The Korean population in the US is about one million (U.S. Census Bureau, 2000). This is an increase of 1500 percent since 1970 (U.S.
Census Bureau, 2000). The Korean immigrants and refugees are concentrated in cities such as Los Angeles, New York, Chicago, San Francisco and Washington DC. New York is the second largest city with Korean population after Los Angeles this is attributed to its earliest link with early immigration of Koreans in the US. In New York, they are mostly found in Northern Boulevard, Flushing and Great Neck. Besides, they concentrated on Union Street on 35th and 41st street avenues in Flushing. Today, Korean population is the seventh largest population in the US (U.S. Census Bureau, 2000)
The Koreans migrated to the US in three consecutive phases.
The early immigrants settled along the West Coast of the US. Mostly, they came to the US as students and farmers. Between 1905 and 1964, among the 600 Korean immigrants that moved to the US were composed of Korean political refugees who rebelled against the Japanese influence in Korea. They attended universities in Columbia, Princeton and New York.
The second phase of Koreans to immigrate to the US occurred in 1950 to 1953, this was after the Korean War. It was prompted by strong Korean and US ties (U.S.
Census Bureau, 2000). The second phase noted more than 15,000 Koreans immigrate to the US. Similarly, the Hart-Celler Act, which the US government enacted in 1965, creating a maximum of number of immigrants at 30,000 per country, further encouraged the immigration of Koreans to US (U.S. Census Bureau, 2000). By 1976, the Korean immigrants to the US reached the maximum limit of 30, 000 per year, this limit was maintained by the Koreans through 1980s. From 1980s to 2007, the number of Koreans immigrants in the US had increased. Critical to note about the Korean population in New York is the challenge of mental health.
Depression among this population has increased steadily since they immigrated to New York; hence, it has affected their general health. Culture and cultural practices has created the acculturation stress which has amplified diagnosis of depression among the Koreans immigrants and refugees in New York. Acculturation stress appoints to the difficulties a person faces while adapting to the daily tasks in a foreign environment (Jang, Kim & Chiriboga, 2005). Korean population has to learn new language, deal with limited employment opportunities and face intergenerational cultural conflicts within the family.
These sources of acculturation stresses have contributed to depression. Immigration stressors such as the loss of friends, disruption of extended family networks, traumatic journeys involving risks has played a significant factor for prevalent of depression among the Koreans immigrants and refugees in New York (Jang et al., 2005).
Stigma towards depression is common. Koreans view that the presence of depression is a sign of weakness on the part of an individual, causing a sense of shame for an individual and the family (Karger & Stoesz, 2010). Because of this factor, they feel reluctant to seek Western mental health services until they exhaust all other avenues of intervention (Hovey, Kim & Seligman, 2006). This has complicated early intervention of depression.
The Koreans seek specialized treatment when depression has advanced than was originally recognized by the individual. The challenge of differing levels of acculturation within the household has been cited by Kim, Kim & and Kelly (2006) as a source of stress contributing to depression for immigrants and their families. Korean parents embrace Korean language whereas their US born children speak English with little Korean, thus, language barrier within the family has contributed to family conflicts. Also, the conflict of value difference has increased family suffering and individual psychopathology. Most Korean parents value education, social status, hard work and family ties (Hovey et al.
, 2006). On the other hand, their children are more interested in American mainstream values. These opposing conflicts have, in way, contributed to depressions among the Korean immigrants and refugees in New York (Karger & Stoesz, 2010). Kim et al (2006) note the Korean population in New York has the lowest coverage of health insurance among other races in the US. Hence, this has had a far reaching implication on their mental health status. Although few Koreans work in highly specialized professions, majority of Koreans are self-employed and working in small businesses. These businesses do not guarantee employment based insurance; hence, many of them fail to access state sponsored health insurance schemes.
These assertions complicate access to healthcare services through which intervention of depression would have effectively been handled.
Despite the mental health related problems, Korean immigrants and refugees have strong family and shared values. Family and shared values help them maintain their emotional status, coping strategies and interpersonal relationship. Similarly, Koreans base their cultural orientation on Confucianism which emphasizes harmony in family and interpersonal relationship. In this context, sacrifice and patience of oneself is critical to family and interpersonal harmony. The Korean community churches play a critical role, it helps the Koreans achieve cultural, spiritual and social needs, of which are important in averting depression. The Koreans meet and maintain interactions with fellow Koreans besides helping them to preserve Korean language and culture (Kim et al., 2006).
Moreover, the church provides vital information and other services for prospective immigrants so as they are better prepared in adjusting to the life in the US. Thus, these initiatives have been critical in reducing depression among them.
The challenge of medical cost sharing in state medcaid program has had far reaching effects on Koreans.
The US government has advocated for this policy to enhance quality and efficient services in state run healthcare facilities. Medcaid is a policy where a person is required to pay out of pocket for medication. It occurs in a form of co-payment or copay. Cost sharing transfers the costs of healthcare to patients. This action has affected Koreans, particularly those with ongoing health problems or severe depression problems. Similarly, the US government implemented the Mental Health Parity Act in 1996. This act supports financial equity for lifetime mental health reimbursement and compels uniformity treatment limits.
It also expands all equity provisions to dependence services. Although the act has been successful over the years until 2008 in providing financial equity, many insurance firms have used flaws in the act by applying disparate co-payments or fixing confines on the duration a patient spent in out-patient and in-patient treatment.
The cost sharing in state medcaid programme has positively transformed salaried Koreans who suffer from depression illness. Through this plan, Koreans are able to pay half of the cost of treatment while the rest is paid for by the state. On the other hand, Mental Health Parity Act has provided financial equity for Koreans who suffers from depression. This policy has ensured parity in disbursement of funds to all US citizens with mental illness.
The policy of cost sharing has affected Koreans significantly. This is because many of them are not actively involved in active formal employments or are not salaried.
Therefore, the policy has stressed the Koreans to an extent that those with acute depression complications are compelled to abandon medication, thus, this has amplified the severity of depression on this population. Similarly, the policy has burdened the vulnerable patients, hence, reducing adherence to medications for depression conditions which ultimately has contributed to poor health outcomes and high costs. Though the Mental Health Parity Act has been instrumental in assisting Koreans access affordable mental healthcare, flaws in the act has made insurance firms to benefit on their behalf.
These policies have failed to address Koreans plights in term of understanding their cultural barriers to mental health services, hence, this has resulted in what Hovey et al (2006) call a ‘cultural gap’. The policies formulated should aim at bridging this gap so as to break the stigma surrounding depression within this population.
Language barrier has hampered communication between Koreans and healthcare givers in addressing depressions on Korean population (70 percent of Koreans speak Korean at home). This has augmented the severity of depression.
A policy that will enhance communication will be significant in allowing Koreans with depression challenge to articulate their problems (Kim et al., 2006). Perhaps, the services of interpreters will prove useful in this case. Presently, Koreans face barriers because of lack of information on public programmes such as insurance cover and medcaid. Hence, engaging them directly through affordable and culturally sensitive healthcare options will be useful.
A policy that encompasses mental needs of Koreans will provide an efficient way in which Koreans can augment their problems. Therefore, to come up with a working policy, all stakeholders need to be involved. Also, Korean immigrants and refugees should identify themselves as part of the American citizens and commit towards addressing the depression as it pertain to them. The issues presented should be brief and factual besides being supported with relevant statistics. This will allow relevant legislations to be enacted.
Depression has been a major issue of contention affecting the Korean population in New York. Factors such as stigma associated with depression, differing level of acculturation and lack of insurance cover has been noted as contributory factor for the cause of the illness. Despite these challenges, Koreans shared family values and the contribution of community ethnic churches has been significant in sustaining their strength and coping with the challenge.
To ensure access to quality health care, the government has tried its best to come up with policies which can aid in preventing mental health problems among the Koreans. Although policies such as cost sharing in state medicare and Mental Health Act has played a critical role in guaranteeing Koreans access the needed intervention of the illness, their high cost and flaws associated with them has augmented the severity of the disease. Thus, policies which grants parity and inclusiveness will be vital in assisting them access quality healthcare and ensure a healthy population
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