic condition impacts the type of healthcare insurance Hmong
people subscribe to – this influences the quality of health care they receive. According to Schulz,
Caldwell & Foster (2013) the resurgence of vector-borne diseases such as yellow fever, and
malaria among immigrants highlights the significance of high-quality insurance.
The geographical place of residence differs in terms of temperature patterns. From
(George, Duran & Norris, 2014) some places of residence favor disease outbreaks. For instance,
the yellow fever is prevalent in North Carolina. Other places subject the Hmong people to
noninfectious diseases, such as melanoma – which emanates from climate change in certain
areas. In such cases, the federal government enacts legislation to protect the people, and ensure
high quality health care. Burke, Evans & Jarvik (2014) explains that the geographical location
creates inequalities in access to healthcare. Rural areas in Illinois, United States characterize
spatial access to primary care, compared to urban areas. Geographical scientists explain that
certain attributes of urban areas, such as water and sanitation attract primary care physicians.
Additionally, such facilities allow community planners and policy-makers to create frameworks
for proper health care. Government policies on socio-economic status of the Hmong people vary
with location. Social factors such as socioeconomic status, sexual practices, and access to
transportation differ with place of residence. The spatial distribution of health care facilities and
equipment subjects Hmong people to diseases such as HIV/ AIDS – in areas where the illness is
prevalent.

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2.2 Midstream Determinants
Intermediate factors influencing public health care are psychosocial issues, health
behaviours and the role of healthcare systems. According to (Hamilton et al., 2016) scientists
attribute certain diseases such as lung cancer to behaviours such as smoking, gene-environment
interactions, age and nutrition. The studies show that high-risk behaviours subject Hmong people
to increased risk of disease. The concept disregards the influence of place of residence; however
several geographical influences create complexities which increase the latency of infections.
Notably, the disease patterns vary depending on the place of residence. Today, geographical
sciences continually engage in research to identify place and time impacts on diseases and
health. By adopting the sedentary lifestyle, and western diet the Hmong people are subject to
stroke, hypertension, diabetes and obesity.
From (Halverson & Ross, 2012) health behaviors such as smoking, alcohol, addiction,
diet, physical activity and preventive health care vary from one location to another. Geological
sciences review drug addictions from four dimensions; disease incidence, occurrence, and
response. Further, they attribute cravings to social influences, such as family, and friends. Some
regions encourage behaviors such as smoking, and alcohol abuse. Hmong Americans living in
such areas may engage in the practices, based on peer influence. Notably, this results in diseases
such as lung cancer. Notably, the environment influences human habits in many ways.
Green & Guyer (2011) suggests that the place of residence promotes access to health care
among Hmong people. For instance, when a person suffers a heart attack, the distance between
their place of residence and the hospital determines whether they live or die. Research also
shows that people living near healthcare facilities have considerable health benefits –this is
because of access to preventive health care. Notably, some Hmong people living in isolation and

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depression due to discrimination. Primarily, this concept affects their general well-being. Spatial
distribution of diseases such as diarrhea and chronic constipation shows that they emanate from
human risk factors which vary geographically. Hmong people living in the suburbs are likely to
take poor diets, resulting in nutrition-related illnesses. In refugee camps, Hmong people rarely
receive social support. The group's girls and women are therefore subject to sexual coercion
since survival requires them to engage in sexual practices with other people. The concept may
result in a spread of HIV/ AIDS among other illnesses. The poor networks and open hostility
inspire men to drug abuse, which negatively affects their health. On the other hand, Hmong
Americans living in urban centers with favorable systems and social support have better health
care.
Figure 2: Hmong Families Sewing and Trading

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Source: (Hein, 2017)
A qualitative study by Thorburn et al. (2012) shows that traditions, culture and a lack of
understanding exposes the Hmong women to cervical and breast cancer. Notably, this emanates
from unethical traditions of the group, which vary depending on the place of residence. The
Hmong people in Oregon delay cancer screening and distrust medical professionals. Also, the
perceived discrimination at hospitals results in sadness, anger and unwillingness to undergo
medical care. One aspect of traditional Hmong customs is that they conflict western medicine,
with a preference towards conventional medication. Studies show that negative experiences
under the discriminative health practitioners create post-traumatic disorders for Hmong women
who have cancer. Primarily, (Schroepfer et al., 2010) attributes the illnesses to ignorance on
matters immunization, asepsis and germs.
2.3 Downstream Factors
The micro-level factors include physiological systems such as endocrine and immune;
health issues such as mortality, morbidity, and life expectancy; and biological reactions such as
glucose intolerance, blood lipids, adrenalin, fibrin production and hypertension. Majority of
Hmong people live within suburbs, meaning the threat of crime is prominent. With gun control
issues in American rural and urban areas, scientists suggest that the place of residence may
influence life expectancy (Culhane et al., 2017). When people with specific illnesses such as
glucose intolerance, and blood lipids live afar from health centers, the risk of physical harm is
high. For instance, a senior woman suffering from hypertension, and living ten kilometers from
the healthcare facility is likely to suffer severe consequences in case of an attack. Sanderson et
al. (2013) explains that the place of residence influences mortality rates. Primarily, Hmong
people living in crime-intense areas have low mortality rates.

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3.0 Addressing Place of Residence in Hmong culture
The Hmong people rapidly blended into the broader American society after immigration;
however, their younger generations lost aspects of their cultural identity. One point is religious
ceremonies relating to death. Initially, they dressed the dead in Hmong clothes, and conducted
ceremonies to "dispatch" the spirit. To mitigate the loss of cultural identity, the community
organized themselves in groups, maintaining their culture and language. An example is the
Hmong groups in Minnesota, United States.
Primarily, the Hmong people reside in the suburbs – this subjects them to crime and
racial discrimination. The place of residence affects the health care outcomes for Hmong
Americans. However, it relies on other determinants such as socioeconomic status, and health
behaviors. Notably, the group faces racial discrimination in education, employment, occupation,
working conditions, and housing. In housing, some landlords deny the group housing concerning
their cultural practices. However, the federal government enacts specific legislation to promote
equality in health care. To help corporation amongst themselves, the group organizes themselves
into social groups and engages in community projects.
Johnson et al. (2009) suggest that the federal government promotes racial equality in the
housing by establishing policies which allow black and Asian staff as landlords. Further, the
legislation provides for the formation of tenant groups which campaign against discrimination of
Hmong residents. Another aspect of addressing the place of residence among the Hmong culture
is utilizing government agencies. An example is the national housing federation (NHF) which
enlists residential terms for landlords, including safe water supply. Proper representation of
ethnic minorities, such as Hmong people in these associations is vital. Notably, Hmong people
are under-represented in Housing Corporation, leading to discriminatory practice in recruitment

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and selection of tenants. Proper representation enables the group to access excellent places of
residence – this positively impacts healthcare outcomes. According to (Sussner et al., 2009)
housing owners should join the registered social landlords (RSLs) - this encourages good
practices such as proper sanitation, and provision of water in residential areas. Research shows
that the majority of the housing associations undertakes RSL practices and equality policies.
Another measure taken to address this determinant is the implementation of the Equality
Act and guidelines of the Equality and Human Rights Commission (EHRC). The agencies
guidelines allow prosecution of social housing providers in the event of unlawful discrimination
of diverse racial groups. Federal governments encourage public bodies, and external housing
organizations to uphold the Equality Act which disregards perception, and strengthens positive
relationships between different ethnic groups. Listman et al. (2011) suggest that EHRC provides
compliance notices to discriminative landlord associations; and assesses if the groups comply
with the equality guidelines.
Notably, the Hmong culture involves customs, taboos, arts and entertainment. (Yeng,
2010; Briain, 2013) Explain Hmong way of life and the generational gap experienced between
the initial and present generations. The authors attribute these changes to continued assimilation
into the western culture, "destroying' their identity, and cultural heritage. Traditionally, Hmong
people neglected medicine, and did not want their blood samples taken. Other cultural issues
include polygamy, opium use, and dietary considerations. The customs subject the members to
inherited defects such as blindness or congenital deafness. Today, federal governments
continually engage the Hmong families in discussions on healthy traditions and practices to
mitigate these defects.

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4.0 Recommendations
Primarily, measures which promote housing among Hmong Americans center on anti-
discrimination. By “fighting” ethnic discrimination in housing, minority ethnic groups attain
better healthcare. Today, attention should focus on eliminating barriers which deny the Hmong
access to better places of residence. One recommendation is that federal governments should
enact immigration policies which allocate better residency for Hmong Americans. Notably, poor
housing subjects the group to pollutants, and vector-borne diseases, such as cholera and yellow
fever. The policies should promote respect, and limit discrimination of Hmong Americans in
education, housing, and healthcare. Further, they encourage the inclusion of the ethnic group in
healthcare – this supports the general well-being.
Another recommendation is creating a cross-departmental plan to allow Hmong
Americans, and another immigrant group's better access to housing. The action plan should
include clear timeframes, actions, and targets which encourage the minority group to express
their cultures. The timescale should include monitoring of places of residence, and their living
conditions regarding water availability sanitation. Notably, the actions must consist of
prosecution of landlords violating healthy living conditions at sites of residency. Mainly, the
areas of residence affect Hmong groups concerning their sanitary conditions, and exposure to
illnesses. Addressing inequalities in employment, housing, health, and education promote the
integration of Hmong people in policy-making. The concept improves access to healthcare. For
instance, favorable job allows the group to purchase balanced nutrition, preventing the
occurrence of nutrition-related illnesses.
Another aspect of improving the place of residence is creating network groups and
engaging Hmong citizens in diversity discussion. The concept should center on the group's

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rights, potential violations and how to report violations at the place of residence, or working area.
The discussions allow sharing of ideas on macro - level, intermediate, and low-level issues
affecting the place of residence. The Hmong people can also join organizations which can help
them. The groups can be workplace-based; residency-based, or education-based. The
associations provide the Hmong Americans with competitive advantage regarding their
recruitment to factories and places of residence. Further, the organization's campaign against
discrimination by prosecuting perpetrators. Proper representation in public policy making
promotes drastic change in housing policies relating to the Hmong people. In this case, the
community's authority structure determines the place of residence, and access to social amenities
including schools, and hospitals. Historical information attributes poor resettlement of Hmong
families to lack of leadership and the lack of a "voice" in issues affecting them. Notably,
leadership roles improve the socioeconomic status of the minority groups; and inspire social
change. Since the community rejects western medication, personalization of the drugs to suit
their social norms is essential. Researchers should identify cultural practices of the Hmong
people and recommend genetic-based medicines to address terminal illnesses such as cancer. The
healthcare providers should also adopt a cultural perspective to healthcare when dealing with
members of the Hmong community. Improved access to healthcare promotes their general
wellbeing.
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