In 1989, students in the People’s Republic of China (PRC) marched for democracy and an end to government corruption. They held Tiananmen Square and the world’s attention for many weeks before martial law was declared and the demonstrations were ended in bloodshed. In the midst of that push for social change, three men from Hunan Province made their way to Beijing and the heart of the protests and threw 30 paint-filled eggs at the iconic portrait of Mao Zedong. Their act of self-expression in prior times would have cost them their lives. However, in the cases of Lu Decheng, a bus mechanic; Yu Zhijian, a teacher; and Yu Dongyue, an arts editor with the Liuyang Daily, this act would exact a high price.

Denise Chong’s “Egg on Mao: The Story of an Ordinary Man who Defaced an Icon and Unmasked a Dictatorship” follows Lu Decheng and his two friends as they live ordinary lives. They are caught up in the euphoria of the political movement and imagine that their defacing of Mao’s portrait would spark a rebellion against autocracy.

Rather, to their surprise, the demonstrating students at Tiananmen Square not only put them under citizens’ arrest but confiscated all their possessions and disavowed any connections. The students were struggling to keep the movement “pure” of hooliganism and want to show their actions as within the purview of citizen actions in the country. They explain, “Tiananmen Square is the important flag of the national student movement and if we fail here then we will fail in the whole country.”

In a controlled state and a surveillance society, the Chinese police and Public Security Bureau are quick to quash any signs of outright defiance, even symbolic acts.

Lu Decheng was born into a worker family and raised mostly by his grandparents. He had a difficult relationship with his father, Lu Renqing, who married the cold-hearted Meilan after Lu’s mother’s death in her 20s.

Even as a youth, Lu was rebellious. He dropped out of school young (just after finishing middle school and a year of apprenticeship), had an affair with Wang Qiuping and a young son who died shortly after his birth, and then found work at the Liuyang Long-Distance Bus Company. During his tumultuous youth, he had run-ins with those trying to enforce the later-marriage and one-child-policy laws of the PRC. He had a feud with a colleague at work, whom he tried to poison with pesticide in his colleague’s thermos.

After the arrest of the three, they are charged with “counterrevolutionary propaganda and incitement, counter-revolutionary sabotage, writing reactionary slogans, and destruction of state property.” In short order, they are found guilty of political crimes through China’s court system and sentenced to between over a dozen years to life in prison.

From there, their lives unravel to mental illness, divorce, and more run-ins with the pervasive bureaucracy. Lu uses his time in incarceration to read and to try to better understand the social and political problems of his society; he tries to maintain a sense of personal dignity in the midst of his struggles. Even in prison, he hears of the collapse of Communist regimes in Eastern Europe and takes heart.

Egg on Mao reveals some of the social rifts between the different groups in China—peasants, workers, students, and intellectuals. It also highlights the patterns of family strife and competition so often described in ancient Chinese literature.

Chong’s descriptions of Lu’s jailers’ strategies to try to get him to recant his political stance and demonstrate his new thinking are intriguing—and show a side of China’s entrenched prison system that is less harsh (in small ways) than those described during the Cultural Revolution.

Egg on Mao is told in flashbacks and snippets, much like collage prose. Chong evokes how this “egg on Mao” incident occurred without attributing grandiose concepts to the three men. She shows well the way power moves in the People’s Republic of China and the invisible lines that are crossed at citizens’ peril.

Lu Decheng now lives in Canada with his second wife and young son. He was released after almost nine years in prison and was contacted by a network supporting dissidents. With their help, he was resettled abroad. Author of The Concubine’s Children and “The Girl in the Picture”, Denise Chong is a writer living in Ottawa, Canada.

Further, Huang suggests that policy changes in the 1990s have had a less salutary effect on the society—with greater disparities between living standards, more pervasive corruption and crony capitalism, and less access to economic opportunities without guanxi (strategic relationships). Without funding a more supportive social safety net for the aged and the infirm, improved healthcare, and quality education for all, the society that the Chinese government is building will become even more imbalanced, he suggests.

This researcher candidly describes the elusiveness of accurate economic data—even as he pored over decades of official bank documents, official speeches, and government data.

He quips: “Here is one major difference between researching (the) Chinese economy and researching (the) American economy. In studies of American economy, scholars may debate about the effects of, say, ‘Reagan tax cuts.’ In studies of the Chinese economy, the more relevant question would be, Did the government cut taxes in the first place?” Huang Yasheng is an economist’s economist—with a thick flow of statistics, detailed minutiae, and macro-level analyses.

These differences stem from a variety of challenges. One may be a problem of a developing field in a closed country with socialist values trying to compete and integrate with a global marketplace. There are difficulties defining terms like township and village enterprises (TVEs) and how they manifest and even what they are. The government reliance on inflated numbers at all levels means a lot of “play” in the data. There are convoluted ownership structures. The record-keeping is medieval. There’s plenty of purposeful obfuscation and a cultural penchant for secrecy and protectiveness against foreigners and non-insiders who want to know information.

A similar sponginess exists in the conventional view that unique “context-specific local insittutional innovations, such as ownership by the local state of township and village enterprises (TVEs), decentralization, and selective financial controls” may be credited for China’s advances, while “private ownership, property rights security, financial lbieralization and reforms of political institutions, are not central compoentns of China’s growth story.” Huang would argue that radical changes in Chinese policies in the 1980s did in fact use classic growth maneuvers by encouraging private entrepreneurship in rural China in non-farm sectors, promote financial reforms to funnel credit to the private sector, to strengthen some property rights, to project policy credibility, and to move in the direction of poltical liberalization.

This economist very much favors the rural model of entrepreneurship over the urban “Shanghai model”. China’s peasantry and rural families, while traditionally disenfranchised and disempowered, have found a high powered ally in Huang, who asserts categorically: “When and where rural China has the upper hand, Chinese capitalism is entrepreneurial, politically independent, and vibrantly competitive in its conduct and virtuous in its effects. When and where urban China has the upper hand, Chinese capitalism tends toward political dependency on the state and is corrupt.”

This author argues eloquently for the importance of encouraging entrepreneurship by codifying more open-market laws and practices. Under Mao Zedong, those who would engage in entrepreneurial activity risked arrest and worse in the country’s dark gulag system. He writes of changes in the 1980s, with no sense of irony, “Imagine the incentive effect changing from an equilibrium in which a would-be entrepreneur faced instantaneous arrest to one in which this was no longer an automatic risk.”

The residual effects of Maoist ideologies have disappeared in many parts of the Chinese economy. The country’s coastal cities have blossomed; there are numerous miles of highways and a budding middle class, with their own homes and even cars. There are some property rights. A budding legal system exists although there are still many credible assertions of the power of people overruling the power of law. Nepotism still holds wide sway in the country, and corruption and bribery are endemic, according to numerous press reports.

However, the “commitment problem” still exists. “The political system, then as now, imposes no institutional constraints on the rulers to renege on their promises. The commitment problem, as political economists know very well, is massive in an unconstrained political system.”

In this gutsy work, Yasheng Huang suggests that China is fast-moving towards a kind of Latin American capitalism with huge class inequities. While he finds hope in some of the liberalism expressed by the Seventh Party Congress in October 2007, he sees the political system as self-serving and less concerned about its citizens.

In the 1980s, economic reform benefitted those in the countryside and originated there. Chinese economic reform then was an “overwhelmingly rural affair” and very much “a poor man’s affair.” No more: current advancements go to those with more social ties, money, education, and technological savvy—and those in the countryside are getting left behind.

The challenges that China’s leaders face are mind-boggling—with policy effects that ripple through a fifth of the world’s population and have spillover effects on the rest of the world (particularly in terms of pollution, potential international strife, trade wars and volatile money valuations, and geopolitical competition). Any missteps have the potential for a true and deep luan or chaos that has been such a traditional fear.

At heart, Yasheng Huang analyzed what worked in terms of Capitalism with Chinese Characteristics—and he thinks the leaders of the 1980s got a lot of it right.

—Niall Ferguson in “’Chimerica’ is headed for divorce” (Aug. 15, 2009, in Newsweek)

If the “marriage” metaphor between China and the US is to be described further, it would be a bare-knuckled relationship of raw interests and not any true meeting of minds or hearts. The honeymoon in this marriage of convenience is long over, and the next stop may be dissolution.

So goes the current news analysis, just as Zachary Karabell’s “Superfusion: How China and America became One Economy and Why the World’s Prosperity Depends on It” is released for publication.

The essential contention of this book is that China and the US have fused into one symbiotic “hypereconomy,” whose trade exchanges, lending and borrowing, and mutual consumption have serious implications for the world economy. The recent economic meltdown in the US and serious government efforts to stave off a total economic disaster revealed the nation’s economic Achilles’ heel but also China’s mixed motives in buying up US debt.

While the financial shoring up was welcome, many in the American government and military establishment eyed this move with even greater alarm, as yet another piece in the accruing of Chinese power. Karabell describes the view: “The Chinese have a fetish for sovereignty and are susceptible to delusions of national grandeur and to an unrealistic sense of their own limitless potential.”

It certainly didn’t help when the Chinese have been using their new-found economic might to shore up their military, and particularly their naval capabilities, which are seen as having the potential to challenge US forces in the Pacific. Their space capabilities also have been causes for concern. There have long been rumors that a majority of Chinese intelligence assets have been deployed against US commercial, research, and military interests.

The author offers a cogent and brief overview of recent Chinese history and the prescience of the late esteemed pragmatist Deng Xiaoping in opening China to the West and to market reforms. The gradual movement from state-owned enterprises to more free-market enterprises was guided by the brilliant Premier Zhu Rongji, who also presided over the mass migration from the countryside to the cities of a large portion of the Chinese population. He also oversaw China’s ascension into the World Trade Organization, and also witnessed the launch of the domestic stock market. The Chinese reform was a controlled one, in direct contrast to the collapse of the Russian economy in its changeover from a government-controlled one to a free-market one.

Without the changes to information technology and the popularization of the Internet and WWW, the ability of “new economy” of such global close alliances would not be possible. The global supply chain of products that enable the lowest-cost, highest-quality production requires the real-time communications of the Net to mitigate distance and time.

Karabell described the start-and-stop challenges of some major American companies in entering the Chinese market—from the examples of KFC, Avon, Fed Ex, and other brand companies. He showed how these companies adjusted to unexpected shifts in the Chinese leadership and their policies and still managed to thrive. He argues that, contrary to the Japanese populace, the Chinese one is a nation of consumers—based on their attitudes towards gambling (pro) in contrast to the Japanese mentality.

This author does not play down the differences in cultures and values between Chinese and Americans. He offers a litany of flashpoints between the two nations in terms of politics (Taiwan, investments in Africa with despotic governments), culture (Chinese secretiveness vs. American “openness”), ways of doing business (a lack of respect for intellectual property in some cases in the PRC, the pervasiveness of corruption), and fairly recent clashes, often related to the military (the forcible downing of a US spy plane onto Chinese territory after a crash with a Chinese interceptor craft, the accidental NATO bombing of the Chinese embassy in Yugoslavia).

China has been criticized for its ramp-up in economy and evolution into a car-based society, which has led to further environmental degradations.

Still, China has come a long way in creating a safer business environment for global investments, with laws codifying and protecing property rights, for example, and some endeavors towards environmental health.

Not all are in agreement that China should invest in the US, which is seen by many Chinese to be an over-extended, hegemonic, and fading power. Some in the Chinese leadership are asking for a move away from the greenback as the global tender of choice.

This author, while he generally glosses over the strains in the China-US economic alliances, soberly points to the US need for credit as its potential future downfall. He suggests that this nation may have to give up its superpower status as a bargaining chip for cash to keep functioning, given its undisciplined fiscal policies and citizen spending beyond their means.

Karabell is president of River Twice Research and senior advisor for Business for Social Responsibility. He has authored several other books on socio-political issues. He worked for years managing an investment fund related to China-based companies.

Ralph J. Lee, the Regional Director of the Seattle Region of the U.S. Census Bureau.

The year 2010 may prove challenging for the new US Census. Many individuals have been displaced from the economic upheaval of the multi-year recession. The greater emphasis on enforcing immigration laws—in a new homeland security environment—has meant a growing lack of trust of government among some.

With a Census that occurs every decade, the federal government relies on this full count of its population for distributing congressional seats (in the US House of Representatives) among the states and for distributing federal funds. These funds support critical infrastructures, such as hospitals, schools, public works projects (like roadwork), emergency services, job training centers, and senior centers.

“More than $400 billion in federal funds is distributed each year to states based on Census data. States and local governments and businesses use Census data for planning roads, schools, emergency services, and business opportunities,” observes Ralph J. Lee, the Regional Director of the Seattle Region of the U.S. Census Bureau. Lee oversees the data collection for program surveys and the 34 local offices administering the decennial Census for the Seattle Region, which includes Alaska, Washington, Idaho, Oregon, and Northern California.

It is not only the federal and state governments that use Census data. Many organizations and businesses use Census information for supporting particular causes, planning for disasters, hiring skilled workers, researching potential markets, and promoting public health and preventing diseases.

The Census Questionnaire

This new Census questionnaire is the shortest in the Census Bureau’s history, with ten questions, such as “name, age, gender, race, Hispanic origin, and home ownership,” said Lee. The Census does not ask about the citizenship status of the respondents; however, since the first census in 1790, it has counted everyone living in the U.S., both citizens and non-citizens.

The collected information will be released in anonymous aggregate statistics.

“The Census Bureau is bound by law to protect the confidentiality of the data. The Census Bureau cannot share individual responses with any other agency or law enforcement organization,” said Lee. All Census employees have to take an oath of non-disclosure to protect the confidentiality of the data. The main goal is to count everyone “once and in the right place.”

To ensure the completeness and accuracy of the Census, the US Census Bureau follows “strict standards and procedures,” said Lee. In 2009, the Bureau verified all existing addresses on their list—with updates from state, local, and tribal governments. The questionnaire is available in five languages in addition to English: Spanish, Russian, Chinese, Vietnamese, and Korean. The Communications Program integrates media advertising and targets outreach to specific populations to ensure there is full participation amongst the diverse communities throughout the nation. Their site reports their launch of a $300 million advertising campaign to rally participation for an accurate count.

Risks of Undercounting APIs

With many educational, healthcare and social service budgets pared down, the risks of under-counting in the Asian Pacific Islander community have many worried.

Linh Ngo, Asian Pacific Islander Community Leadership Foundation (ACLF) Program Class Member 2009 and Interim Census 2010 Project Manager, said that ACLF has been working to increase the likelihood of APIs to complete the Census by addressing API barriers and by increasing awareness of the Census. They conducted community focus groups among Chinese, Filipino, Hmong, Japanese, Lao, Mien, and Vietnamese ethnic groups to identify barriers to completing the Census. They identified prevalent myths and facts and disseminated this information through a traveling display and on their website; these details have been translated into eight languages: Cambodian, Chinese, Korean, Laotian, Tagalog, Thai, Samoan, and Vietnamese. ACLF has also hosted a variety of outreach activities, trainings, and events.

Ngo suggests that the Census is particularly critical for communities of color for “voting power” and to “analyze the impacts of a growing, diverse US population.” Asian Americans have the largest ethnic population “that has non-English speakers, meaning (that) translated materials are important as well as languages courses,” she said. Bilingual services, public safety, early childhood education centers, English learning programs, public libraries, and student loans, all may be affected. Community services that serve elders in the community are funded in part by federal dollars, which are affected by Census numbers.

Christine Loredo, Marketing and Communications Supervisor for the International Community Health Services, said, “For organizations like ICHS, which rely on federal, state, and local funding, the Census can have a potentially big impact on our ability to provide affordable health services.” She noted that the Census Bureau has been working to build trust with the API communities to promote an accurate count. In the 2000 Census, it is estimated that 4.5 million people went uncounted.

The Census Form may be previewed online at http://2010.census.gov/2010census/how/interactive-form.php; however, for 2010, it must be a unique bar-coded form that must be completed and returned by mail. People will be able to get help at official Be Counted sites particularly if they did not receive a form in the mail or were not included in any other census form. Questionnaire Assistance Centers (QAC) may assist those who need language assistance. Language assistance guides may be accessed at http://2010census.gov. QAC and Be Counted sites may be identified via the Regional Census Center at www.2010.census.gov/partners/pdf/censusRegionMap.pdf.

2010 Census Myths and Facts:

Myth: “I DO NOT need to fill out the Census because I am not responsible for the mail. My spouse and/or children get the mail. If they bring the mailed form to me, then I will fill out the form. If they do not, then I do not need to fill it out.”

Fact: It’s the LAW! No matter who gets the mail, EVERYONE is required to fill out the Census. The Census is a count of everyone living in the United States including Father, Mother, Sister, Brother, Children and extended familiies in the same household

Myth: “I do NOT need to fill out the Census because I cannot read or write in English.”

Fact: It’s culturally sensitive! The Census will be available in most dominant languages/dialects. There will be members in your community that can help you fill out the Census.

The boy, Leap Forward (Yuejin), is the much-beloved child of a musician father and an educated mother, but his father passed on when the boy was only five. He keeps silkworms and crickets. He spends his days with his best friend, Little-Little (Xiao-Xiao). They are both children of musicians, and their housing in this same hutong reveals the government hand in clustering those with like backgrounds into neighborhoods.

The two friends have interesting philosophical discussions, such as whether birds choose which notes to sing, with Xiao-Xiao musing: “They just sing the music that’s in them. That’s all they can do. It’s as simple as that.” They talk about the Russians sending people to the moon. They talk about their near-constant hunger.

They make and fly kites as friendly competitors. As an aside, he recalls how people would write messages on the tails of their kites before Chairman Mao, before self-expression meant potentially severe political and personal danger. He continues: “My mother remembers flying them in the winter with her Russian friends, when she was a little girl. They all wore fur coats, so they didn’t feel the cold.”

One day, his friend sets a clever trap and captures a beautiful yellow bird, which Leap Forward takes as his own. He gets his sister’s boyfriend (Clear Waves) to build him a cage for her. In school, he brags about her to his friends and is asked whether he’ll teach her the patriotic political songs they have all memorized. His teacher chides him for writing with his left hand, so he’s forced to use his clumsy right one.

Among his classmates, he’s a bit of a dreamer. He has a crush on a beautiful girl named Blue (Lan). Lan’s family lives in the journalist compound. “I had never been inside a writers’ compound before, and had imagined the walls to be covered with newspapers—the black print still wet, rubbing off on my finders—the sound of a hundred tapping typewriters filling the air.”

Leap Forward and Lan’s romance and friendship grow even as the politics of the Great Proletarian Cultural Revolution heat up. Leap Forward’s mother wistfully remembers her friendships with her foreign Russian friend but knows that the xenophobic turn in her nation’s politics will disallow any sign of that former friendship.

Leap Forward, named ironically after the disastrous policies of the Great Leap Forward (1958 – 63) that resulted in mass starvation, starts learning some core truths of his life and times through his pet bird, who has never sung one note while in captivity. His philosophical friend Little-Little asks him: “Wouldn’t you rather be free, just for a day, than spend a lifetime in a cage?”

Artist Helen Cann’s lovely, patterned images bring Leap Forward’s experiences to charming life: a boy standing with his father, who is holding an erhu; a tender mother looking in her son’s face; boyhood friends mingling on a busy street; children playing in a traditional schoolyard (from an aerial view), and childhood friends walking on a street teeming with Red Guards posting political tracts. Black-and-white photos of the author and his friends are included in the Afterword.

Little Leap Forward offers a touching boy’s view of the Cultural Revolution as the backdrop for his growing-up years.

Guo Yue and Clare Farrow are married and have two children. They live in London. Illustrator Helen Cann lives in Hove.

“Little Leap Forward: A Boy in Beijing”, by Guo Yue and Clare Farrow. Illustrated by Helen Cann. Cambridge: Barefoot Books, 2008.

Powerfully illustrated in full-color hand drawings, Mao and Me strives for realism both in the words and the images, without much of a shielding overlay of any childhood enchantment.

This story opens in 1966 in a large, unnamed industrial city of China’s north (the author was born in Tianjin). The narrator is a little boy living with his two sisters, their parents, and grandparents.

He describes with fondness his grandmother’s cooking, especially her noodle and jiaozi specialties. His grandmother raises chickens in the courtyard, and the family has a pet cat named Hu-Hu. Grandfather would practice tai-chi in the courtyard and argue with his friends about whose caged bird was more beautiful.

His older sister was a deaf-mute who would share her sign language learning with her little brother.

He played with his hand-me-down wooden blocks, and when he exhausted of ideas, his grandfather would exhort him: “When one has truly understood something, a single thing, then one is able to understand everything.”

Mao and Me continues with real-world aspects of life there, with its electrical shortages, the hand-me-down clothes from his sisters, and the use of a tub to share a bath.

Into this simple but joyful life comes a radio announcement of their supreme leader Chairman Mao’s announcement of a Cultural Revolution, the violent over-turning of a feudal cultural way of life, to make way for a more communist China.

Savvy to the different social changes, his grandparents destroy precious old photographs. People start reading and memorizing Chairman Mao’s Little Red Book, which was the only text that could be read. The youthful Red Guards visited their peaceful courtyard to burn books and destroy ancient objects.

The little boy himself starts wearing Mao’s smiling visage on a medallion around his neck. In the park, the Chairman Mao statue has been raised up with a gesture of openness and smiling beneficence.

As the political turmoil deepens, the children become hungrier and hungrier. The adults use ration coupons to get access to bare staples. And the types of food available becomes less and less. A kindly neighbor who shares candy with the children and plays music for them is taken away by the Red Guards, tortured in public, and disappears, never to be seen again.

The political dangers touch the family even more intimately, when his father is “sent down” to the forests of Heilongjiang on the Russian border.

For comfort, this little boy begins to draw. Because of the lack of paper, he draws on the floor with a pencil stub.

In 1970, he is 7 years old and starts school. The first phrase he learns is “Mao is our salvation.” His education is part of a nationwide campaign to promote a cult of personality around their “great leader.” He learns to “confess”: “Every morning in front of a portrait of Mao, with his Little Red Book held over our hearts, we had to make a self-critique, listing our good and bad actions of the previous day. We also did daily eye exercises and gymnastics. We had to train our bodies in order to be able to protect our country.” He watches movies about evil landlords and at 8 years-old, he is inducted to be a Little Red Guard. He loses his grandfather to death, and shortly thereafter, the Red Guards come and kill his grandmother’s chickens—potentially because they represent any sign of independence of the Party or reveal some sign of entrepreneurship.

This text concludes with Chairman Mao’s death in December 1976 and the return of his bedraggled father a year later, when the author was 13. His father brings him a four-set volume of sayings by Chairman Mao as a gift. His drawing talent led to his studying art in Beijing.

He concludes subtly, “For a number of years now I have lived abroad, but I return to China regularly to see my family. My parents have not moved. The city of my childhood has changed a lot, yet my apartment building has stayed the same and the tree in the courtyard is still there.”

Mao and Me, evocatively illustrated with ink, watercolors and calligraphy, shows an innocent child’s view of Mao and his service to this leader in his childhood.

Chen Jiang Hong doesn’t mince words about the suffering that many Chinese experienced in this succession of political movements over a decade, but his use of a child’s framework simplifies the horrors and losses. And, ironically, a small affection for the country’s supreme chairman seeps through the book.

“Mao and Me” by Chen Jiang Hong. New York, Enchanted Lion Books, 2008.

Risk factors include being age 45 and older, having a close family member with diabetes, heart disease, high cholesterol levels, obesity, and not getting sufficient exercise. Those who have dyslipidemia (low HDL cholesterol and a high triglyceride level) are also at risk. Those with hypertension (blood pressure of 140/90) are also at heightened risk of diabetes. For women, having gestational diabetes or delivering a baby weighing more than 9 pounds are risk factors, as is having polycystic ovary disease. About 11 percent of Americans adults (24 million) have diabetes. Asians and Pacific Islanders are named in the ethnic groups at particular risk of diabetes, with 1.4 times the risk as white Americans.

What is Type 2 Diabetes?

Type 2 diabetes, which is the most common type, occurs mostly in adults—although young people are increasingly diagnosed with this disease. Type 2 diabetes is associated with insulin resistance or the body’s inability to effectively use the insulin created. The pancreas often does not make sufficient insulin to maintain normal levels of blood glucose.

High levels of glucose in the blood may cause a number of symptoms: blurry vision, fatigue, frequent urination, hunger, weight loss, increased appetite, and excessive thirst. Type 2 diabetes may occur gradually and without any symptoms at all. Diabetes-related complications include blindness, heart disease, kidney failure, and limb amputation.

Type 2 diabetes may respond to doctor-prescribed oral medications, proper exercise, and a healthy and balanced low-fat, low-sugar diet. Health interventions also include careful testing of blood glucose levels, foot care, proper medication use, and proper exercise and diet. The diagnosis of Type 2 diabetes means a lot of life-changes, not least involving food.

Food Substitutes

Making dietary changes may be difficult because of lifelong eating habits and comfort foods. Luckily, there is not one set diet for those with Type 2 diabetes but the application of disciplined eating tailored to the individual and dependent on how the individual’s body responds to the changes. Essentially, a healthy diet involves moderate eating on a consistent schedule, and the monitoring of carbohydrates (which directly affect blood sugar levels), and avoiding sugars and fats. Various mainstream health sources advise diets that emphasize vegetables, fruits and whole grains; they emphasize moderate portion sizes. Alcohol should only be consumed very sparingly and with caution because of the often high caloric content and the body’s response to the alcohol, which processes it similarly to fat.

Janet L. Kapp, a Registered Dietitian and Certified Diabetes Educator, suggests that it’s not realistic to eliminate certain foods entirely. People need to be able to eat foods that are important to their culture and well-being. Rather, she advocates portion control of foods that have the highest impacts on blood sugar levels. People with Type 2 diabetes need to eat regular portions on a regular schedule. They need to reduce saturated fat to reduce the risk of heart disease (since those with diabetes are at higher risk of heart disease).

“Sweets and other treats can be ‘traded’ off for other carbohydrate rich foods once in a while,” she said. Alcohol may be contraindicated by medications treating Type 2 diabetes and so should not be consumed without medical consultation.

A professional registered dietitian may help individuals create a workable healthy eating plan. Personal preferences are important to mention when talking with a dietitian. Risks to avoid involve bingeing or over-eating, such as during celebrations, vacations, parties, holidays, or dining out.

“Grain fiber is important. Instead of processed or refined grains such as polished white rice or the Chinese white steamed buns, International Community Health Services (ICHS) nutritionists encourage our diabetic patients to incorporate more whole grains into their diet such as red, black, or brown rice, and to replace traditional white noodles with soba noodles,” said Alice Chiu, a certifier for the ICHS Women, Infants and Children (WIC) Nutrition program.

Another strategy is the use of so-called “exchange lists” of equal food servings—based around the basic food types (starches, fruits, dairy, meat), and these exchanges are similar in the amount of carbohydrates, protein, fat, calories, and fiber. Consuming one item may be equivalent to consuming another and may offer more dietary variety. It is advisable to have a wide variety of foods to maintain proper nutrition and weight.

People with Type 2 diabetes should work with their physicians to ensure that their disease is being treated properly and with the appropriate medicines and advice. Sufficient exercise (and proper weight loss for those who are overweight) may delay or prevent Type 2 diabetes. People’s bodies respond differently to different interventions. Having the advice of a health professional is also helpful for determining a proper diet in order to manage a chronic disease which affects many but is often very manageable with the right interventions.

Alice Zahler, an ICHS Community Advocacy Supervisor, addressed some common myths about diabetes. “One of the major ones is that you have diabetes because you ate too many sweet/sugary foods. Sugary foods definitely have an effect on your blood sugar, but they are not the cause of diabetes and it takes more than just cutting sugary foods to manage diabetes well. Also, many Chinese believe that pumpkin is good for diabetes, but as a carbohydrate it actually raises blood glucose. In fact, many popular Asian root vegetables are starchy and high in carbohydrates.”

ICHS provides diabetes education classes and monthly free support groups, with courses taught in Cantonese, Korean, Mandarin, Samoan, Tagalog, and Vietnamese. This organization also offers one-on-one consultations to support “workable lifestyle changes.” ICHS also has a series of “Healthy Asian Recipes” cookbooks (in Chinese, Vietnamese, Korean, Tagalog, and Khmer) that are available on their website (http://www.ichs.com/index.php?page=Publications).

Disclaimer: This article is for information only and is not any kind of health or medical advisement.

The History of Asian American Fare

Asian foods were first introduced to the US with the arrival of Chinese laborers in the 1850s to California, and most of their creations were consumed by the male migrant laborers in their ghettos. This cuisine became more popularized in the 1920s among Jazz Age cosmopolitan youth. However, it wasn’t until World War II that Chinese and Japanese foods entered the mainstream. Then, in the 1970s, the influx of Vietnamese, Hmong, and other Southeast Asians introduced yet other peoples’ food traditions to the US.

The website, Asian Nation (asian-nation.org) separates the various Asian food origins into larger regions. The southwest style includes foods from India, Pakistan, Sri Lanka, and Burma (described as flat breads, kebabs, mutton, rice and beans). The northeast tradition stems from China, Korea, and Japan—with a focus on rice, meat stir-fried with vegetables, stews, and various raw fish. The southeast style hails from Thailand, Laos, Cambodia, Vietnam, Indonesia, Malaysia, Singapore and Brunei (for example, stir-fried, steamed, or boiled foods seasoned with herbs and citrus juices).

The foods of a place and a people evolve from the local wild animals and crops, domesticated food animals and crops, the local climates, and human ingenuity. Foods are prepared in numerous ways—roasted, boiled, baked, stir-fried, steamed, or left raw—after various preparations with sauces, cuts, and intermixing of ingredients. People’s palates are informed by their childhood foods and food experiences and then their sense of adventure as they are further exposed to the world.

The Americanization of Asian Fare

The Americanization of the traditional Asian diets has resulted in the infusion of more meats, deep fried foods, and food colorings into the various dishes. Some menus in restaurants offer Americanized dishes for those who speak English but offer more traditional fare to those who speak the local language or know to request particular foods.

High delicacies—those with medical potency, unusual flavors, elusive ingredients—never appear on any menus. These would include stewed brain, deer antlers, shark’s fin, bird’s nest, and ginseng-based stews, for example. Other dishes which would not appear would likely be those that would not directly appeal to the mainstream palate—like cooked loaves of fat, sliced thin, and topped with spices; deep-fried frogs; syrup-covered deep-fried bananas; stir-fried silkworm larvae; bean-filled lollipops, or shapeless Northern Chinese-style baozi.

Those who travel to Asian countries would be hard-pressed to find similar fare in their restaurants or street food vendors. While the Asian Food Pyramid from the USDA and HHS shows more of a focus on primary foods such as rice and noodles and vegetables, with meat eaten more rarely, Asian American diets have aligned with the mainstream American ones sufficiently to change the health effects of the larger consumption of high calories, animal meats and fats, and sugars.

While traditional meals were occasions for socializing, ceremonial events, and business meetings (think of feasts and hot-pots), the Asian American approach has involved fewer interactions, as a reflection of a more individualistic and less communal lifestyle. The focus on efficiencies in American fast-food preparation has meant a greater use of pre-packaged foods. The focus on value has resulted in the increasing amount of food portions.

The federal focus on food safety means that few of the vibrant street foods found at vendors and open-air markets throughout Asia exist stateside.

Also, inventive Western cooks have made foods that have little tie-in to actual formal cuisines of Asian countries. There are widespread mentions of how fortune cookies came from Japan, not China. “Chop suey” is a Western creation of odds-and-ends, not something that typical Chinese would go to a restaurant to eat. Many adaptations may be localized ones and are influenced by the backgrounds of the various cooks.

Jennifer 8 Lee, author of “The Fortune Cookie Chronicles”, makes the point that there are numerous types of fusion Chinese food that she encountered in her around-the-world search for Chinese food for her book: French-, Italian-, British-, West Indian-, Jamaican-, Middle Eastern-, Mauritian-, Indian-, Korean-, Japanese-, Peruvian-, Mexican-, Brazilian- and other cultural amalgams.

Fusion Asian American Cuisine

Fusion refers to the combination of culinary traditions. While these approaches were initially more common in high-end chi-chi restaurants, Asian American fare has been a favorite for such mixing and matching. Now, such practices have become much more popularized in populist restaurants and even in airport eateries and the frozen-food aisle of the local grocery stores.

Different types of rice (and flavors of rice) may be integrated into sushi. Northern-style flavored meats are used for the Southern influenced dimsum. Salads are topped with a nori-topping and miso-influenced dressing.

Fusion itself is all about mix-and-match based on the chefs’ inspirations and diners’ palates.

There are deep-fried salmon rolls dipped in Chinese hot-mustard sauce. Lamb basted in hot Korean spices. Jiaozi dumplings filled with seafood mixtures. Spring rolls filled with crabmeat. Fusion cuisine is about mixing and matching. What fuses well then is a matter of taste and aesthetics.

I “fuse” (as an amateur) at home when I mix ingredients for different effects (or because I don’t have the core ingredients at home). And my Pacific Northwest palate has been honed well to the nuances of Asian American fare, so when I come across an interesting mix (mix-up?) at a local Midwestern eatery, I have to remember where I am and call it good (and maybe call it “local fusion”).

To contact Shalin Hai-Jew, e-mail iexaminer@iexaminer.org.

Photo credit: Asiance

Quality health care, as defined by the effectiveness of quality of care and access to care, patient safety, timeliness (in terms of speedy access to care), and patient centeredness, has been elusive for many Asian American and Pacific Islanders (APIs), according to the National Healthcare Disparities Report.

The recent national debate around American healthcare has revealed this to be an expensive system with disparate experiences between Americans based in part on their racial identities.

Traditional barriers to care have been issues of cultural competence and linguistic barriers. Studies have found health disparities due to “access to care, provider biases, poor provider-patient communication, poor health literacy, and other factors,” according to the 2008 report.

APIs are one of the fast-growing minority populations in the US, with approximately 14.9 million in 2006, or 5 percent of the total national population, according to the US Census Bureau.

In the past 5 years, at least 60 percent of the 220 measures of quality of health care have not improved for Asians, Blacks, American Indians/ Alaska Natives, Hispanics, and the poor; these indicators have stayed the same or worsened.

A 2002 “Quality of Health Care for Asian Americans” report by the Commonwealth Fund found that Asian Americans reported poorer “quality of health care than the overall population,” even though this group has higher socioeconomic status (SES) than the mainstream. SES is often correlated with higher health status.

The report continues: “Asian Americans had greater communication difficulties with their physicians, fewer preventive services and less chronic disease care, and less satisfaction with the quality of their health care.”

The rates of those without health insurance vary greatly across the Asian American population. The 2002 report found: “One of five Asian American adults ages 18 to 64 is uninsured or has been uninsured at some point in the past year, with especially high rates for Korean and Vietnamese Americans.”

Sub-group disparities extended to whether Asian Americans have access to a regular doctor. Sixty-eight percent of Asian Americans have such access, but only 46 percent of Korean Americans and only 59 percent of Vietnamese respondents. Only a third of Asian American respondents of the survey felt they had “a great deal” of choice in their selection of healthcare, compared to 50 percent for the US population overall.

Asian Americans were much less likely than the overall population “to rate their care highly, less likely to be confident about their care, and more likely to indicate having a communication problem with their doctor.“ Many expressed belief that their doctor understood their background and values, and many felt that their doctor looked down on them. “Twice as many Asians (11 percent) believe that they would get better care if they were of a different race or ethnicity than the overall population (5 percent),” noted the report.

Preventive care services were more rare for Asian Americans, with only 41 percent of Asian Americans reporting having had a physical exam in the past year and only 70 percent having had their blood pressure checked (vs. 48 percent and 79 percent for the mainstream population). Cancer screenings were also lower for Asian Americans as well. Asian Americans were also less likely to receive physician counseling about smoking cessation, healthy diet and weight, exercise, and mental health.

This 2002 report also found Asian Americans less likely than Americans in general to use herbal medicine (20 vs. 23 percent overall) and chiropractors (10 percent vs. 15 percent overall); however, APIs were more likely than Americans to use acupuncture and the services of traditional healers.

Asians along with other minority groups “receive less adequate and less intensive health care than whites—and that such disparities persist even after taking into account health insurance status, age, sex, income, and education,” according to an article lead-authored by Dr. Quyen Ngo-Metzger, for The Commonwealth Fund. Ngo-Metzger writes: “While nearly four of five (79.6 percent) of white patients said that their doctors involved them in care decisions as much as they wanted, only three of five (59.4 percent) Asian Americans reported this. Nearly 70 percent of whites said that their doctor listened to everything they had to say, but less than half (47.1 percent) of Asian Americans said this.”

Anecdotally, health professionals who work with APIs suggest that language barriers, cultural incompetence, and prejudice have led to misdiagnoses of health and mental health problems.

While there have been efforts to improve outreach and healthcare to the many diverse communities in the US, individuals are expected to take initiative to learn about health issues, to attain sufficient health insurance coverage, to communicate with their physicians, and to reach out to the health establishment for proper advice and health care. Social service agencies working within the local Asian American communities may stand in the gap to assist APIs in their pursuit of health.

In many Asian countries, parents have near-absolute power to discipline their children, uphold particular social mores or encourage strict educational outcomes. This cultural value conflicts with the American legal system, which is set up to protect children from abuse or neglect.

Washington State law defines child abuse or neglect as: “the injury, sexual abuse, or negligent treatment or maltreatment of a child by any person” which harms “the child’s health, welfare and safety.” Negligence is “an act or omission which evinces a serious disregard of consequences of such magnitude as to constitute a clear and present danger to the child’s health, welfare and safety.”

A non-accidental physical injury (whether temporary or permanent) involves bruising, burns, fractures, bites, internal damage, dental injuries, auditory harm, eye or brain damage. A mental injury includes harm to the child’s intellect, psychology, or emotions. These mental injuries may stem from emotional rejection, isolation, ignoring, frightening or corrupting a child. Sexual abuse may involve indecent liberties, molestation, sexual exploitation, sexual misconduct, and rape. Neglect involves the failure to provide adequate food, clothing, shelter, health care, or supervision. It may involve abandonment or reckless endangerment.

The diversity of Asian Americans in terms of countries of origin, values, languages, religions, socioeconomic statuses, educational levels, occupations, and levels of acculturation means no over-arching generalizations may be made with any accuracy. And families each have their own unique features.

The lack of professional childcare may affect many immigrant families who may not be able to afford quality childcare. In such cases, children may be left at home alone or with untrained babysitters; many are brought to workplaces, which may not be designed to accommodate the presence of children. Others may dress their children with pajamas or slippers as street clothes, which may be appropriate in some Asian countries but not in the U.S. In some Asian cultures, parents sharing a bed with children (of a certain age) is not considered sexualized.

Rsearch on child abuse and neglect in the API community includes some of the following family structures that may allow abuse or neglect: respect for the father as someone with unlimited power; alcohol or drug abuse by one or both of the parents; a family culture of abuse or violence; avoidance of shame and bringing honor to a family; a traditional vertical parent-child relationship structure (with expectations of filial piety); family isolation from the larger society, with no discussing family issues with those on the outside, and unrealistic expectations of children (such as their caring for younger siblings or supporting a high-pressure family business).

Many immigrant families (some dealing with traumas from their experiences prior to reaching the US) face demoralization at having to take on menial jobs; living in dangerous and impoverished neighborhoods; facing racism and non-understanding from neighbors, and the pains of social transitions. Many families look to education as a stepping-stone to higher social attainments and therefore pressure their children and grandchildren to such achievements.

While some view acclimating to the larger society as a benefit, some research suggests that more domestic violence occurs with acculturated Asian Americans who are “socialized into violence.” Intergenerational differences in terms of acculturation often leads to strife, with tensions between conservatism and liberalism, collectivism vs. individualism, and authoritarian parenting vs. more laissez-faire parenting.

Some Asian American families prefer homeopathic and Eastern medical treatments, particularly where the high cost of Westernized medical care would be difficult for the family. These treatments may include the preparations of special foods or drinks, the application of herbs and poultices, and other endeavors.

Sometimes, this reliance on folk medicine may delay medical treatment, which may be considered medical neglect. Some traditional healing practices involve the extraction of illness from the body by applying heated cups, coins or spoons to the body, which may result in bruising and abrasions.

Some common worldviews may result in the belief that suffering is fore-ordained or fated, which may encourage passivity in the face of abuse.

For many Asian Americans, particularly those in the first and second generations, there may be an entrenched mistrust of government—from their countries of origination (for immigrants who are fearful of putting their immigration status at risk) and others who may be acculturated in the idea of intrusive government.

Research has found a reluctance to seek professional help for emotional or mental health challenges among the API populations. Many individuals worry about the cultural insensitivity of mainstream counselors. Family members may worry that reaching out to child welfare professionals may result in an invasion of privacy and shaming by the system. Others fear the traumatic removal of a child from his or her nuclear family. Still others, when faced with potential child abuse, may discuss these issues with a local pastor instead of social service personnel.

Professionals in public health suggest protecting against child abuse by strengthening family bonds and developing stronger communications skills. Support for the family includes respect for parental authority and the reinforcement of cultural values. They encourage parental resilience against stress, and promote the use of multi-generational and multi-lingual education about the standards for child welfare and care. There should also be endeavors to reduce the acculturation gap between parents.

8 Facts About Child Abuse

Seattle’s API Women and Family Safety Center (APIWFSC) Executive Director Lan Pham shares her insights.

1. “It should be understood that there are many, many child abuse cases that go unreported.”
2. “People who abuse their partners (verbally, emotionally, physically) often also abuse their children.”
3. “In cases of sexual assault (SA), we generally see victims of child abuse/molestation many years after the abuse. This is because most of the times, victims feel too “shameful,” “do not want to relive the trauma,” or “do not want to punish the perpetrator, who might be someone close … Statistics reveal that over 80 percent of perpetrators are people that the victim knows.”
4. “The cases of human trafficking-related crimes against children are the buying and selling of children for sex work, and the exploitation of poor children in forced labor.”
5. “Parents should not only teach their children about “stranger danger,” but also teach them about danger with the familiar, how to handle unwanted touching and uncomfortable situations, local resources, and how to call for or get help.”
6. “There are many challenges in addressing child abuse in our community: lack of information about child protection laws, lack of exposure to alternative parenting style, abusive learned behavior or socialization, cultural perception about the role that children play in society, idea that child rearing is a “family business” and no one else should be involved, exploitation of children and the vulnerable, and so forth.”
7. “To the contrary to what most people think, child abuse – the kind that you think is beneficial to the child has less to do with teaching the child good behavior, but more to do with the parent gaining control and taking out anger and frustrations. Children who are abused grow up to be depressed, angry, have low self-esteem, high risk for suicide, more violent tendencies, or are more likely to becoming victims to other types of abuse.”
8. “Parenting is not easy. No parents are perfect. This means, that if your intent is to be an effective parent, you have to actively want to learn and also train yourself to be the type of parent – the type of person – that you want your child to emulate.”

Lan Pham may be reached at
lan@apiwfsc.org or
(206) 467-9976.

Community Resources

Asian Counseling and Referral Service
206-695-7600

http://www.acrs.org/services/

Chinese Information and Service Center
206-624-5633

http://www.cisc-seattle.org/

Within Reach (formerly Healthy Mothers Healthy Babies of Washington)
206-284-2465

http://www.withinreachwa.org/

Korean Community Counseling Center
206-784-5691
Parents’ Guide to Child Protective Services of the DSHS (in multiple languages)

Refugee Women’s Alliance
206-721-0243

http://www.rewa.org/

Washington State Child Care Resource and Referral Network
253-383-1735 / 1-800-446-1114 (toll free)

http://www.childcarenet.org/

Washington Council for Prevention of Child Abuse and Neglect/ Children’s Trust Fund of Washington
206-464-6151

http://www.ccf.wa.gov/