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Asian American and Pacific Islander (AAPI) Heritage month celebrates the diaspora of the AAPI community in the United States. The AAPI community has played an essential role throughout American history, yet the community is often left out of conversations on racial justice. While steps such as the COVID-19 Hate Crimes Act represent historic starts to addressing the recent visibility of racial injustice faced by the community, there is still much progress to be made to address inequitable health outcomes, which are often ignored due to the lack of available data.
The pandemic has drastically affected the most vulnerable AAPI communities whose members often work low-wage jobs such as in restaurants and salons. These workers typically have daily face-to-face encounters with the public, are provided no paid leave options, and reside in multigenerational homes where social distancing is not possible. According to a study from Kaiser Family Foundation, Asians were found to be more likely than white people to die (49 percent) and be hospitalized (57 percent) as a result of contracting COVID-19. Some states have reported Native Hawaiian and Pacific Islander (NHPI) data separately from Asians; In California they have found that NHPI communities had the highest rate of COVID-19 cases and deaths compared to all other racial groups. These outcomes could be attributed to limited English skills that create barriers to testing and treatment, poorer health conditions, limited access to health insurance coverage, lack of internet or transportation access, and/or fear of seeking help due to their immigration status.
However, the true impact of the pandemic and other health disparities faced by the AAPI community is still relatively unknown. Data on Asians is often very difficult to collect; community members may face language barriers or fear that providing information could be a problem due to their immigration status. Some may be reluctant to provide personal information due to political concerns from their country of origin. Health data often shows Asians as an aggregated single group, which masks the nuanced implications AAPI groups face as a result of differing resettlement trends and socioeconomic backgrounds. Aggregated health data often shows Asians without particularly alarming concerns or often with insufficient data to produce conclusive findings.
The available disaggregated data reveals a stark difference between ethnic groups. According to the Pew Research Institute, 2019 data shows the median income of Asian Americans was $85,800 while Burmese Americans had a median income of $44,000; Asian Americans had a 10% poverty rate while Mongolian Americans had a 25 percent poverty rate (twice that of all U.S. households at 13 percent). Many Southeast Asian Americans arrived in this country having fled genocide and war; they carry a heavy weight of Post-Traumatic Stress Disorder that affects their daily lives. Many South Asian and East Asian immigrants resettled as highly skilled workers with professional careers or as higher education candidates. Native Hawaiians and Pacific Islanders are often the most overlooked community as they make up the smallest percentage of the AAPI population; they stem from indigenous roots and have endured colonization of their land and forced displacement, resulting in very challenging socio-economic status.
Only 34 percent of Asian Americans speak only English in their homes. A report from the Association of Asian Pacific Community Health Organizations found that limited English proficient (LEP) Asian Americans are more likely to forgo medical services while also being more likely to report poor mental and physical health. LEP individuals are less likely to use preventative services and often are not aware of the purpose or need for them. While some may only choose to seek a doctor’s appointment when they find it medically necessary, the burden of medical bills afterwards becomes impossible to navigate for many. While the US Census Bureau reports that only 9.7 percent of Asians have medical debt, that figure could be much higher in smaller ethnic groups with poorer outcomes such as NHPI and Southeast Asian American populations. Prior to the ACA, “over 15 percent of Asian Americans and 14 percent of NHPIs were uninsured with some ethnic groups, including Koreans, Pakistanis, and Guamanians or Chamorro having uninsured rates over 20 percent.”
Having access to accurate disaggregated data is pertinent for advocates to effectively address the concerns of the community. We applaud the Biden-Harris administration’s Executive Order On Advancing Racial Equity and Support for Underserved Communities and Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats. These efforts to advance transparent and robust disaggregated race, ethnicity and language data are crucial to addressing inequities in underrepresented populations. Following these Executive Orders, the Office of Management and Budget (OMB) has been tasked with identifying “effective methods for assessing whether agency policies and actions (e.g., programs, services, processes, and operations) equitably serve all eligible individuals and communities” through consultation with underrepresented members of the community by July 2021. OMB has put together a request for information as a critical step to ensuring underrepresented voices are heard. We must do our part to ensure inclusive practices and place involve local community leaders who are trusted resources for historically underserved populations.