Christina Wang
I grew up in China without knowing that one in ten people around me suffered from hepatitis B. It wasn’t until I came to college that I learned what hepatitis B is and that this disease is in fact ten times more prevalent that AIDS, and 100 times more infectious.1
My childhood ignorance is a testament to the evasive nature of this virus to community public health efforts. Hepatitis B mostly affects Asian Pacific Islanders, a demographic that only comprises six percent of the United States population. In a country that frequently focuses on public health efforts that will affect populations that comprise a greater proportion of society, hepatitis B does not constitute a significant enough threat to motivate sizeable involvement by the public health community. In addition, a vaccination for hepatitis B exists and has been widely implemented. The urgency of addressing hepatitis B lessened beginning in 1992, when all newborns began to be vaccinated against this virus. Thus, for young, American-born individuals, hepatitis B no longer poses an immediate threat. However, in port cities including San Francisco and New York City, immigrants from highly afflicted countries are constantly arriving, warranting continued focus on this topic. Additionally, the asymptomatic nature of hepatitis B leads to continuing concern, as patients do not know they are infected until they are already significantly ill.
As a member of Team HBV, an intercollegiate organization that seeks to eradicate hepatitis B in nearby communities, I have experienced all of these barriers to hepatitis B awareness efforts, first-hand. The goal of the organization is to educate Stanford’s campus members through events like the Screening Initiative Program. The premise is simple: visit Vaden Health Center, provide documentation to show that hepatitis B screening was performed, and receive a reward. Analysis of the results of 80 test subjects left the organization both optimistic and perplexed. None of the 80 students who had been screened for hepatitis B tested positive. Clearly, Team HBV was not targeting the right audience, as the majority of the test subjects were Stanford undergraduates, born on or after 1992 and who had been vaccinated.
Though on-campus screening proved to be a rather ineffective measure to reduce hepatitis B prevalence, the organization still wanted to increase on-campus awareness of the disease and its prevalence in a tangible manner. Thus, Team HBV organized a “Hepatitis B Awareness Week,” during which flyers illustrating hepatitis B facts and a schedule delineating a week’s worth of educational events were distributed across campus, attached to balloons in order to call attention to the event. Yet all of these efforts proved to be largely ineffectual. Some students may now be cognizant of the existence of hepatitis B and the organization’s efforts dramatically increased the occurrence of on-campus screening, but the overall effects were strictly limited to the Stanford campus.
Despite the narrow improvements on the Stanford campus, other eradication efforts worldwide have shown significantly more promise. I was fortunate enough to have the opportunity to organize World Hepatitis Day in the summer of 2012. The World Hepatitis Alliance challenged viral hepatitis organizations across the world to participate in a Guinness World Records Challenge of having the most people performing “see no evil, hear no evil, speak no evil” actions in numerous venues around the world, over a 24-hour period. A total of 50 Team HBV high school and college students came out to the Crissy Field location in San Francisco on July 28th, 2012.
The worldwide event was featured in articles in the World Journal and the Tsingtao News, the two largest circulating newspapers among the Chinese-American population in San Francisco. The publicity that this event received shed light on a more effective method through which to target the population at risk: reaching out to the local media. Not only were we able to communicate directly to the highest risk population in the Bay Area, but we were also communicating to them in their language, through media sources that they trusted.
A second event that proved effective was a service trip that addressed the subject of hepatitis B in San Francisco. One of the trip days highlighted advocacy efforts by splitting the group in half and rallying legislative offices to raise awareness of hepatitis B. While the group members were initially skeptical of the potential impact of this type of advocacy work, the majority of students came out feeling that the representatives of elected officials had heard and understood the message that they were sending. While state budgets were a constraining factor, the offices told the students that they would do their best to advocate for hepatitis B screening in the future. Most interestingly, many of the representatives reported that they had not heard of hepatitis B prior to the students’ visit, which raises the question, if these elected officials had not heard of this critical public health issue before, how can we expect their constituents to be aware of the disease? The experience of Team HBV highlights the efficacy of discussing key public health issues with legislative offices. In particular, Senator Feinstein’s office noted that they greatly enjoy student input because student constituents are not paid for the messages that they deliver, but rather do so out of sheer interest and concern.
Team HBV has approached their goal of the eradication of hepatitis B through a variety of methods, several of which offer fresher and arguably more effective methods than on-campus education. While the latter remains an important tactic, the battle with hepatitis B will require use of a wide variety of broadly targeted avenues to educate a greater percentage of residents in the United States. The sooner that awareness is raised, the sooner hepatitis B will be eradicated.
References:
1. Liu, J. and Fan, D. Hepatitis B in China. The Lancet. 2007; 369 (9573): 1582–1583.