By Nora Kadas ’27, Lawrence University
Imagine moving to an entirely new place with an entirely different healthcare system and language along with a lack of understanding of your culture and background.
Unfortunately, this is the reality many Hmong Americans face when navigating the American healthcare system daily and this affects their health outcomes.
One example of these outcomes is Coronary Heart Disease (CHD). The Hmong community faces higher levels of heart disease risk factors including hypertension, cholesterol levels, and blood sugar issues. Hmong adults in the U.S. tend to experience strokes at a younger age than white adults and are more likely to have fatal strokes (Thao, 2019).
Heart disease is one of multiple health disparities amongst this ethnic minority alongside diabetes, Chronic Hepatitis B (CHB), depression, and cancer (Brown et al., 2023). These issues may not be addressed because of systemic barriers such as socioeconomic status, language barriers, and uninformed Western mental health services (Wang et al., 2019).
Language is one of the many determinants of health that can explain the disparities shown in the Hmong community.
Census data shows that 17% of Asian-Americans do not speak proficient English (US Census Bureau, 2025). Research by Lor et al. (2015) finds that areas with lower amounts of language interpreters are associated with higher rates of chronic disease.
Without care offered in multiple languages, issues of not attaining preventative care or delaying treatment will only worsen for those who do not speak proficient English.
For my research, I decided to gain an insider perspective from a community health worker at the Milwaukee Consortium for Hmong Health in order to further understand the experiences and root causes that needed to be addressed.
Milwaukee, Wisconsin is home to one of the largest Hmong populationsin the United States. In order to combat these disparities, community-based organizations have played a major role.
An example of these community-based organizations is the Milwaukee Consortium for
Hmong Health which aims to address disparities through culturally tailored health education, outreach, and preventative screenings.
In an interview, Maria Chay, a Community Health Worker (CHW) from the organization, describes the importance of recognizing historical trauma and mistrust.
“It’s important to meet people where they are at and address them with respect, kindness and education,” Chay said.
According to Chay, preventive healthcare services such as blood pressure screenings and annual checkups are not used as often in the Hmong community. She shared a success story where a skeptical client got screened for blood pressure issues after a CHW in the Hmong community taught a health education lesson. The client did ultimately need treatment but was luckily able to prevent their issues from worsening.
This aligns with past research from Wang et al. (2019) that found that Hmong individuals are disproportionately affected by Chronic Hepatitis B (CHB) yet screening rates to test for these conditions remained low.
Another major finding from the interview was that language barriers affect health outcomes significantly.
It was noted that having a limited number of bilingual speakers was a recurring challenge. But according to Chay, translation only scratches the surface of problems that need to be solved.
“It has to be explained in a way that it is culturally tailored and respects their spiritual beliefs rather than just be translated” she said.
She explained that some diagnoses don’t have direct Hmong translations and it is necessary to educate using stories or find other creative communicating strategies. On top of this, the Western diagnosis may not align with spiritual views on disease. Hmong individuals also tend to view health issues more holistically and focus on spiritual and emotional health as well as traditional practices.
A project incorporating culturally tailored education approaches for cardiovascular health
to the Hmong community reduced hypertension (Hussein, 2020). Applying traditional remedies instead of or with biomedical approaches can help to increase patient retention. It was discussed that using herbal remedies alongside Western medications can work through building client trust.
Some remedies include Shamanism and practices that improve spiritual wellbeing and resolving symptoms through natural techniques such as lemongrass and ginger. These traditions have been passed down throughout generations and are tried-and-true, highlighting a strength of the Hmong community and their culture.
There is also more focus on family values in Hmong society.
Since family members are important in the decision-making process to help with screenings, the Milwaukee Consortium for Hmong Health uses community-based approaches to screenings and outreach through cultural events to help reach its intended audience.
Elders are highly respected and this asset can help to strengthen health in the community. It is also noted that older populations are more resistant and skeptical of the healthcare system due to lack of trust in providers which make cultural humility even more important.
In the interview, it was elaborated that economic barriers and funding were common challenges. Hmong Americans have higher rates of poverty (16%) than non-Hispanic White Americans (8%) (US Census Bureau, 2025). Lower income is correlated with higher cardiovascular risk due to its association with access to healthy food, preventative care, and other environmental factors affected by income (Shahu et al., 2021).
Chay stated that “insurance policies disproportionately affect the Hmong and refugee communities” which makes sense because many of them are learning to operate an entirely new and disorganized healthcare system.
Having a public health initiative to collaborate and fund trusted community organizations like this one can ensure the longevity of these organizations and help to address these economic disparities.
Although some studies have been done on combining alternative medicines with Western remedies, the research is still limited and has not been done on Hmong populations specifically. Some cultural interpretations and cures for illnesses were invalidated by Western healthcare professionals which has previously caused mistrust. Research focused on cultural routes of healing and their interactions with the United States healthcare system can help to expand the accessibility and understanding for more groups of people.
References
- Brown, K. M., Silveira, C., Xiong, S., Lumpkin, N., Carlin, C., Pang, C. J., & Schafer, K. M. (2023). A Digital diabetes Storytelling Intervention for the Hmong Community: a pilot study. Health Promotion Practice, 26(2), 201–204. https://doi.org/10.1177/15248399231208990
- Hussein, H. (2020). Hmong Cross-Cultural adaptation of Stroke educational material. In WMJ (Vol. 119, Issue 2, pp. 115–116) [Brief report]. https://wmjonline.org/wp-content/uploads/2020/119/2/115.pdf
- Lor, M., Xiong, P., Schwei, R. J., Bowers, B. J., & Jacobs, E. A. (2015). Limited English proficient Hmong- and Spanish-speaking patients’ perceptions of the quality of interpreter services. International Journal of Nursing Studies, 54, 75–83. https://doi.org/10.1016/j.ijnurstu.2015.03.019
- Shahu, A., Okunrintemi, V., Tibuakuu, M., Khan, S. U., Gulati, M., Marvel, F., Blumenthal, R. S., & Michos, E. D. (2021). Income disparity and utilization of cardiovascular preventive care services among U.S. adults. American Journal of Preventive Cardiology, 8, 100286. https://doi.org/10.1016/j.ajpc.2021.100286
- Thao, Y. (2019). Barriers in Health Care in Hmong Men and Women with Cardiac Diseases. https://doi.org/10.31979/etd.bf5s-2ewg
- US Census Bureau. (2025, June 10). New data on detailed languages spoken at home and the ability to speak English. Census.gov. https://www.census.gov/newsroom/press-releases/2025/2017-2021-acs-language-use-tables.html
- Wang, T., Liu, Y., Letran, D., Dang, J. H. T., Harris, A. M., Li, C., Chen, M. S., Bowlus, C. L., & Chak, E. (2019). Healthcare Disparities Identified Between Hmong and Other Asian Origin Groups Living with Chronic Hepatitis B Infection in Sacramento County 2014–2017. Journal of Community Health, 45(2), 412–418. https://doi.org/10.1007/s10900-019-00763-1
About the Author:
Nora Kadas is a psychology and public health student at Lawrence University interested in health equity and research. She is interested in understanding how social determinants of health, gender, and healthcare access shape outcomes. Her most recent work focused on the mental health of community health workers.
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