Cultural Perspectives on Korean American Cancer Control

Abstract

This paper emphasizes the importance of sociocultural research for successful ethnic-based cancer control. The article first delineates some demographic characteristics of Korean Americans and then describes six subcultural groups within this population, illuminating that Korean Americans are a diverse people. The author emphasizes that any cancer control program needs to acknowledge these cultural differences in selecting the target population, identifying intervention strategies, and training a team of health-care professionals, as well as in determining psychological factors related to cancer. The author also suggests that the traditional Korean American notion of health, the preventive approach to illness by using food as medicine, the traditional classification of body types, and the sasang theory for the treatment of illness are all important factors worthy of further research. Finally, the synchronistic and holistic approach to health common among Korean Americans is described by citing recent studies of cancer control that combine the use of Western medicine together with proper physical exercise, diet control, and psychological and family counseling.

Greetings

It is a great honor and privilege for me to be here and share some of my thoughts on Korean and Korean American culture as it pertains to cancer control. I wish first of all to thank two special people, Dr. Moon Chen, organizer of this historic conference, who invited me to speak, and his collaborator, Dr. Howard Kyongju Koh, who has not only been a dedicated public health commissioner but also an exemplary son. It is indeed a treat to meet and work with you, Dr. Chen. I draw vicarious pride from the accomplishments of these two fine Asian American public health professionals, who have tirelessly worked to improve Asian American health. As a person who has spent a lifetime studying East Asian and Korean American cultures and trying to improve cultural understanding between East and West, I will provide some sociocultural perspectives to Korean American cancer control.

Demographic Information

Today, nearly two million Koreans live in the United States. They are relative newcomers, however, having first landed in Hawaii in 1903 to work as laborers on sugar plantations. Figure 1 shows the immigration pattern of the past one hundred years (Hurh 1998, U.S. Bureau of Census 2000, Yu et al. 2002). A large influx began during and following the Korean War (1951–53), and then steady growth occurred after 1965, when new immigration legislation lifted the ethnic quota system and gave preference to families of American citizens. Until recently, Koreans remained one of the fastest growing Asian groups in America. Another trend — reverse immigration — began in 1980, when news of an “economic miracle” in Korea led some Koreans in the United States to return to their homeland.

Figure 1. Korean Immigration to the U.S., 1903–2000.

Source: U.S. Census 2000 & Hurh 1998

Korean immigrants in recent history started coming about 100 years ago. Most of them came to the US after WWII. 1965 saw the fastest growth of immigration, but after 1990 the rate gradually dropped and some returned to Korea after 1978.

According to U.S. census data, the total population of the country in 2000 exceeded 281 million, with about 4% or 10 million people being Asian American (U.S. Bureau of Census 2000). And of them, Korean Americans make up about 10%, numbering 1,076,872. As can be seen in Figure 2, the Korean population is half or less than the Chinese and Filipino populations and about 65% of the Asian Indian population. The Korean American population is similar in size to that of Japanese, Vietnamese, and other Asians.

Figure 2. U.S. Asian Population 2000.

Source: U.S Census 2000

The 10 million Asians in the U.S. comprise 4% of the U.S. population of 282 million. Korean Americans comprise 10% of that group, totaling to over 1 million.

Thirty percent of Korean Americans older than 25 years of age are college graduates (see Figure 3) (Hurh 1998). Despite their relatively high educational background, however, more Korean Americans are below the poverty level than the U.S. average (see Figure 4) (Hurh 1998). Japanese Americans, whose education level is similar to that of Korean Americans, have significantly fewer families below the poverty level. The annual income of Korean Americans is about the same as the median family income in the United States, which is $32,000, but is much less than that of Japanese, Asian Indian, Filipino, and Chinese families.

Figure 3. Income Level of Selected Ethnic Groups in the U.S., 1990.

Source: Hurh. W. M. 1998

The median family income for Korean Americans is comparable to the U.S. median.

Figure 4. Education and Poverty Levels of Selected Ethnic Groups in the U.S., 1990.

Source: Hurh. W. M. 1998

While Korean Americans are more, educated than the average American, they are also poorer. There is a higher percentage of Korean Americans who are living below the poverty level than the corresponding U.S. average.

Korean Americans are more ethnically and racially integrated into European American communities in some regions of this country than are other Asian Americans, in part because they are widely scattered all over the United States. One reason for the wide geographic coverage of Korean Americans stems from the 1965 amendment to the McCarran-Walter Act of 1952, which repealed the ethnic quota system and added seven criteria for giving preference to new immigrants. Three provisions covered spouses, children, and siblings of American citizens. Another two provisions covered occupations that suffered from a labor shortage in the United States. Preference was given to professionals, scientists, and artists of “exceptional ability,” as well as certain jobs requiring both skilled and unskilled workers. The new law favored those with technical expertise in order to alleviate the shortage of people in such fields as medicine and engineering. Thus, Korean immigrants who came to the United States under these provisions tended to settle wherever their particular skills were needed. Although there are major concentrations of Korean Americans in California, the total concentration on the East Coast is larger, including New York, Pennsylvania, New Jersey, and Virginia. Other states with substantial numbers of Korean Americans are Illinois, Washington, and Texas. Much of the literature currently available on Koreans in America is from the Los Angeles, Chicago, and New York areas. The distribution of Korean Americans in the United States is shown in Figure 5 (U.S. Bureau of Census 2000).

Figure 5. Original Occupation of Korean Immigrants (in 1986 sample).

Data Source: Hurh. W M. 1998

Diversity and Korean American Subcultural Differences

Korean Americans are not all alike. By Korean Americans, we mean a rather diverse group of people that includes everyone who is related to Korea by birth, marriage, adoption, or choice. For this discussion, I define the following six subcultural Korean American groups:

• First-generation Korean Americans (Ilse), who emigrated from Korea when they were 19 years of age or older.

• 1.5-generation Korean Americans (llchom ose), who were born in Korea and emigrated to the United Stales between the ages of 4 and 19.

• Second- and third-generation Korean Americans (Ise and Samse), who were born in the United Stales or emigrated before the age of 4 and were raised in the United States.

• Korean immigrant women who married American military personnel.

• Korean children adopted by European American families.

• Korean Americans in interethnic or interracial marriages.

For the purposes of developing and implementing plans for ethnic-based cancer control, we need to understand the racial, ethnic, and sociocultural diversity among these subgroups, as well as the various factors of stress that affect them. Differences within the Korean American community lie in the ability to speak English and Korean languages, the degree of assimilation into American culture (which depends on the number of years spent in this country), food and health-care habits, cultural values, causes of psychological stress, economic means for health care, and possible channels for cancer prevention, education, or treatment. Also, some subcultural differences depend on gender and region of residence. Table 1 highlights the key differences among these groups. As these differences may have a bearing on the development of cancer control programs, I discuss some of the more important ones in the rest of this paper.

Table 1.

Korean American Subcultural Groups.

Subcultural Group	Length of Time in the U.S. Racial and Ethnic Composition Gender	Language Food Habits Degree of Cultural Assimilation	Ethnic Identity and Its on Mental Health*(See footnote below)	Education Income Level	Occupation	Ethnic, Religious, and Other Associations+ (See footnote)
First-Generation Korean Americans (Ilse) (Note: This generation is at a greater risk for developing diseases, inducing cancer, than are other subgroups.)	Immigration after age 19 Asian 60 to 70% are women	Korean (more than 50% of those 5 years old or older do not speak English well) Predominantly Korean food Selective assimilation: about 13% in L.A. 1989. out marrying	Strong identity with Korean culture and close ethnic ties Intergenerational conflicts Mental health effects depending on gender differences and length of time in U.S. Men: loss of prestige, downward mobility, and diminished power in the household Women: double burden, overworked, lack of formal recognition for economic contributions, inadequate financial rewards Depression among men from work-related problems, among women from ethnic detachment Vulnerability higher during early years of immigration Interethnic conflicts faced by small-business owners in Korean towns like L.A., New York. Chicago, etc. Negative American image of North Korea affecting identity of persons from North Korea High prevalence of psychosomatic symptoms	30% of those older than 25 years of age are college graduates; passion for education 14.7% in 1990 were below the poverty level	About 2/3 over the age of 16 in the labor force (a higher percentage of women are in the labor force than are while women in the U.S. or women in Korea) Tend to be self-employed: small businesses, such as greengrocers or dry cleaners (30%) (Small business are usually run by women, employing many family members.) Professional and technical jobs, such as doctors, engineers. Christian church pastors (26%) Remainders are mostly in blue-collar or service work	About 70% attend Korean Christian churches (with regional variations) Alumni associations Regional associations Professional and business associations
1.5-Generation Korean Americans (Ilchom ose) (Note: The term “1.5 generation” emerged after the L.A. riot in 1992.)	Immigration between ages 4 and 19 (This generation comprises 37.2% of all immigrants.) Asian	Bilingual Predominantly Korean but mixed with other ethnic foodsc) Selective cultural assimilation	Dual identity with Korea and America, sometimes leading to identity conflicts Often referred to as the “sandwich generation,” “bridge generation,” or “transition generation” May experience a “bamboo ceiling” at work High ratio of youth in trouble as a result of working parents	Higher level of education than first generation Higher level of income than first generation	Wide range of occupations (This is an ideal group from which health professionals could be recruited owing to their language and cultural proficiencies.)	Large % attend Korean ethnic churches (more so than the second generation)
Second- and Third-Generation Korean Americans	Born in the US or emigrated before 4 years of age Asian (See **)	Primarily English but some Korean (Even those who speak Korean are not fluent enough for technical communication.) Some Korean food but mostly non-Korean food Mostly assimilated into American society	Asian American identity May experience identity crisis periodically when international and national moods fluctuate Subtle discrimination Experience “glass” and “bam-boo ceilings” Burdened with intergenerational conflicts	Highest level of income among Korean Americans	Wide range of occupations, including a significant number of professionals	Small % attend Korean ethnic churches: larger % at American churches
Korean Immigrant Women Who Married American Military Personnel	From adulthood Multiracial	Primarily English Mixed, but predominantly American Mixed, but predominantly American Varied assimilation	Experience both multicultural and cultural conflicts Frequent cases of identity crises, some with strong ethnic identity as Korean Suffer from negative stereotypes from both Koreans and Korean Americans	Lower educational background but with numerous exceptions Varied, from low income levels to high economic stains	Varied (data on this group are sparse)	Some attend Korean ethnic churches
Korean Children Adopted by European American Families	Typically since infancy Multiracial 70% of adoptees are female	English Predominantly American food, with occasional lasting of Korean dishes Fully assimilated into American life.	More American than Korean Identity crisis when growing up and after leaving their families because of being judged by physical features and even considered foreigners while their self-image is American May experience double discrimination from both Koreans and non-Korean relatives Active national network of adoptees is emerging	Information not available	Wide range of occupations, with an increasing number of professionals	Information not available
Korean Americans in Interethnic or Interracial Marriages**	Since birth Multiracial and multicultural	English Predominantly American food, with occasional lasting of Korean dishes Full assimilation.	More American than Korean but with some multicultural identity, racism, and exclusion experiences	Higher levels of education	Wide range of occupations (data on this group are limited)	Information not available

^*Korean Americans have a higher incidence of mental disorders than do white Americans.

⁺Religious and other associations may prove to be good channels for cancer education and prevention, especially for first-generation Korean Americans

^**A high percentage of second-generation and the majority of third-generation Korean Americans intermarry with other ethnic groups.

Most studies about communities of Korean Americans have focused on first-generation immigrants. Information on subsequent generations and bicultural families or adoptees is emerging but is not yet substantial enough to help plan and execute cancer control programs in a concrete way. In the following, I will describe what is known about the different subgroups and present suggestions and hypotheses as appropriate.

First-Generation Korean Americans

One common feature of the first generation (Ilse) is that their primary language is Korean and their life-style, including personal food habits and cultural values, is more Korean than American. First-generation immigrants usually encounter language and cultural barriers, although they gradually adjust to American life over time. This is perhaps the group with the largest percentage of low-income people, including some below the poverty level. This is also a group with a large number of stresses, which can lead to health problems and put them at risk for certain cancers. It is reasonable to assume that a higher proportion of people in this generation will not have health insurance, owing perhaps to economic barriers, ignorance, or a lack of understanding of the system.

Traditionally, Korea has been a highly stratified society, with upward mobility and wealth possible through educational and occupational achievement. Korean Americans are quite class-conscious and highly motivated to climb the social ladder. Their passion for education is related to their cultural values and subconscious belief that education is the most effective way toward success in America, as well. Most Koreans who immigrated to this country did so in order to improve the quality of their lives and provide for better education for their children. However, in actuality, they experienced a considerable drop in social status and worked in less prestigious occupations following immigration. Figures 6 and 7 show occupational data before and after immigration; these data are from a 1986 study by Hurh (1998). Before immigration, more than 50% held professional, technical, or managerial positions in Korea. Once in the United States, however, the largest portion of Korean Americans (30%) became small-business owners; the second largest group consisted of professional and technical people (25%).

Figure 6. Current Occupation of Korean Immigrants in U.S. (in 1986 sample).

Data Source Hurh. W M.1998

While nearly 60% of Korean immigrants were professionals or managers in Korea, a large number became small business owners in the U.S.

Figure 7. Distribution of Korean Americans in the US.

Source: U.S. Census 2000

Many first-generation men thus experienced a loss of prestige because they were not able to find jobs commensurate with their training or experience. Social scientists commonly refer to this situation as “status deprivation.” In a society where male household heads enjoyed a considerable degree of prestige and power, together with sole financial responsibility to support the family, the loss of occupational status and reduced income severely affected their self-image, often resulting in depression. Depression may lead to excessive alcohol consumption or heavy smoking, which correlate with liver and lung cancer (Koh and Koh 1993). At times, their tension has been released through abusive treatment of their wives and children. These stresses are reflected in cases of battered women and child abuse, as reported by psychologists and social workers (Lee and Liu 2001).

About 30% of first-generation Koreans, as stated above, are engaged in small businesses. Small businesses are usually run by members of the family. They are overwhelmingly operated by women who are related to each other. These women tend to sponsor new immigrants to the United States, especially family members and especially after 1965 when U.S. immigration law was changed to favor members of American families. The small-business owners needed reliable, inexpensive labor and were able, in return, to offer an initial foothold for new immigrants, as well as emotional and economic support. A study of small businesses in Queens, New York (Park 1997), documented that the new immigrants who joined family businesses were more often from the wife’s side of the family and were, generally, women. These small businesses are largely “sister-initiated kin mobilization” and “women-centered kin organizations.” In such situations, sisters and daughters wielded economic and family power, while sons and brothers, who immigrated much later, had less important roles, quite unlike the traditional Korean family structure in which the man’s role is dominant. As the household head in Korea, men often had responsibilities not only to their own families but also to their ancestors and therefore were not able to leave home as easily as women. In small-business situations in the United States, women may hold the actual power and responsibilities, while the formal title to the business is held by men. Thus, women undergo stresses from the lack of formal recognition for their economic contribution to the family as well as from the heavy responsibilities of being the virtual household head. Meanwhile, men in small businesses tend to suffer from the loss of power both within and outside the family.

Both men and women in the first generation tend to be overworked, but women carry additional burdens. In the traditional Korean value system, gender and family roles are well established. Men are the breadwinners, while a woman’s role is to be a “wise mother and good wife.” Under the new situation in America, women need to work outside the home to help make ends meet, but the division of labor at home remains the same. Domestic work, such as cooking and cleaning, is still a woman’s duty in order for her to be considered a faithful wife and loving mother. In this way, women employed outside the home have double burdens.

Seventy-five to 80% of married first-generation Korean American women hold full-time jobs outside the home, many for the first time in their lives. This number is higher than the American average, which was 59% in 1993, and 25 to 30% higher than that of their sisters in Korea (Hurh 1998, Min 1988, Min 1992, Paik 1991). Furthermore, they often work more than 50 hours a week, which, after including housework, amounts to a workweek of 75 to 80 hours. Moreover, the jobs these women find tend to be lower paying and have less prestige than the ones that men obtain. Thus, they work long hours with little social recognition and with inadequate financial rewards.

One additional characteristic of this group of women is their strength and perseverance, derived from lessons learned during the Korean War. Even after 50 years of living almost halfway around the world, first-generation Korean women still hold deep and indelible feelings about the Korean War. Much of their determination focuses on succeeding in life against all odds, so that their own children will never face hunger and the life-threatening experiences that they confronted firsthand during the Korean War (Koh 1993).

Studies have shown that Korean American immigrants have a higher incidence of mental disorders than do white Americans (Hurh and Kim 1990a,b). Furthermore, there are gender differences. For example, men are more likely to be depressed by work-related problems, such as occupation, income, and job satisfaction, while women’s mental well-being is related to ethnic attachments, factors such as family-life satisfaction, kinship contact, ethnic Korean church affiliation, Korean neighbors, and regular reading of Korean papers. As for stresses pertaining to adjusting to American life, length of residence in this country was related to both men and women’s mental health. The early stage of immigration is the most critical phase in the entire adaptation process. Some of the factors that directly affect this stage include language, job search, social isolation, and cultural unfamiliarity. Different types of depression come from the realization of the glass ceiling or the so-called “bamboo ceiling” in someone’s occupational life when qualified minorities and women are barred from managerial and supervisory positions (U.S. Commission on Civil Rights 1992, 130–136). This experience usually occurs after they have adjusted to American life over an extended number of years. In this way, the reasons and causes for stress vary according to the length of stay in the United States (Hurh 1998).

Another source of stress for first-generation Korean Americans is identity conflict. For years, Korean Americans, especially those who had immigrated from North Korea, had a strong sense of longing for their homeland and concern about the safety of other family members, relatives, and friends. After the September 11 tragedy, however, President Bush singled out North Korea as a member of the “Axis of Evil.” This public announcement deeply affected the emotions and identity of the Korean American community. Meanwhile, anti-American sentiment surged among college students in Korea, further disturbing many Korean Americans, who discovered that they are more loyal to America than they originally thought.

Some of the reverse immigration that took place in the late 1900s was related to this identity conflict, when individuals found that, after living in the United States for more than 10 or even 20 years, they are neither strictly Korean nor American. Some interviewees complained of frequent headaches, indigestion, and extreme fatigue from excessive work, classic symptoms of stress (Hurh 1998). Some immigrants called this syndrome “miguk pyong,” or “American disease.”

Thus, we can see that, for a multitude of complex reasons, first-generation Korean Americans may be at risk for developing diseases, such as cancer. In planning for cancer prevention and education, it is important to note that more than 70% of Korean Americans, mostly women, attend ethnic Korean Christian churches. On the other hand, while Korean churches provide ethnic identity and serve as community centers, women are excluded from leadership positions despite their substantial contributions. Many educated women are becoming dissatisfied with the male dominance and the rigidly hierarchical structure of the church (Kim 1996) (For further information on Korean Americans in general and the first generation Koreans in particular, see Chang, ed. 2000).

1.5-Generation Korean Americans

1.5-generation immigrants were born in Korea and came to the United States between the ages of 4 and 19. This group is sizable; about 37% of all people admitted to the United States each year are under the age of 19. The term “1.5 generation,” or Ilchom ose in Korean, became popularized after the Los Angeles riots in 1992.

This generation understands both the struggles and the identity issues of their first-generation parents, while they can also identify with second- and third-generation Korean Americans, who were born in America of Korean parents. For this reason, the 1.5 generation can be a “bridge generation,” understanding and working with both the first and the second generations.

People in this generation are usually bilingual, fluent in both Korean and English, and bicultural. These people would make good translators, interpreters, social workers, and doctors for cancer control efforts. Members of this generation will be crucial in promoting education, prevention, and early detection of cancer to other Korean Americans. (For further information on the 1.5 generation, see Chang 1999, Hurh 1993, Kim 1999, Danico 1999.)

Second- and Third-Generation Korean Americans

The next group, second- and third-generation Korean Americans, includes those who were born and raised in the United States or came to the United States before 4 years of age. Although some second-generation Korean Americans speak Korean fluently, most speak so-called “kitchen Korean” or “grocery store Korean.” Many had previously learned the Korean language and spoke it fluently within their family but later had difficulty retaining their knowledge of the language in the work world. Those in the second and third generations find that, as professionals, their Korean language skills are insufficient to carry on a technical or academic conversation. Descriptions of symptoms of illness are difficult terms to express in English, and translation from Korean may be unsatisfactory. This generation’s contact with Korean culture is mostly secondhand, through parents, churches, or occasional visits to Korea. Although their ethnic identity may be Korean American, their contacts with Korea or Korean culture are minimal outside of immediate family members or church.

A number of best-selling novels written by Korean Americans, such One Thousand Chestnut Trees (Stout 1998) and The Foreign Student (Choi 1998), vividly portray the psychological split felt by some who identify themselves as second-generation Korean Americans. The two protagonists, Anna and Chang, in their respective novels, see themselves as being divided into two halves, or two distinct individuals, with one half or one individual threatening to undermine the other. This division of self proved truly problematic when Chang fell in love with a Caucasian woman, as he was unable to feel intimacy with her, being two different people himself (Koh 2000).

The Korean and Asian notion of self is a critical link between the past and the future, not an autonomous individual focused on the present. This difference of the notion of self between first-generation immigrant parents and their American-born children has been the source of frequent cultural and generational conflict. Parents clash with their children over many issues, such as whom they can date or marry, what areas they should study, and so on. This is because immigrant parents consider their children to be extensions of themselves, not separate individuals. The Asian notion of self as a critical link between one’s ancestors and offspring creates conflict and sometimes even mental health difficulties. Parents’ strong expectations for their children to excel at school and at work sometimes lead the offspring to nervous breakdowns or even suicide. In a recent journal article, Chen et al. (2002) point out that the suicide rate among Asian American women is higher than the United States average for all women.

Second- and third-generation Korean Americans are burdened with issues dealing with intergenerational conflict and identity, especially during their adolescent years. Owing to a shortage of clergy and mental health professionals who are fully knowledgeable of Korean American culture and of the specific issues of this subgroup, public health officials will have difficulty helping them.

Korean Immigrant Women Who Married American Military Personnel

An unanticipated consequence of the United States military occupation of Korea during 1945–48, followed by the Korean War shortly thereafter, was the large number of Korean war brides and war orphans, babies fathered by American soldiers and mothered by Korean women.

Studies of Korean women married to United States military personnel usually focus on severe identity crises, difficulties in adjusting to American life, lack of acceptance by their American relatives, and relatively low educational and economic background. These women also suffer from negative stereotypes — namely, that they are disadvantaged, poorly educated, and less respectable according to Korean standards of virtuous women (Yoo 1995, Brewer 1982, Kim 1972, Kim 1979). However, the evidence suggests otherwise. Many women in this group are very capable, assertive, and well-adapted to their new life in America. They can, of course, speak the Korean language and often retain a strong sense of Korean identity, but because most of them live in European American and biracial families, their food habits and lifestyle may be more American than Korean American.

Systematic studies of children of biracial and bicultural families are still rare. However, successful writers, artists, and journalists are beginning to emerge from this group (Choi 1998, Anthony 1960, White 1995).

In the early 1970s, a noteworthy group, the Korean-American Women’s Society of Washington State, began to challenge common misconceptions about Korean women married to American servicemen. In 1972, a small group of leaders from Pierce County, Washington, formed an organization, Korean Wives of American servicemen (KWA), to address their needs. Today, 30 years later, KWA has a $5 million annual budget and serves to meet a wide range of needs for all Korean American and other ethnic minority women, from home care for persons with Alzheimer’s disease and dementia to low-income housing to immigration assistance, education, and technical training. Most impressive, however, is the amazing 4,500,132 hours of service documented over these 30 years. KWA offers perhaps the best in ethnic-based programming serving all ages, from children through seniors. This type of program would make a good model for a cancer control program for multicultural families.

Korean Children Adopted by European American Families

As of 2002, American families had adopted more than 200,000 Korean children. According to the PBS Adoption History website, these children constituted the largest group of foreign-born adoptees in the United States. More than 70% of the adoptee are girls. Many were adopted during their infancy, or before their third birthday, and most were raised in European American households. Their ethnic identity is usually American, except when the adoptive parents made special efforts to raise them as Korean Americans. A large and growing number of adoptive parents actively participate in Korean American conferences and other cultural programs or take their children and families to Korea to help their children with identity issues and acknowledge their dual ethnic heritage.

These children often faced double discrimination, first from members of their own adopted family and neighbors and later from Korean or Korean American communities. Korean adoptees, who are generally raised in white families, usually in predominantly white suburbia, are often shocked and disillusioned by how they are treated differently once they have left their home environment. They are no longer viewed as members of white families but as Asians, even as foreigners (Han 1995). However, an increasing number of them are now professionals, and many themselves have turned to issues concerning other adoptees. Since 1973, East Rock Institute (which I direct) has actively worked with adoptive parents and, more recently, with young professionals who were adopted and are keenly interested in issues relating to the identity and welfare of adoptees. Two major national networks have developed, one being the Korean American Adoptee Network, which can be reached through the Internet. Research about this group of Korean Americans is also becoming available

Korean Americans in Interethnic or Interracial Marriages

One consequence of Korean Americans being widely scattered over the country is that many families settled in substantially European American communities without a strong Korean ethnic core. Korean Americans are more ethnically and racially integrated into European American ethnic groups in some regions of the country than are other Asian Americans. As a result, a large proportion of 1.5-, second-, and third-generation Korean Americans are choosing to marry non-Koreans, who cover a wide spectrum of ethnicity.

Korean Americans in this category tend to be well educated, holding such professional, managerial, or skilled jobs as systems analyst, Internet manager, entrepreneur, journalist, musician, lawyer, physician, public health professional, or college and graduate school professor. They are usually more highly paid than their parents were. Although these men and women may encounter racial and gender discrimination in the workplace in the form of an invisible ceiling often referred to as the glass or bamboo ceiling, the growing acceptance in American society of multiethnic and multicultural diversity helps ease the complexities of ethnic identity issues. Systematic study of this group is lacking.

Judging by their educational attainment, occupational diversity, and economic contribution, it is obvious that Korean Americans in interethnic or interracial marriages are more fully integrated into the American mainstream than are other Korean American subgroups and will be difficult to reach as a group.

Korean American Approaches toward Health and Foods

Korean American notions of health can be found in Taoism, one of the earliest religions of Korea and one that still resonates in the Korean psyche. Taoism stresses long life as a religious goal, a goal that can be achieved by discipline and control (Lee 1983). Thus, Korean attitudes toward health are largely holistic, with food and herbal medicine playing major roles.

My own cultural theory of Korea and Korean Americans is synchronistic (Koh 1982, 2002). In human life, as Figure 8 shows, three distinct forces are integrated into a working and harmonious whole. These three distinct forces are symbolized as yin, yang, and a third force that integrates these opposing forces. This integrative pattern manifests itself in numerous ways, such as in folk paintings, inheritance systems, attitudes toward religion, and lifecycle rituals, to name a few. Another Korean folk belief is that if two opposing forces are somehow magically reconciled, luck and happiness will result.

Figure 8.

Distribution of Korean American Population in Top Ten States, 2000

Like other aspects of their life in America, Korean Americans may approach health care with a combination of Eastern and Western attitudes. For example, while they may go to Western-style clinics and hospitals for specific care, they are also likely to drop by the herbal store or seek acupuncture and massage on their way home.

This holistic approach to illness, especially as it relates to cancer control, was demonstrated by a recent study of Korean American men who survived liver cancer (Ro and Lee 2002). The men had been treated, in Western hospitals, with catheter arterial embolization over a period of 5 to 15 years. They did not undergo chemotherapy. They ranged in age from 44 to 60 years at the time of the study. As they were unhappy with the medical treatment they received in the Western-style hospitals, they sought an alternative, holistic therapy, individually designed with the help of a wide range of specialists in nutrition, nursing, religion, physical exercise, and psychology. During interviews, most of them stated that they thought they were completely cured or were in the process of being cured.

The program consisted of

• Adequate food intake.

• Regular exercise.

• Avoidance of stress.

• Enhanced mental activity.

• Deep faith in God, including a positive attitude toward death and life.

• Moderate sexual activities.

• A sharing of their practices and hopes with other patients.

The diets chosen by the patients varied from person to person, with some common features:

• Avoiding meat.

• Using cereal-based foods as a staple.

• Drinking large quantities of fresh vegetable juice and soybean milk.

• Eating natural foods, such as mushrooms, certain larva, and yeast.

• Drinking large amounts of bottled water.

Following this holistic approach, patients believed that they experienced a reduction in the size of the cancer, an improvement in their skin color, a feeling of freshness, and ease of elimination of bodily wastes. While such approaches should be subject to more rigorous evaluation in the future, the subjects did acquire a strong belief in overcoming cancer, which developed into a spiritual experience of faith in God.

Indeed, Korean tradition emphasizes the importance of health and the prevention of illness through the proper use of food. This belief reveals itself on many levels. For example, at the end of a recent business trip to Los Angeles, I met with three relatives and friends, all of whom plied me with health food of some sort, from green vegetable juice for breakfast, to bean-cereal-and-nut tea, and to special dietary supplements and even an expensive electronic bean-tea maker. Being shown concern for your health and long life is one of the ultimate signs of respect and appreciation.

During my experience in conducting a 3-year comparative study of the food habits of 300 cultures of the world at Human Relations Area Files, a cross-cultural research organization headquartered at Yale University, I discovered that Koreans had the most extensive list of scientific names for wild edible plants of all cultures. First-generation Korean Americans, especially the women, have extensive knowledge of edible wild plant foods like bracken (kosari), bell flower roots (toraji), and mushrooms (Koh 1968). This may be related to harmony with nature, another traditional Korean value.

As an older example, an encyclopedia for Korean women published in 1803, called Kyuhap ch’ongso, emphasizes the nutritional and medicinal value of foods, noting that there are five grains and five vegetables that are necessary for the proper growth of the human body. In particular, elders and parents should be nourished with fish and meat. This valuable resource claims that out of 405 illnesses that can afflict humans, 404 are related to food and can be prevented by proper diet. Only death, the 405th “illness,” is beyond human control (Pinghogak Yissi 1809).

Considering food to be medicine, food preparation is tantamount to prescribing medicine for individual members of the household. In fact, the word “yangnyom” which means “seasoning food,” can be literally translated into “thought of medicine” (Lee 1998). Thus, Korean cuisine often mixes medicinal plants and substances, such as ginseng, ginger, jujubi, shiitake mushrooms, and root products, in with other foods to make healthy, tasty hot cereals and stews. Some such recipes can be found in the above-mentioned encyclopedia, which also refers to “Noyangsik,” food for nourishing elderly people. The development of such food can perhaps be attributed to filial piety, one of the important Asian values emphasized by Confucianism. Daughters and daughters-in-law who help prolong the longevity of their parents and parents-in-law are upheld as models of filial piety.

One of the principles of health drawn from a traditional Korean theory, the Sasang theory, categorizes people into four body types according to their physical constitutions: tae yang (TY), tae eum (TE), so yang (SY), and so eum (SE). This theory emphasizes the importance of harmonizing food and medicinal intake according to body type. Table 2 illustrates desirable and undesirable foods for different body types (Lee 1998). Some foods are good for all body types, such as polished rice, brown rice, colored beans, kidney beans, Italian millet, lettuce, spinach, garlic, tomatoes, lotus root, strawberries, and peaches, while sugar is considered undesirable for all body types.

Table 2.

Desirable (O) and Undesirable (X) Foods for People of Different Body Types

	T.Y	S.Y	T. E	S.E		T.Y	S.Y	T.E	S.E		T.Y	S.Y	T.E	S.E		T.Y	S.Y	T.E	S.E
Polished rice	O	O	O	O	Sugar	X	X	X	X	Tomato	O	O	O	O	Walnut	X	X	O	O
Brown rice	O	O	O	O	Glucose	O	O	X	O	Mustard	X	X	O	O	Ginkgo nut	X	X	O	O
Glutinous rice	X	X	O	O	Chocolate	O	O	X	X	Pepper	X	X	O	O	Pinenut	O	O	O	X
Barley	O	O	O	X						Curry	X	X	O	O	Peach	O	O	O	O
White bran	X	O	O	X	Korean cabbage	O	O	X	X	Chinese radish	X	O	O	O	Sea mustard	O	X	O	O
Buckwheat	O	O	X	X	Cabbage	O	O	X	X	Carrot	X	X	O	X	Laver	O	X	O	O
Wheat soybeans	X	X	O	O	Kale	O	O	X	X	Lotus root	O	O	O	O	Sea tangle	O	X	O	O
Black soybeans	O	O	X	X	Lettuce	O	O	O	O	Root of Chinese bellflower	X	X	O	X
Colored beans	O	O	O	O	Young radish	X	O	O	O	Codonopsis lanceolata	X	X	O	X	Beef	X	O	O	O
Kidney beans	O	O	O	O	Spinach	O	O	O	O	Burdock	O	O	O	O	Pork	X	O	O	X
Peanuts	X	O	O	X	Crown daisy	O	O	O	O	Hemp	X	X	O	X	Chicken	X	X	O	O
Gray redbeans	O	O	O	X	Celery	X	O	X	X	Musk melon	X	O	X	X	Dog meat	X	X	O	O
Red beans	O	O	O	X	Parsley	O	O	O	O	Watermelon	X	O	O	X	Milk	X	O	O	O
Adlay	X	X	O	X	Watercress	X	O	X	X	Strawberry	O	O	O	O	Egg	X	O	O	O
Italian millet	O	O	O	O	Green onion	O	X	O	O	Persimmon	O	O	X	X	Shellfish	O	O	X	X
Indian millet	X	X	O	O	Onion	O	X	O	O	Pear	O	O	X	X	Shrimp	O	O	X	X
Sorghum	X	X	O	X	Leek	O	X	O	O	Apple	X	X	O	O	Crab	O	O	X	X
Corn	O	O	O	O	Red pepper	O	O	O	O	Citrus fruit	O	X	O	O	Oyster	O	O	X	X
Mung beans	O	O	X	X	Ginger	O	X	O	O	Orange	X	X	O	O	Squid	O	O	X	X
White sesame	X	X	O	O	Garlic	O	O	O	O	Lemon	X	X	O	O	Hairtail	O	O	X	X
Black sesame	O	O	X	X	Sesame leaf	O	O	X	X	Grape	O	O	X	X	Mackcrel	O	O	X	X
Perilla	O	O	X	X	Pumpkin	O	O	O	O	Banana	O	O	O	X	Herring	O	O	X	X
Potato	O	X	O	O	Eggplant	O	O	O	O	Jujube	X	X	X	O	Yellow corvenia	O	X	O	O
Sweet potato	O	X	O	O	Cucumber	O	O	O	X	Chestnut	X	X	O	X
Honey	X	X	O	O	Young antler	X	X	O	O	Ogapi	O	X	X	X	Vit. E	X	O	X	X
Ginseng	X	X	O	O	Yongso	X	O	X	X	Vit. B	X	X	O	O	Vit. C	O	O	O	O

T.Y. = TaeYang; S.Y. = SoYang; T.E. = TaeEum; S.E. = SoEum

Source: Lee, Chul-ho 1993

Conclusion

I have presented some major sociocultural characteristics of Korean Americans in general, as well as some of their subcultural differences. From these observations, what have we learned that can be applied to cancer control?

Taken as a whole, Korean Americans tend to be from the urban middle class and are relatively well educated. However, especially among the first generation, many are under-employed and may, in fact, be below the national poverty level. In addition to the particular stresses imposed on the first generation, which may lead to ill health, they may lack health insurance and the means to pay for screening and treatment.

The wide geographic dispersal of Korean Americans around the country makes comprehensive ethnic-based cancer control planning difficult to implement. The subcultures from which health professionals can be actively recruited are members of the 1.5, second, and third generations. These groups will be easier to target for education and cancer prevention strategies than are the three multiracial and multiethnic groups, who are geographically dispersed and culturally more diverse.

The racial, ethnic, and social-class diversity of Korean Americans makes cancer control planning all the more challenging. Not all the subcultural differences have been systematically studied. We may need to develop regional centers and traveling units so that inventories of the various subcultural needs can be made. Once needs have been defined and efficient means for cancer control for each of the subcultures identified, pilot models that are developed for Korean Americans can be further utilized and applied toward other multiracial and multiethnic groups.

Korean American ethnic churches may be the first and best channel for cancer education, prevention, and detection for first generation Koreans. Unlike Chinese kinship and regional associations or Japanese prefectural and provincial associations, Korean American communities are centered around ethnic Christian churches. More than 70% of first-generation Korean Americans are churchgoers (Kim and Kim 2000, Kwon et al. 2001). At least in parts of New England, some ethnic churches sponsor free lectures and workshops on health issues, as well as, on occasion, free health clinics. All major cities have Korean American associations, and many immigrants belong to alumni associations or professional organizations, other good channels for cancer prevention education.

Members of the 1.5 generation of Korean Americans will be crucial in promoting education, prevention, and early detection of cancer. Being bilingual and bicultural, this generation can be a bridge generation for cancer control programs. Professionals in this generation, with training in nursing, social work, psychology, and health care, will become vital to cancer control programs in the coming years.

The Korean American notion of health, which is very closely related to food, is preventive, synchronic, and holistic. First of all, Korean Americans attach high value to health and prevention through food intake. The old Korean theory of differentiating body types in determining desirable and undesirable food deserves more scientific attention and testing. Second, we should develop integrative approaches to cancer control through food intake, combined with regular exercise and therapeutic methods for dealing with stress.

The influence of culture on how individuals express mental distress is increasingly being recognized as essential for gaining accessibility to patients and for proper psychiatric diagnosis and treatment. For example, depressive disorders among Korean immigrants are characterized by a preponderance of somatic symptoms rather than sadness. Without an understanding of the cultural beliefs and the social dynamics of Korean American society, cancer control efforts may not be fully effective.

Cancer control requires interdisciplinary and cross-professional collaboration, such as Drs. Moon Chen and Howard Koh have exemplified by bringing together this conference. I would like to close with a Korean saying, “Shijak I pan ida,” the beginning is the half-way point. We have made a new beginning today.