Though they make up 5.6 percent of the US population, discussions about Asian-American health appear to be few and far between. According to the Asian-American Health Initiative, a variety of medical and public health scourges disproportionately affect the Asian-American community. Some of these disparities entail disease incidence, while others describe a paucity of certain preventive health measures being delivered to this group. Asian-Americans, for example, account for over 50 percent of chronic hepatitis B cases in the United States, and hepatitis B-related deaths are seven times higher among Asian-Americans than among their white counterparts. At the same time, Asian-American women have the lowest screening rate for breast cancer. There are additional disparities affecting the Asian-American population in conditions as varied as cancer, osteoporosis and diabetes.
Across the country, the Center for Disease Control works alongside researchers and the Centers for Asian-American Health to both uncover and diminish various health disparities affecting the Asian-American population. To be fair, significant strides have been made. The 2014 National Healthcare Quality and Disparities Report notes advances in the delivery of important preventive care, particularly when it comes to monitoring the condition of patients with type 2 diabetes. However, there is a deeper, more systemic issue facing attempts to research and further disrupt health disparities among Asian-Americans. The clinical approach to Asian-American patients lacks an appropriate level of cultural competency, and the way data about Asian-American patients are collected and organized has limited public health and medicine’s effectiveness in uncovering and addressing the full range of health disparities facing the Asian-American population.
One of the prominent issues facing the disruption of health disparities among Asian-American populations is that of cultural competency among health care providers. In a 2010 interview with NPR, Kathy Lim Ko, the president and CEO of the Asian Pacific Islander Health Forum, identifies both language barriers and the myth of the model minority as particularly problematic in the administration of culturally-competent care. While the link between language barriers and health outcomes is well established in a wide variety of populations, the model minority myth’s influence on the clinical setting is an issue unique to and reflective of the place Asian-Americans occupy in our social imagination. In March 2016, researchers from New York University’s Center for Asian-American Health published a paper detailing gaps in the communication between Asian-American teenagers and their health care providers in areas of sexual health. The paper found that many Asian-American adolescents were uncomfortable initiating conversations about sexual health and that their health care providers also did not broach the topic. When interviewed about the paper, researcher Jessie Zhao explained, “Asian-Americans are viewed as this ‘model minority…’ and that they don’t participate in things that could be a hazard to their health, including teenage sex, drinking and smoking.”
Though blanket assumptions of abstinence are damaging to any patient population, they are particularly dangerous for Asian-American adolescents, who are only just learning to balance the pressures of familial expectations with the social dynamics of their peers. The need to find such balance is compounded by the two different sets of cultural values that confront them. Indeed, the “model minority” way of understanding Asian-American adolescents is in sharp contrast to emerging data about their habits. For example, Betty Hong writes that unpublished data from the California Department of Health Services indicate that, throughout the 90s, Asian-American adolescents’ “susceptibility to smoking … increased by 30-50 percent, and their smoking rates … also increased dramatically.” Culturally-competent care requires an understanding of the actual dynamics at play in patients’ lives, rather than relying on often misguided stereotypes. Though this conversation occurs extensively in terms of care for patients of different religions, orientations and gender identities, it is clearly not extensive enough in terms of care for Asian-American patients.
At the same time, the way data about Asian-Americans are collected has hindered the uncovering of further health disparities among this population. Many researchers, clinicians and activists have noted an invisibility of Asian-Americans in most existing health databases and data repositories; this invisibility stems from a lack of available longitudinal health data about Asian-Americans. Longitudinal studies like the Framingham Heart Study have been essential in unearthing health disparities. However, many of the most established longitudinal data repositories gather information from largely Caucasian populations, and those that try to address issues of diversity have lacked sufficient representation from the Asian-American community. Though this has been redressed in the past few decades by programs like the Children of Immigrants Longitudinal Study, which has data from 1991-2006, California Health Interview Survey, which began in 2001, and the National Asian-American Survey, which was carried out in 2008, it will be several years — if not decades — for longitudinal studies to discover health information about Asian-Americans on par with the results of the Framingham Heart Study. In the meanwhile, more work needs to be done to understand the health needs of the various Asian-American communities across America.
Meanwhile, many studies that do report statistics on the Asian-American population do not account for the vast ethnic and national diversity that sits under the moniker “Asian-American.” Such a generalized title encompasses ethnicities ranging from Pakistani-Americans and Sri Lankan-Americans to Filipino-Americans and Vietnamese-Americans. With such a geographically and culturally expansive category, the specific issues facing specific communities become flattened under a monolithic “Asian-American” title as both the cultures and the needs of these communities get lost in the tide of data about individuals with unrelated experiences. Betty Hong of the National Cancer Institute expresses a similar sentiment in her discussion of tobacco use among Asian-American adolescents, writing that “because national data are aggregated, the data that do exist often mask health disparities between different ethnic and AAPI sub-populations.” Such specific data are important because each Asian ethnicity has a unique culture and history. Both play key roles in shaping social determinants of health, informing everything from diet, which is often linked to cardiovascular disease and type 2 diabetes, to the conditions of immigration, which in turn shape socioeconomic standing and mental health.
For example, while the underuse of mental health services among Asian-Americans is well documented, the differences in the incidence of mental health disorders among various Asian American ethnicities and nationalities is not; tellingly, the second article linked in this sentence was published in 1991. Certain groups, such as first-generation Vietnamese, Cambodian and Laotian Americans, are disproportionately more likely to have experienced trauma and to have come to the United States as refugees. Flattening these experiences, and their manifestations years down the line, into a broader “Asian-American” categorization is not only a disservice to these communities and their specific health needs, it also buries the community’s needs under mountains of data about ethnicities that do not share the same sorts of trauma. At the same time, smoking rates and illicit drug use is widely variable among different Asian-American subgroups, a point that even purportedly comprehensive examinations of tobacco use have failed to mention. While the major Asian-American data repositories take care to differentiate data based upon nationality, and an increasing number of studies are taking such specificity into consideration, the practice is not as widespread or consistent as is necessary: the 2014 National Healthcare Disparities Report mentioned earlier in this article, for example, does not detail health disparities based upon ethnicity.
Asian-Americans make up a growing segment of the American population, so if the American medical system hopes to achieve positive health outcomes across all population segments, attention must be paid to the way Asian-American patients are studied and treated. Physicians cannot let their judgement and clinical approach be clouded by deeply ingrained racial stereotypes, and researchers must further and more consistently account for the vast diversity on display within the “Asian-American” population. To do otherwise would be a disservice and would betray the very ends of medicine and public health.
Writer-in-Training
Rowan University School of Osteopathic Medicine
Neepam Shah is a New Jersey-based osteopathic medical student interested in Netflix binges, Spotify's eclectic recommendations, and examining the power structures and cultural trends that shape lived experiences. When he's not in class, you can find him in a Philadelphia coffee shop over-caffeinating and procrastinating.