Is Taiwanese Healthcare a Model to Emulate?

Healthcare. That word in the United States draws controversy from all sides of the spectrum. Our nation’s healthcare reform debate is an ongoing political issue, as the United States is still the only industrialized democracy without universal health insurance.

Imagine a small island nation over seven thousand miles away. Here, residents may visit a clinic down the street and meet with a doctor they haven’t seen before, without scheduling an appointment. When meeting with the physician, they present a medical card that contains a chip with all their medical records. The doctor has immediate access to these patients’ medical history, any drugs they are taking, and other important health information.

Though quite different from what we’re used to in the United States, the above scenario depicts the healthcare system in Taiwan. When I visited last summer and stayed with my cousin and his family, I had the chance to learn more about how the country’s health insurance system works. Since 1995, Taiwan, with 23 million residents, has had a universal healthcare system called the National Health Insurance (NHI). This form of socialized medical care allows Taiwanese citizens and residents to enjoy the benefits of a single-payer health insurance system.

My first week in Taipei, where my cousin lives, his three-year old daughter came down with a cold. On a Saturday morning, I tagged along with his wife and the child to the hospital.

What first caught my attention was how no appointment had to be made; another that struck me was how little time we had to wait at the clinic. Within a few minutes, a pediatrician escorted us to her office and my cousin-in-law handed her a medical card. My cousin’s daughter was given a checkup and rescribed some medicine. What also surprised me was that the medicine only cost 100 NT, which is just over US$3.

Why not: the actor Jerry Yan in The Hospital, a popular Taiwanese television drama

Though Taiwanese citizens have equal access to healthcare, the country spends only about 6.6% of its GDP on health expenditures, while the United States spends more than 17%. Residents of Taiwan pay a monthly fee for the NHI themselves, and their companies pay for a portion of the fee. The vast majority of patients and doctors in Taiwan are satisfied with this convenient and affordable system.

Of course, there are also costs to having unlimited access to healthcare. With a lack of funds, the Taiwanese government has had to borrow money from banks. Additionally, with the convenience of healthcare, there is a large number of patients relying on too few doctors. When patients pay frequent visits to the doctor, it causes doctors to limit the amount of time each patient can be seen.

With a system that promises equal healthcare access, Taiwanese residents take care of each other. In the United States, healthcare is seen more as the responsibility of an individual. Perhaps these two nations’ different systems stem from this cultural disparity.

Making Sense of the Recent Attacks in China

There have been three assaults on civilians in China in the past three months, the last two having occurred within a week of each other. The Chinese government has labeled these incidents terrorist attacks.

Photo: The Guardian

The most recent killing involved an assailant who stabbed six people on May 6 at a railway station in the southern city of Guangzhou. There were no fatalities, but the six victims were injured and the suspect was shot and wounded by Chinese police.

The violence occurred less than a week after three were killed and 79 injured in a knife and bomb attack at the railway station in Urumqi, the capital of the northwestern region of Xinjiang.

However, the government first became alarmed in March when five attackers with knives and machetes killed 29 and injured more than 140 at a station in the southwestern city of Kunming.

Twenty-nine people were killed in a knife attack at Kunming rail station, southwest China, in early March. More than 140 others were injured when assailants, thought to be Xinjiang separatists from the west, began hacking at people apparently at random. Four attackers were shot dead by police at the scene.

Officials have blamed the incidents in Urumqi and Kunming on separatist terrorists from Xinjiang. It is suspected that the region’s Uighur minority is unhappy with the regulation and seeks to form an independent state, East Turkestan. While the most recent attack has not been officially linked to the earlier two, it is highly suspected they are related.

Before the attack in Guangzhou, President Xi Jinping had travelled to Xinjiang to address the ongoing issue of violence. There he announced plans to arm Chinese police officers with guns. He said that as China’s westernmost border region, the city of Kashgar in Xinjiang is at the frontline in the fight against terrorism. Furthermore, he ordered the army to help local government deliver a “crushing blow” to terrorists.

However, Xi’s visit also involved visiting a mosque and directly addressing the issue of religion in the region. This could be seen as more indirect measures of dealing with the issue because the ongoing violence has been associated with the Turkic Uighur Muslim population of Xinjiang.

Xi visited a 120-year-old mosque and sat with a group of religious leaders and listened to their views about regional issues. He made a comment that maintained his view that religion needs to adapt to social developments, but acknowledged that religious publications contain wisdom that can help guide people toward tolerance and acts of kindness.

These efforts are significant especially when considering China’s history with religious freedom and regional minorities. Nevertheless, the Chinese government will have to continue to find ways of preventing future violent events and protect its citizens.

Despite Lower Body Weight, Asian Americans are at High Risk for Diabetes

Even with a lower body weight, Asian Americans faced a higher risk of diabetes than Caucasians, which were caused by both genetic and environmental influences, said the Asian American Diabetes Initiative in Boston.

Revealed by a study from American Diabetes Association, Asian Americans remained 30 to 50 percent more likely to have diabetes than their white counterparts, based on the U.S. National Health Interview Survey from 1997 to 2008.

Common myths and misconceptions about diabetes in the Asian American community

“For the same weight, Asian Americans tend to have more insulin resistance. Insulin resistance is the way that people develop type 2 diabetes,” said Greeshma K Shetty, associate director of the Asian Clinic in AADI.

Type 2 diabetes is the most common form of diabetes, according to the American Diabetes Association. With type 2 diabetes, either the body cannot produce enough insulin or the cells ignore the insulin. However, insulin is necessary for human body to regulate the blood sugar level.

The higher risk of diabetes in the Asian American community also came from the diet habit. Asian tend to eat more rice, especially white rice, than the rest of the population. “There is a difference between you eat white rice from brown rice, or white rice from whole-grain, whole-wheat bread,” said Shetty, “The more fiber it contains, and that makes it less likely to make your blood sugar level high.” Comparing to the rest, white rice containing less fiber raised the risk of diabetes.

Diabetes is not just a trend among Asians or Asian Americans, but an issue for the global community

“We try to make sure they decrease fat or change from white rice to brown rice. Simple changes like that to make a big different,” said Shetty. Besides diet, she also emphasized the importance of regular exercise and losing weight, even before the start of medication.

Among all the Asian American subgroups, shown by a lot of researches, Asian Indians had the highest odds of prevalent type 2 diabetes. A study led by the New York University showed that, in the New York City, using the Asian BMI standards, 74 percent of Asian Indians were overweight or obese. Meanwhile, in the general Asian groups which consists of Chinese, Koreans, and Asian Indians, 41 percent were overweight and 13 percent obese.

In 2000, Joslin Research Director George L. King and his colleagues in Joslin Diabetes Center established the AADI. 14 years later, beyond the patient clinic, they have also been doing research and education for patients in other clinical care givers. They gave community outreach at local culture events or other language tools.

“So our effort are that we are beyond just physical clinic, we actually try to make connection with our community,” said Shetty.

Immigrants from the East Arrived on the West

Being a nation of immigrants has long been a point of controversy for the United States. The idea of immigrants overcoming discrimination and hardship to achieve the American dream, however, is generally dear to the hearts of most Americans. Unsurprisingly, stories of struggling immigrants coming to the United States and arriving on Ellis Island are cherished. Stories of those arriving from the opposite side of the country, though, are less heard. Europeans arrived from the Atlantic Ocean, but Asians arrived from the Pacific and they ended up in Ellis’ counterpoint: Angel Island.

Poetry carved onto the walls of detention barracks at Angel Island

(Photo: Preservation Nation Blog)

In 1970, Chinese poetry carved into the walls of the Angel Island Immigration Station saved it from destruction. After these carvings were found, Bay Area Asian Americans formed the Angel Island Immigration Station Foundation (AIISF) and began a long journey that led to the restoration of the station and its opening to the public in 1983. Today, AIISF’s mission is to continue preserving the site and educate the public about the role of the Pacific Rim immigration in U.S. history.

Immigrants arrive on Angel Island

Asian immigration into the U.S. began in the 1850s, when young single men were recruited as laborers. The recruitment was so extensively that, by 1870, the Chinese represented 20% of California’s labor force. But the 1876 depression changed the attitudes towards these workers so strongly that Congress eventually passed the only U.S. law to ever restrict immigration and naturalization on the basis of race. The 1882 Chinese Exclusion Act would restrict Chinese immigration for the next sixty years.

Thirty years after the Act’s inception, a national system had formed specifically targeting Asian immigration. Immigration officials developed a new facility on Angel Island, the largest island in the San Francisco Bay, isolating immigrants from the mainland. Men were separated from women. People were put through humiliating medical exams and harsh interrogations that required immigrants to remember minute details of their lives, such as how many steps were in front of their home. Until they were approved, immigrants suffered long waits on Angel Island, which could span from weeks, months, to years.

An aerial view of Angel Island

The AIISF hopes to make this part of U.S. history better known and to give voices to the immigrants that faced such conditions. In this effort, it has created a forum where people can read the personal stories and those of friends and family that went through Angel Island. The stories span from immigrants arriving in the early 20^th century, like that of Japanese-born Kaoru Okawa who arrived in 1919 to more recent arrivals like that of Sri-Lankan born Kumar Emayan, who arrived in 1997. What may be the most empowering work the organization has done, though, may be allowing readers to submit their own stories. Visit their website to find out how people can share their own stories.

Beyond Aung San Suu Kyi: Five Asian Female Leaders You May Not Know

For a long time, gender equality has been something the world has strived for. In the U.S., the fight for gender equality erupted during the Women’s Rights Movement more than a century and a half ago.

With that in mind, as well as the bad rap Asian countries often receive for female oppression (foot binding and geishas, anyone?), it may be a surprise to some that Asian countries seemed to have made more progress in terms of female leadership than Western countries. In fact, nine Asian countries (South Korea, Indonesia, India, Pakistan, Sri Lanka, Bangladesh, Thailand, the Philippines, and Mongolia) are currently or were led by a female, democratically elected head of government.

Needless to say, the U.S. has yet to have a female president.

While the reasons for this political difference give rise to a whole ‘nother article, in this one, I’d like to highlight a few of these – inspirational? controversial? certainly always interesting – Asian female leaders.

Pratibha Patil – 12th President of India (2007-2012)

Born in 1934, Patil had a long political career prior to becoming president, holding roles such as parliament member and governor. After winning the presidency with nearly 2/3 of the votes, her time in office saw a few controversies. For instance, she commuted the death sentences of 35 people, and embarked on more foreign trips than any other president.

Corazon Aquino – 11th President of the Philippines (1986-1992)

Born in 1933, Aquino was the first female president not only of the Philippines, but in all of Asia. Without holding any past political experience, she was the most prominent figure in the 1986 People Power Revolution and oversaw the promulgation of the 1987 Constitution. As president, she emphasized human rights and peaceful negotiations. Additionally, she focused on molding a market-oriented and healthy economy in the Philippines.

Yingluck Shinawatra – 28th Prime Minister of Thailand

Born in 1967, Shinawatra is a businesswoman, politician, and the first (and current) Prime Minister of Thailand. After election to office in 2011, she invoked the Disaster Prevention and Mitigation Act in response to the 2011 Thailand floods; reshuffled her cabinet in 2012, and dissolved the Parliament, calling for early elections due to the 2013 anti-government protests. She is currently facing corruption investigations.

Chandrika Kumaratunga – 5th President of Sri Lanka

Born in 1945, Kumaratunga was elected Prime Minister of the People’s Alliance and was the leader of the Sri Lanka Freedom Party until 2006. She spent much of her presidency trying to negotiate and make peace with opposing national political parties. She is also a member of the Council of Women World Leaders.

Megawati Sukarnoputri – 5th President of Indonesia

Born in 1947, Sukarnoputri was the country’s only female president and is also leader of the Indonesian opposition party. While her presidency was characterized by slow progress, reforms, and resolutions, it also brought about the stabilization of democracy and more solid relationships amongst the legislative, executive, and military branches of government.