Let Me Be Brief: Addressing Health Disparities Among the AAPI Community

A series of briefs by Texas Medical Students

By: Jasmine Liu-Zarzuela, Emily Liu, and Justin McCormack

Asian Americans are the fastest-growing ethnic group in the United States, with Texas ranked 3rd in overall population and 2nd in an increase in population over the past 20 years.¹ While this group is often referred to and perceived as a monolith, the label of Asian American and Pacific Islander (AAPI) encompasses over 50 ethnic groups speaking over 100 languages.² With such a variety of ethnicities and language barriers within one group there also comes a variety of unique healthcare problems this population faces. AAPI individuals have been shown to face health disparities in cancer screening and mental healthcare, amongst many others, despite the population being relatively understudied compared to others.³ Thus, it is paramount for healthcare providers to be aware of AAPI health disparities to ensure access to adequate resources and outreach for proper screening, preventative care, necessary follow-ups, as well as proper research and study of this population to ensure disparities can be prevented. 

The AAPI community is composed of distinct ethnic subgroups which differ significantly by socioeconomic status, educational attainment, cultural background, amongst other major social determinants of health. For example, Asian Americans are the most economically divided racial group,⁴ and access to healthcare can depend on factors such as insurance coverage and interpreter access, which vary wildly based on subgroup.⁵ Thus, disaggregation of demographic data is paramount in order to identify within-group disparities in health outcomes and representation in medicine. The disaggregation of AAPI data will also aid in helping determine necessary initiatives to decrease disease burden in subgroups within the AAPI community. 

According to the National Alliance of Mental Health, AAPIs have the lowest rate of seeking mental help of any minority group, with just under a quarter of AAPI adults with mental illness receiving treatment.⁷ Several barriers contribute to difficulties seeking care, ranging from language barriers, stigma, the model minority myth, and alternative treatments, amongst others.⁸ The COVID-19 pandemic has increased xenophobia against Chinese Americans and the AAPI community as a whole, and these experiences have been associated with an increased level of depressive and anxiety symptoms.⁹  

In the US, incidence and death rates for liver cancer are second-highest in Asians compared to other ethnic groups (after Hispanic), reaching as high as twice the rates of other racial or ethnic groups.¹⁰ Liver cancers have been attributed to Hepatitis B (HBV) and C virus (HCV), which are often silent infections.¹¹ Compared to other demographics, Asian Americans have the highest rates of HBV infection and are least aware of their HCV status.^11,12 However, AAPIs with Hepatitis infection do not engage in established risk factors for HCV in other populations, and hence are often under-diagnosed.¹³

TMA Policy

Currently, TMA policy 260.126 supports the Texas Department of State Health Services efforts in addressing racial/ethnic healthcare disparities and the funding needed to lessen such disparities. However, there are no current TMA policies that acknowledge disparities in healthcare specifically among the AAPI population. TMA does support AMA policy H-350.954, which advocates for the restoration of web pages on AAPI initiatives that address disaggregation of health outcomes concerning AAPI data.

Recently, the medical student section (MSS) of the TMA have submitted several resolutions to address the health disparities within the AAPI population. One of the proposed policies calls for the TMA to support the disaggregation of demographic data regarding AAPIs to reveal the within-group disparities that exist in health outcomes and representation in medicine. A second proposed policy calls for the TMA to support legislation for the funding and promotion of HBV screening, treatment, and education among the Asian American and Pacific Islander population. Lastly, a third proposed policy urges the TMA to support raising awareness and educating providers about the discrepancies in mental health among AAPI populations. 

Advocacy Goals/MSS Perspectives

Advocacy goals on increasing HBV screening and education among the AAPI community would improve health outcomes, education, and treatment for HBV and HCV screening, while decreasing the prevalence of liver cancer among one of the most commonly impacted racial and ethnic groups in Texas and the United States. Similarly, advocacy goals on increasing mental health screening and education among this population would improve health outcomes and quality of life. By bringing awareness and policy to decreasing the prevalence of liver cancer, HBV, HCV, and mental illness among the AAPI community, the TMA-MSS has an intricate and influential role in building a stronger screening program and culturally specific interventions to improve the livelihoods and health outcomes in the AAPI community.

Current Bills

Stop Mental Health Stigma in Our Communities Act (H.R. 3573) (7) is a current bill that instructs the SAMHSA to provide outreach and education strategies for the Asian American, Native Hawaiian, and Pacific Islander (AAPI) community.¹⁴

Call to Action

It is imperative that medical professionals and students acknowledge the health disparities that exist within the AAPI community and further spread awareness and policy to ultimately improve the health outcomes of this community. 

References

1. Asian Americans are the fastest-growing racial or ethnic group in the U.S. (2021, April 9). Pew Research Center. https://www.pewresearch.org/fact-tank/2021/04/09/asian-americans-are-the-fastest-growing-racial-or-ethnic-group-in-the-u-s/
2. Asian American and pacific islander. (n.d.). Nami.Org. Retrieved April 8, 2022, from https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Asian-American-and-Pacific-Islander
3. The center for Asian health engages communities in research to reduce Asian American health disparities. (n.d.). Nih.Gov. Retrieved April 8, 2022, from https://www.nimhd.nih.gov/news-events/features/training-workforce-dev/center-asian-health.html
4. Kochhar, R. (2018, July 12). Income inequality in the U.s. is rising most rapidly among Asians. Pew Research Center’s Social & Demographic Trends Project. https://www.pewresearch.org/social-trends/2018/07/12/income-inequality-in-the-u-s-is-rising-most-rapidly-among-asians/
5. Lee, S., Martinez, G., Ma, G. X., Hsu, C. E., Robinson, E. S., Bawa, J., & Juon, H.-S. (2010). Barriers to health care access in 13 Asian American communities. American Journal of Health Behavior, 34(1), 21–30. https://doi.org/10.5993/ajhb.34.1.3
6. Misra S, Le PD, Goldmann E, Yang LH. Psychological impact of anti-Asian stigma due to the COVID-19 pandemic: A call for research, practice, and policy responses. Psychol Trauma. 2020;12(5):461-464. doi:10.1037/tra0000821
7. Duh-Leong C, Yin HS, Yi SS, et al. Material hardship and stress from COVID-19 in immigrant Chinese American families with infants. J Immigr Minor Health. Published online 2021:1. doi:10.1007/s10903-021-01267-8
8. Why Asian Americans don’t seek help for mental illness. Mcleanhospital.org. Accessed December 20, 2021. https://www.mcleanhospital.org/essential/why-asian-americans-dont-seek-help-mental-illness
9. Cheah CSL, Wang C, Ren H, Zong X, Cho HS, Xue X. COVID-19 racism and mental health in Chinese American families. Pediatrics. 2020;146(5):e2020021816. doi:10.1542/peds.2020-021816
10. Products – data briefs – number 314 – July 2018. (2019, June 7). Cdc.Gov. https://www.cdc.gov/nchs/products/databriefs/db314.htm
11. Ho, E. Y., Ha, N. B., Ahmed, A., Ayoub, W., Daugherty, T., Garcia, G., Cooper, A., Keeffe, E. B., & Nguyen, M. H. (2012). Prospective study of risk factors for hepatitis C virus acquisition by Caucasian, Hispanic, and Asian American patients: Ethnic differences in risk factors for HCV. Journal of Viral Hepatitis, 19(2), e105-11. https://doi.org/10.1111/j.1365-2893.2011.01513.x
12. Kim, H.-S., Yang, J. D., El-Serag, H. B., & Kanwal, F. (2019). Awareness of chronic viral hepatitis in the United States: An update from the National Health and Nutrition Examination Survey. Journal of Viral Hepatitis, 26(5), 596–602. https://doi.org/10.1111/jvh.13060
13. Products – data briefs – number 361 – march 2020. (2020, June 26). Cdc.Gov. https://www.cdc.gov/nchs/products/databriefs/db361.htm
14. https://www.congress.gov/bill/117th-congress/house-bill/3573/text#:~:text=Introduced%20in%20House%20(05%2F28%2F2021)&text=To%20amend%20the%20Public%20Health,Hawaiian%2C%20and%20Pacific%20Islander%20 population.