HMONG AMERICANS
Authors
Author’s note: This narrative is principally drawn from Ma Vang’s “Rechronicling Hmong Histories: Toward a Hmong Feminist Perspective,” in Unequal
Sisters: A Revolutionary Reader in US Women’s History, edited by Stephanie Narrow, Kim Cary Warren, Judy Tzu-Chun Wu, and Vicki L. Ruiz (Routledge, 2023) and Maichou Lor’s “Systematic Review: Health Promotion and Disease Prevention Among Hmong Adults in the USA,” Journal of Racial and Ethnic Health Disparities 5 (2018): 638–661.
Author
Ma Vang
Ma Vang is an Associate Professor of Critical Race and Ethnic Studies at the University of California, Merced. Her book History on the Run: Secrecy, Fugitivity, and Hmong Refugee Epistemologies (2021) examines how secrecy structures both official knowledge and refugee epistemologies about militarism and forced migration. She is a coauthor of Departures: An Introduction to Critical Refugee Studies (2022) and coeditor of Claiming Place: On the Agency of Hmong Women (2016). She founded the program in Critical Race and Ethnic Studies and is a founding member of the Critical Refugee Studies Collective.
Have Hmong Americans found home in the United States?
This module focuses on Hmong experiences with health care in the United States. It shows how Hmong Americans experience racism in health care through mistreatment and negative experiences, often based on the belief that their culture is not compatible with Western medicine. The module also discusses how Hmong Americans are navigating the health care system, practicing their ancestral systems of medicine such as asserting shaman and herbal healing beliefs, and bridging multiple scales of care for the health of the community. It explores how access to Western medicine and health care has saved many Hmong lives while also exposing Hmong as a whole to disproportionate levels of negative health outcomes.
What are the pressing health issues Hmong Americans are more likely to experience?
How are illness and health care access linked to racism in the United States?
What are the different ways Hmong Americans enact care that exists outside of—but may also be complementary to—the medical system?
Popular Images of Hmong
Health care for Hmong Americans has always been a topic of fascination for the American public, beginning with the group’s arrival in the United States in the late 1970s. In addition to various refugee health reports, Anne Fadiman’s The Spirit Catches You and You Fall Down (1997), documented the experiences of a Hmong family and the supposed “culture clash” with their American doctors in Merced, California, in their efforts to find the best care for their epileptic daughter, Lia Lee. Although the book was published in 1997, Lia’s story began in 1982 and has been read in numerous college classrooms and influenced cultural competency training in medical schools. The book has also spread misinformed and problematic ideas about Hmong culture serving as a barrier to medical care.
Popular television shows like Dougie Howser, M.D. (1991), Grey’s Anatomy (2005), and House (2012) devoted full episodes to exploring Hmong health as anomalies. In the Hmong-specific episodes of these series, the plots’ conflicts involve a culture clash between Hmong and Western medicine, representing Hmong noncompliance with their doctors’ orders as unfortunate and shameful. The typical resolution and overarching lesson of these stories assert that when doctors accommodate noncompliant Hmong people, it pays off because they are saved. There is no disruption to the institution of health care and medical training; instead, it is strengthened through its flexibility to include anomalies. The tragedy within these narratives—and many others in real life—are used as teachable messages for Americans to understand Hmong health care experiences.
Hmong People and Their Health Care Experiences
Health disparities for the Hmong adult population are largely related to health promotion and disease prevention. A lack of health data contributes to these disparities. According to the scant available data, hepatitis B virus, diabetes, and cancer are the main chronic diseases impacting Hmong American adults. According to Maichue Lor’s review of health studies for Hmong adults between 1975 and 2015, a high occurrence of hepatitis B infection exists.
According to a study on cancer incidence for Hmong in Central California, Hmong have higher age-adjusted incidence rates of cervical cancer, leukemia, stomach cancer, non-Hodgkin’s lymphoma, nasopharyngeal cancer, and liver cancer compared with Asian American and other groups. Increased risk and incidences of diabetes and gout are also prevalent health issues.
Even though the health issues themselves—such as diabetes, hepatitis B, and cancer—are not at all unique to Hmong people, Hmong experiences with these chronic diseases and other health issues have shaped their unequal access to health care and their disproportionately poor health outcomes. Many factors contribute to the difficulties of Hmong Americans’ health, including the following general categories:
- First, Hmong people sometimes mistrust American medical practices and their invasive treatments, as well as health care professionals’ lack of understanding about Hmong beliefs about health care. Hmong patients report a positive health care experience when their providers are kind and caring with a positive attitude, but they are less willing to seek care when they have experienced negative treatment by providers.
- Second, many Hmong people experienced substandard health care during the Secret War through USAID and International Voluntary Service agencies and in refugee camps through humanitarian agencies, including the United Nations. As refugees, they also experienced extensive health screenings before they could be eligible for resettlement to the United States or another country.
Video 11.05.01 — Footage of the education work at the Hmong Cancer Coalition 4th Patient Empowerment conference in 2017 in Fresno, California. The footage shows Hmong American health professionals and advocates leading workshops in the Hmong language to make cancer education more accessible.
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- Third, trauma from living through and escaping after the war produced significant mental health issues among the Hmong refugee population. According to Hmong American psychologist Alyssa Kaying Vang, we cannot talk about mental health for Hmong people without talking about the historical trauma from war and flight, trauma that has been internalized among first-generation Hmong and their American-born children. Intergenerational experiences of trauma are linked to historical trauma. In unpacking Hmong American mental health, Vang has explained that when trauma is decontextualized for a people, it is seen as that people’s culture. Therefore, Hmong American experiences with trauma and mental health struggles have been viewed as inherent to their culture.
Listen to
An excerpt from the Hmong Mental Health Podcast
Dr. Alyssa Keying Vang: Can you guys talk a little bit about what—your thoughts on historical trauma versus intergenerational trauma and psychological trauma?
Chu He: I think when we talk about historical trauma, it’s usually an event that has, you know, happened that has affected, you know, a lot of people, right? And so—not just families, but multiple families within a culture or within a society, however that is. And so this might be, you know, like war, this might be slavery, right? All those things are what I would consider more historical trauma.
Chu He: And then when I think about family trauma or intergenerational trauma, that’s more trauma patterns that are being passed down from families that might not necessarily fit for, like, the bigger group. So this might be, you know, family rules in the household where, you know, we don’t talk about things in the family. That might have been a trauma response at some point that has now become a family rule, right? That we don’t talk about stuff.
Chu He: And then psychological trauma, you know, I don’t know if you both—I’m just talking, if you guys want to go to, you guys are more than welcome. Whereas I think, you know, psychological trauma is something that—something has occurred to you, maybe it’s more like on an individual level, and now you are experiencing that trauma effect from it, right? So this might be, like, maybe abuse, this might be being assaulted, those instances where it’s more I think on an individual level and we’re thinking about your psychological state in that sense.
Mozi Tao: Yeah, to add on, something I’ve learned over the course of time about historical versus that intergenerational—one thing that I’ve learned that was interesting that I’ve picked up is that a lot of times historical trauma is looked at as being done to a group of people by an outsider, right? When we talk about oppression or slavery or war, right? That’s a dominant population or something like that happening or doing or causing some form of trauma to that group of people.
Mozi Tao: Whereas with that intergenerational trauma, a lot of the times it’s within that group of people, right? From one generation of parents to their children and from that child to their next children, right? So that’s within a group of people. And I think that’s a big distinction for us because when we talk about Hmong people, right? When we talk about that historical trauma, right? That’s very war-driven, right? And that’s very us being not the dominant group, right? But very a smaller group or a less population within society where or on the short end.
Mozi Tao: And I think when we talk then about that intergenerational trauma, it’s—it’s about how families and how over generations, Hmong people have dealt with that historical piece of not having a country or not being able to say we have land and then how we’ve adjusted and tried to live life. So for me that’s that distinction, right? That outside person versus the inside person.
Audio 11.05.02 — Therapists Alyssa Kaying Vang, Chue Her, and Mosi Thao discuss the differences between historical trauma, intergenerational trauma, and psychological trauma. For Hmong Americans, intergenerational trauma can manifest in how families navigate not having a country and being forcibly displaced.
- Fourth, the Western/American medical system and its individualistic approach to diagnosis and treatment is largely incompatible with traditional Hmong health practices, which are anchored in spiritual beliefs and community care. This systemic incompatibility, combined with language barriers between Hmong patients and their health care providers, has created perceptions within the health care industry and the American public that Hmong typically do not seek medical care, or at least not until they are already dying. And even when they do seek care, they purportedly do not comply with doctors’ medication regimens and other treatment plans. Indeed, concerns about medical compliance have been attributed to the “backwardness” of Hmong culture and beliefs. According to Lor’s review of health studies, the specific issues associated with language barriers include the lack of specific language for discussing cancer, hurtful experiences related to their status as English language learners, and inaccessible or poor-quality interpreters.
Partnerships for Health Care Access
Hmong Americans are changing the landscape of access to health care beyond the cultural competency model, where health and social service providers receive training to increase their cultural sensitivity and awareness when working with patients or clients. Rather than considering Hmong illness and treatment as a clash between two cultures or worlds, Alyssa Kaying Vang has called for “culturally specific care” to explain how the Hmong worldview of personhood is based on the connection between the body and the spirit.
Palee Moua is a remarkable Hmong woman who has advocated for culturally specific care to create more equitable access to health care. Her work bridges Hmong spiritual healing with the US health care system. Moua attended primary school in Vientiane, Laos, at a young age, learning both Lao and French. She arrived in the United States at the age of twenty with a young family and moved to Merced, California, in 1977 to reunite with extended family.
Early on, Moua realized that she and other Hmong women had to communicate family planning and women’s health issues through male interpreters. She wanted to help Hmong women access better health care. She took English classes at Merced College and started working at the local health clinic in its Women, Infants, and Children program. In this capacity, Moua became an interpreter for Hmong families. Moua explained that she became a community health equity and cultural advocate because Hmong people had died enough in Laos during and after the war, and she wanted to “help people not die” here in the United States.
Moua created institutional change in her roles for Healthy House, a nonprofit organization that promotes well-being and health in Merced, California, that was established to address the “culture clash” issues documented in Anne Fadiman’s book, as director of case management, cultural brokerage, and cultural services; as community liaison for the Shaman Project; and as an interpreter. She directed projects for the Building Healthy Communities Health Equity Project, the Human Services Agency of Merced County, and Behavioral Health of Merced County. In addition, Moua developed a Hmong glossary for health-related terminology, led a chronic disease community health education program, developed Partners in Healing, a shaman training curriculum, and trained interpreter trainers.
Partners in Healing
As the curriculum developer and trainer for both interpreters and the Partners in Healing programs, Moua advocated for centering Hmong knowledge and social context to effectively bridge communities with health and social welfare institutions. As of 2000, she has co-developed and currently leads Partners in Healing, a nationally known program created to train physicians and Hmong shamans to share health care experience and information. The shamans would learn about biomedical procedures and the doctors would gain knowledge about shaman healing practices. Partners in Healing developed a partnership between health care organizations and Hmong communities by implementing an orientation program for Hmong shamans.
The project has a dual curriculum: one program to train shamans and the other to train physicians as part of their three-year hospital residency. This program works in conjunction with the Hmong Shaman Spiritual Healer policy implemented at Mercy Hospital in Merced in 2009, which allows shamans to conduct nine different healing ceremonies at the patient’s bedside unsupervised by doctors and hospital staff. Throughout all of this, Moua has been the program’s anchor as she brokers and bridges relationships among shamans, doctors, and hospital administrators to operationalize curriculum.
Video 11.05.03 — This clip highlights the transformation from the racism Hmong Americans experienced in healthcare to a meaningful partnership between Hmong ancestral systems of medicine and western medical practices. Through Palee Moua’s advocacy, shamans are respected as partners in the Hmong healing journey.
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Palee Moua’s work demonstrates that health care for Hmong people requires care that is collective and centered in Hmong practices and beliefs. Language access is one barrier for first-generation Hmong to receiving proper health care, and interpreting services have been important to bridging that gap. But language access issues in training interpreters can still occur due to the perception that the Hmong language does not have terms for certain illnesses or medical procedures. This perception is rooted in the belief that a written Hmong language was only developed in the 1940s and 1950s, and it erases the fact that this seemingly more recent development is centered on the Romanized Popular Alphabet (RPA).
In fact, Hmong writing systems existed prior to this moment but were destroyed through encounters with Chinese imperialism. As a result, it is assumed that there are no direct Hmong words for concepts like “depression” or “cancer.” For this reason, Moua’s work in training interpreters involved producing a terminology booklet for interpreters. It also involved orienting interpreters in relation to patients, so that they use kinship terms like “aunt,” “uncle,” “grandmother,” and “grandfather” to create a collective care environment. This “language of care” highlights the abundance of the Hmong language and how community relations between the interpreter, patient, and doctor can enhance the experience of health care for Hmong Americans.
Community Organizations
Furthermore, community organizations have sought to provide mental health support for the older adult Hmong population. The Fresno Center in California was founded in 1991 to help Southeast Asian refugees who were primarily Hmong but also included Cambodian, Lao, Thai, and Vietnamese people who resettled in Fresno. The organization worked with the Office of Refugee Resettlement to help refugees transition to life in the United States. To this day, it provides mental health and food services, education, training, and other services.
The organization has also spearheaded a community garden project to provide culturally sustaining mental health support and engagement for Hmong Americans. Gardening would help relieve stress while also providing food in this agriculturally rich region of California, which paradoxically can also be a food desert for low-income communities.
Video 11.05.04 — Dr. Ghia Xiong explains The Fresno Center’s Community Garden Project as a way to connect people and provide mental health support. Gardening allows Hmong participants to engage in traditional cultural practices while promoting wellness, especially among the elderly.
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Still, some Hmong Americans point out that disabled and queer folks experience difficulty in seeking wellness with both Western and Hmong medicine. Using a Hmong disability and queer lens, Nancy Yang, who identifies as neurodivergent queer and a shaman, explains that there is a lack in language regarding disability, disability justice, and disability issues. Therefore, queer disabled Hmong folks keenly experience the racism and ableism of the US medical industrial complex, including mental health services, and the erasures of queer identities within Hmong traditional medicine.
Learning about Hmong experiences of health care provides an important lens to understand medical racism, the need for culturally relevant care, and how Hmong Americans enact care. In addition to health, this chapter has discussed the themes of Hmong history through storytelling, Hmong involvement in the Secret War through soldiering and secrecy, organizing practices around being a people and intersectional inequalities, and access to education. These themes help us understand Hmong lives as complex and dynamic. It also helps us to understand that home is both a physical place and the ongoing practices to negotiate how we belong to each other.
Glossary terms in this module
intergenerational Where it’s used
[ in-tur-jen-uh-ray-shuh-nuhl ]
Involves or refers to something that occurs across two or more generations.
resettlement Where it’s used
[ ree-set-uhl-muhnt ]
The transferring of refugees from an asylum country to another state, where they are ultimately given permanent residence.
Glossary terms in this module
intergenerational Where it’s used
[ in-tur-jen-uh-ray-shuh-nuhl ]
Involves or refers to something that occurs across two or more generations.
resettlement Where it’s used
[ ree-set-uhl-muhnt ]
The transferring of refugees from an asylum country to another state, where they are ultimately given permanent residence.
intergenerational
[ in-tur-jen-uh-ray-shuh-nuhl ]
Involves or refers to something that occurs across two or more generations.
resettlement
[ ree-set-uhl-muhnt ]
The transferring of refugees from an asylum country to another state, where they are ultimately given permanent residence.
