What are your expectations for health equity?
Model Minority and Health: A Journey to Equity and Justice in a Growing Population of Colored Asians and the Challenges of Social Discrimination
The concept of Asian Americans being a model minority, whereeveryone is assumed to be well educated, financially secure and generally healthy, is a part of the reason for this. The model-minority trope illustrates how race-based assumptions can bias scientific research, says Tina Kauh, a program manager at the Robert Wood Johnson Foundation. “It’s important for people to recognize that systemic racism is really what’s driving the fact that we don’t disaggregate data.” The model Minority myth has been difficult to debunk due to the fact that so little nih funding supports their work. Kauh says that it is like a hamster wheel.
We are still at the beginning of rethinking our health infrastructure and improving health equity. Each solution adds support, and begins to build a path towards justice.
The social stressors Kauh’s parents experienced were financial and cultural, both of which can affect a person’s health. Language barriers, racism, changes in diet with the move to a new country and the circumstances of that move—whether someone migrates to pursue a graduate degree or to flee from conflict—can add up. The factors that determine what resources a person or community should have for good health are unrelated to the biological basis of disease.
Certain diseases and conditions have been used to justify discrimination, especially when the disease is more prevalent in a group that’s already marginalized. Men who have sex with men are more at risk of receiving mpox than anyone else. Researchers, clinicians and community members are building up networks and clinics that cater specifically to stigmatized people, as global health expert Charles Ebikeme writes. Even health-care communication is improving, writer Rod McCullom shares in a feature, as the movement toward culturally sensitive care helps clinicians better understand and empathize with their patients.
What are the happiest young people? What are they willing to do? What can young people do to help us move toward equity?
Just fanning their energy, their passion, might well be the biggest source of hope for all of humankind. Their ability to act is limited even though they have a perfect diagnosis. They aren’t in power and don’t usually vote. They are given 2 minutes to speak at the front end of the meeting and be shown out of the room as the adults make big decisions. So what do we do to get them to do things and not just do sound bites?
I feel like their moral clarity is the clearest because, unlike older people who already bought into something or were worried about their next paycheck or position or winning awards, young people are devastatingly clear in terms of what’s wrong. The problem statements are on point, so they give me a lot of hope. I teach global health to young people because of that.
Young people are my biggest source of hope. It’s the youngest people who are shining a clear light on why climate change is devastating and why leaders are not acting on what has been obvious for many years. It’s the youngest people who are doing great work in the U.S. on gun control, even as they’re getting slaughtered in schools. It’s the young people who are alarmed about the rollback of reproductive rights in the U.S., in Afghanistan, you name it.
“Justice work needs to be underpinned by hope,” says Maybank, the chief health equity officer at the American Medical Association. It is a hope and faith that we will all be able to experience optimal health.
One of the things that gives me hope is the work that I’m doing, along with many other incredibly brilliant scholars across the country, around measuring racism. In my work and within our research center, we have to be able to make the invisible visible. racism is passed off as something that is hidden in the system, and it is really hard to identify when it isn’t an interaction with someone.
We need to question who gets to be trained, what people can do, and what they are able to do. Who gets to have the knowledge? Who gets to make the decisions? Who will decide what to make and where to put it? All those decisions happen at some level of leadership. If you diversify that leadership, you will have a better, more balanced opinion about how things should be done. That’s how you start moving toward equity.
Four African American students did their part to get the Moderna COVID vaccine into the first phase 1 trial. We are very proud that they launched the whole vaccine program.
There is a faith that things can evolve towards the good. The moral arc of the universe bends toward the good. It may take a long time. Helping to diversify the public health workforce through creating more opportunities and knowledge for students is a multigenerational process.
More than 20 years ago I remember going to a clinic very far away from the capital city in one of the provinces in South Africa. I remember vividly the nurse who used to work here opened a notebook and said she had a list of people who needed treatment, because there was noHIV testing or treatment here. She looked at the second sheet of paper, and said, “Look at this.” I own a certificate. I have been trained. I’m ready. I want to save my people.” And I remember walking away thinking, “This gives me hope. There are people who care about their communities. They’re ready, they’re willing.” I will never forget the look on her face when she said that she couldn’t wait anymore.
In a lot of my work and in what I’m seeing across the country with other scholars—incredibly brilliant Black scholars in particular—is an investment and interest in figuring out how we leverage data to measure structural and other forms of racism and then how to use that to inform policy change. We need to understand that health policy and social policy go hand in hand. Historical redlining and racial covenants can only be discussed with data and knowledge of what is happening currently and in the past. Just as much as we might use that evidence to inform health policy, if we use that to inform housing policy.
For example, if someone wanted to do a study in Nigeria and the people who are going to lead it come from London, they would rely on a lot of the infrastructure in Nigeria but disregard that the local collaborators know anything. They get home to write a paper and publish it in a journal. What I see is the pushback on that changing more and more for me. That is just one part of the picture. There is a bed of assumptions and practices that we took from the colonial experience and that sits on a countable phenomenon of partnership research.
There is a belief among global health professionals and academics in the Global South that the field needs to be changed, and I think this is one of the reasons why. Historically the field was premised on this idea that the West—or the Global North, as we refer to it today—has a right and a duty to impose itself on the rest of the world.
Efforts to improve AANHPI health outcomes are being made. In recent years disaggregating AANHPI data has helped health-care professionals improve hepatitis B vaccination rates, reduce the devastation that has been caused by COVID and wildfires among Hawaiian communities, and identify better diet strategies to help South Asian communities reduce their risk of heart disease. Yi says that it has been exciting to watch.
Identifying a community’s needs and meeting them appropriately can make a range of infectious diseases more manageable. In New York City in the early 2000s, routine hepatitis B vaccination was available only to children. Among adults the virus was typically seen as a sexually transmitted infection (STI), and testing and treatment were offered primarily at HIV clinics.
The infections were common among Asian American immigrants because of the high endemic rates in their countries. In families the virus passed between married partners, from person to person through household contact such as the sharing of utensils, and from mother to child during childbirth. The adults were unlikely to go to a clinic for an STD. At the time, researchers reported that the rates of disease among Asian Americans was 50 times higher than those among non-Hispanic white people, and that they had a higher incidence of cancer from infections. In 2003 researchers at New York University teamed up with community organizers, politicians and clinicians in the city to help address the disparity.
Bringing a collective understanding to the United States after the Maui wildfires: How to Fix Health Data for People with Asian and Pacific Islander Heritage
The team was able to provide care based on specific needs such as shelter and medicine after the Maui wildfires. The World Health Organization pointed out the method’s effectiveness in reducing health disparity.
The researchers worked with each community to identify specific requirements. Some wanted a place to stay away from their COVID friends, while others wanted more resources allocated to food or medical care, and still others wanted to keep in touch with friends and family.
The team members didn’t just gather information—they shared it with the communities through hours of virtual visits and phone calls. The details that were gathered as they spoke helped communities see their own losses. No one could deny the devastation they’d experienced, nor could their experiences be minimized by a database that didn’t represent them and their needs. Matagi says that the strategy was especially effective in the Samoans, Marshalleses and Chuuk, the three Pacific islands most affected by the disease.
Getting granular with community data proved to be a lifesaving strategy in Hawaii during the worst of the COVID pandemic. The state health department’s infectious disease team was heavily focused on controlling the spread of the virus at the start in 2020. The scientists were thinking about it in terms of a purely biological system rather than understanding what would put people at risk. “Accurate measurement of social factors is so important.”
Data such as these can help clinicians advise patients more effectively by offering dietary solutions that may be easier for them to follow rather than forcing a more Western lifestyle on them, Kanaya explains.
For the past decade Kanaya and other researchers have run a study of heart health among South Asians living in the U.S. called Mediators of Atherosclerosis in South Asians Living in America (MASALA). Many South Asian foods include dhokla, sambar, steamed fish, lamb curry, and popular snacks. The researchers analysed the diet of nearly 900 people from the study and found that a diet high in fresh vegetables, fruit and fish correlated with a South Asian Mediterranean-style diet. They found that people who ate more of these foods had a lower risk of heart disease and diabetes than other people in the cohort.
Source: How to Fix Health Data for People with Asian and Pacific Islander Heritage
How Do We Fix Health Data for People with Asian and Pacific Islander Heritage? A Conversation with Annihilating Bethe Anastase Kauh
Kauh’s parents were Korean immigrants who owned a convenience store in Philadelphia. Kauh could know that the social isolation of being a teen had a physical and mental toll. Their lives were hardly those of a model minority. “I could see the challenges they experienced on a daily basis, but no one ever really talked about that except to frame it as ‘look how hardworking they are,’” she says.
Kauh first bumped into that cycle in college during an undergraduate psychology class about how culture and ethnicity shape someone’s behaviors and perceptions of social norms. Fascinated, she tried to dig deeper into the experiences of Asian Americans, yet she couldn’t find the data. Kauh continued with her graduate school thesis, but she said it was difficult to get funders interested. Since then, she says, “it’s been this mission of mine to try to push for collecting data about Asian Americans.”
The nuances disappear when the data is pooled. The University of Hawaii at Mnoa physician says that you don’t need to rely on estimates anymore since one group looks better than the other. “It’s nonsense. It’s not good science, yet people have been doing this for decades.”
Now efforts led by advocates, researchers and community organizers—most of them from AANHPI communities—are paving the way to data equity and better health.
Source: How to Fix Health Data for People with Asian and Pacific Islander Heritage
Socio-ethnic differences in risk factors for cardiovascular disease: Evidence from a Southeast Asian medical community at Eugene Yang’s Cardiology Clinic
The recently completed study showed that the same stressors manifest differently in people of different ethnicities. Across the board, those who experienced more social stress had poorer sleep, struggled to exercise and used more nicotine—all factors associated with higher rates of heart disease. There were differences between groups. Filipino residents have a lower risk of diabetes than Chinese Americans due to the fact that high stress is linked to high blood pressure. Asian Indians were more likely to experience sleep problems than any other people in the country. “There are significant differences in how social determinants of health impact the different Asian subgroups,” Yang says. Understanding this variation is a first step towards helping physicians tailor interventions more appropriately.
Many of the patients at Eugene Yang’s Cardiology Clinic have come from other parts of Southeast Asia. Seattle is home to thousands of immigrant workers, and is a hub for the tech industry. There are people in each of the groups who are at risk of heart disease and how their lifestyles differ.
Asian and Pacific Islander Heritage (AANHPI) groups in the US have been working to improve health outcomes of their communities, researchers said. “The data we have doesn’t tell the whole story, it just tells part of the story,” researchers told Nature. They found that AANHPI groups had a higher incidence of cancer and disease than their non-AANHPI counterparts.