Michelle Nealy
The struggle for visibility, equity and support for Asian American and Pacific Islander (AAPI) communities has never been more urgent. Incidents of hate reached new heights at the onset of the COVID-19 pandemic, and the fight for representation in conversations around minority health is ongoing.
The term AAPI is used to describe a diverse population of 23 million people who make up the fastest-growing racial/ethnic group in the U.S., with roots in more than 40 countries. The AAPI community represents some of the highest and lowest income earners in the country. Health data on AAPI communities are often lumped into one category, masking the meaningful differences among the numerous AAPI subgroups. Given the disparities within and the sheer enormity of the community, disaggregated data have proven to be a significant challenge in driving health equity.
As our nation marks Asian American Pacific Islander Heritage Month, we talk to Dr. Eliza Chin, Executive Director of the American Medical Women’s Association and Assistant Clinical Professor (Voluntary) of Medicine at University of California, San Francisco, about the needs of AAPI communities and how health care leaders can use this knowledge to inform their work.
Reservoir: What inspired you to pursue a career in medicine?
Dr. Chin: I didn't grow up thinking about medicine as a career. When I was young, I wanted to be a teacher. In college, I realized that I really enjoyed science, and I also liked working with people. Medicine became a way of blending both of those passions. Yet it wasn’t until my third year of medical school that I realized I had made the right choice, when I experienced the thrill of taking what I learned in the classroom and applying it to the care of patients.
Reservoir: May is Asian American and Pacific Islander Heritage Month. Sadly, when it comes to conversations about health disparities, AAPI communities aren’t always included. How can health care leaders and policy makers better prioritize the needs of the AAPI community?
Dr. Chin: Many people do not think about the AAPI experience when it comes to minority health, but we have to give all people of color an opportunity to share their experiences. Different communities face different health issues. We have to tackle inequity from these diverse perspectives and work to ensure that the AAPI community isn’t being left out.
We have to be intentional. Too often, people think of the AAPI community as the ‘model minority,’ and somehow that stereotype doesn’t include the experience of racism. Yet I remember the racial slurs hurled at me as a teenager, even when just stepping outside my house. Being one of the ‘model minority,’ doesn't mean we haven't struggled to navigate a place in the world when we don't necessarily look like everyone else.
Reservoir: What are some of the unique health challenges facing AAPI communities and how does disaggregated data help bring about meaningful change?
Dr. Chin: We are a large and diverse group. I never thought about health care disparities until I saw various subgroups within the community drive different awareness campaigns, for example, related to screening for diabetes at a lower body mass index or encouraging the need for early screenings for osteoporosis. The stigma around mental health within AAPI communities has been especially prevalent.
Many AAPI communities also grapple with a mindset of neglect that poses a barrier to care. Given the perceptions around being the ‘model minority’ and the value placed on success and achievement, some people may not be so forthright about talking about challenges that they have experienced. These are the kinds of issues health care leaders must understand as they approach their work with AAPI communities.
Really, data comprise the missing piece. When you begin to look at the data of various subgroups within the community, you can see that the disparities are not uniform across the AAPI population.
For instance, in a report from the National Cancer Institute, the incidence of cervical cancer appears lower compared to white Americans when the data are aggregated for all Asian Americans. When disaggregated by subgroups, however, we observe that rates are much higher in Vietnamese and Cambodian women but lower in Chinese and Asian Indian women.
In arenas beyond health care, data are also challenging traditional assumptions. For example, despite perceived notions about the AAPI community as the ‘model minority’ group, we haven’t grown in leadership ranks for companies and institutions in the way that one would expect. It is in the data that you start to see these disparities.