Last week’s report from the Pew Research Center, The Rise of Asian Americans, has stirred up much controversy. Many advocates in the Asian American and Pacific Islander (API) community are arguing that the findings further a damaging idea about Asian Americans — the “model minority” myth. Advocates have said that these myths, which include the idea that Asian Americans are wealthier, more educated, and happier than other groups (all purported in the Pew report) are damaging because they hide the real challenges that exist for Asian Americans and Pacific Islanders, in particular for certain national and ethnic minorities that fall under the API umbrella.
One place this “model minority” concept can have negative implications is in discussions of health disparities. Whether due to population size or misconceptions about the health of Asian Americans, we do not often hear about the specific health disparities facing the API community. In the discussions about race and health, people of color are often grouped together, and disparities are talked about in terms of the gap between white people and people of color (Asian Americans included). These simplifications ignore the differences between racial groups, and even within nationalities and ethnicities within those racial subsets. Because of the Pew report, and as part of my focus on race-based health disparities and maternal child health, I decided to look further into the data on Asian Americans and Pacific Islanders.
One challenge when looking at data for Asian American and Pacific Islander groups comes simply from defining the community. It’s not always standard who is included when it comes to Asian Americans — sometimes Native Hawaiian and Pacific Islanders are under the umbrella, other times they are distinguished from South Asian and East Asian groups, and still other times they are not represented at all. As a result, conclusions drawn about people from such diverse nations and backgrounds represents, at best, a scattershot approach to understanding the challenges faced by those within the “big tent” surveys are based on.
What we do know is that API women suffer from higher rates of certain negative maternal and child health outcomes than their white counterparts. According to the Asian and Pacific Islander American Health Forum, Asian American women have higher rates of gestational diabetes than all other racial groups. Asian American women also die from maternity-related causes at higher rates than non-Hispanic whites. But the picture is only really clear when these disparities are looked at within the subgroups. Infant mortality, for example, is lower among Asian and Pacific Islanders as a whole than other racial groups, but much higher in certain subgroups. The rates of maternal mortality in the Pacific Islands for example, places like American Samoa and the Marshall Islands, is actually significantly higher than other groups on the U.S. mainland. Laotian and Thai communities in California also experience high infant mortality rates.
Within the Asian Pacific Islander umbrella it’s important to acknowledge racial, ethnic, and economic differences that often represent major differences in health outcomes. In particular it’s necessary to distinguish and examine the outcomes of Native Hawaiian and Pacific Islanders apart from Asian Americans more broadly because the former group tends to experience higher rates of health disparities. These groups also present a complication to our traditional understanding of U.S. geographic landscape, as they include American territories like American Samoa and Guam, which, while affiliated with the United States, are in many ways more similar to other foreign and developing nations. Their health care delivery systems often lack resources and infrastructure, making this comparison even more faulty.
What’s challenging is that identifying the problem is only the very first step in addressing maternal and child health disparities in the API community. Without comprehensive data that paints a true picture of the community, finding a solution that might address these disparities is still far out of reach. And as the Pew report pointed out, we risk a lot in neglecting the needs of this diverse community, which is the fastest growing immigrant group. One piece of good news on this front is that the Affordable Care Act includes a provision that would improve reporting on national health surveys of a wider variety of identities including race, ethnicity, sex, primary language, and disability status.
Looking in depth at communities of color in regard to this data on race-based health disparities is important because it highlights and debunks some of the more commonly assumed causes on which these disparities are often blamed: economic status, racial group, ethnicity, language, and country of origin. What we find is disparities across all of these markers. What these statistics paint instead is a picture of a society that creates myriad challenges for non-whites, from access to and quality of health care, to economic and educational challenges, to health problems that are more prevalent because of lack of access and economic opportunities. It is in the details and differences, as well as the big picture of race-based disparities where complex solutions to a complex problem will be found.