The 2009 United Cambodian Families (UCF) Success for Health (SFH) program was funded principally through the Sierra Health Foundation, with additional funding from Health Plan of San Joaquin. SFH has been part of a longer-term effort on the part of UCF to positively impact the poor overall quality of life of the San Joaquin County Cambodian Community. This longer-term effort began with a case management program addressing health and social needs for Cambodians, funded by First 5 of San Joaquin, extending from 2006 through 2008. During this period, a program dealing with the risks of subsistence fishing in contaminated waterways was added, thanks to funding from the California Environmental Health Investigative Branch (EHIB), California EPA, and most recently, the Ford Foundation.

Before describing the SFH program, it should be noted that one key factor motivating UCF’s effort to impact Cambodians quality of life is the perception that Cambodians face a unique set of adverse circumstances when compared to other disadvantaged populations. These circumstances are rooted in Cambodians’ pre- and post-emigration history and demographic characteristics, their distinct culture, the comparatively short time they have been in the U.S., and many other circumstances which, although sometimes similar to those faced by other groups, are in each case substantially different for Cambodians.

Specific differences include the prevalence and particularly severe nature of Post-Traumatic Stress Disorder in this population; the intensity of the racial intolerance they experienced in Stockton, California during the initial immigration wave; the smallness and relative isolation of the Cambodian population relative to other immigrant groups; and the effect that poor health of Cambodian refugees has had on their economic viability, family relationships, parenting capacity, and social adjustment of the youths.

UCF perceives that for Cambodians, poor health—including PSTD-related mental health conditions that project from individuals to entire families—threatens to be an intergenerational problem that could become embedded in the fabric of Cambodian-American society.

There are a number of additional, noteworthy health problems affecting Cambodians:

• Cambodians have consistently had the highest rate of tobacco use among all South East Asians and other immigrant groups
• Higher proportions of death due to stroke and diabetes
• High consumption of mercury-contaminated fish from local waterways
• Relatively slow rates of progress in overcoming language and cultural barriers which complicate efforts to promote health access.
• Poor health among Cambodian parents may well be associated with relatively weak parental influence in the lives of Cambodian youth, contributing significantly to one of their deadliest social/health problems: gang involvement.
• According to the Stockton Police Department, there are 1,000 documented Cambodian gang members in Stockton, while the latest U.S. Census numbers put the local population at around 10,000. This means one out of every ten Cambodians is a documented gang member!

The interrelationships among different pathological factors affecting Cambodians are also of great concern to UCF. These interrelationships may include the following:

• PSTD-related poor mental health may be related to high rates of smoking among elders
• Parents’ mental health issues and high rate of tobacco use may be combining to produce a smoking epidemic in the younger generation of Cambodians
• Excessive consumption of mercury-contaminated fish may be exacerbating the poor mental health of this community and may even factor into the poor educational performance of youths
• All of these factors and more may be associated with the high rate of gang involvement among and juvenile delinquency for Cambodian youths.

Clearly, Cambodian-Americans face a health and safety crisis. However, an even greater challenge is that, just when our society has begun to understand and respond to this crisis, recent economic events have changed the entire funding landscape for social and health services. Mounting financial losses that threaten the sustainability of our healthcare system, the lingering national economic and financial crisis, and the effect of this crisis on the availability of public and private funding for the needy—all of these circumstances have led UCF to recognize the urgent need for addressing the Cambodian health crisis with an approach that is exceptionally resourceful and cost-effective. This key consideration has guided our agency in the development and implementation of this Success for Health program.

Success for Health features the following innovative methods:

• Achieving exceptional cultural competence by acquiring staff and volunteers from the neediest and most unassimilated low-income Cambodian communities.
• Using field-based rather than office-based outreach methods.
• Using language competencies and creative communicative approaches to increase the richness of information exchange between our agency and the people that desperately need to be understood by institutions and systems.
• Applying quantitative and qualitative methods to the wealth of information we obtain in order to map out community patterns, dynamics, and concerns with substantially greater precision than previous efforts. This is done at little cost, relative to many high-profile projects.
• Promoting active participation of program participants in the systemic effort to address health and well-being. Health education contacts are used as an opportunity to foster a culture of self-advocacy, public participation and health system stewardship among these traditionally disengaged people.

Services provided through Success for Health include:
• Health insurance screening and application assistance
• Enrollment maintenance and renewal assistance
• Health care information and referral
• Nutrition, fitness, health access, tobacco cessation, and environmental hazard workshops
• Health utilization support including translation services and resolution of health access and quality of care issues raised by Cambodian patients

These methods and service components have led to new knowledge, which will be used to refine our programs and make further innovations and improvements in the future.