COVID-19 has claimed more than 600,000 lives in the U.S. yet hidden in that number is how deadly the pandemic has been for Asian Americans.
Emerging evidence shows that the COVID-19 mortality rate for Asian Americans is the highest among all races and ethnicities for some subpopulations. Yet sadly, this loss remains largely invisible.
According to a new report by the Department of Health and Human Services, Asian nursing home residents had the highest COVID mortality rate among all race/ethnic groups. Similarly, Health Affairs revealed that Asian American Medicare beneficiaries had the highest COVID-attributed mortality rate in 2020. A Kaiser Family Foundation analysis of 50 million U.S. patients also found Asian Americans had the highest risk of hospitalization and death when tested positive for COVID.
Asian Americans are dying at an alarmingly high rate. Why is there so little public discussion about why this is happening, and how we should remedy it?
The invisibility of Asian American health issues is largely rooted in the model minority myth, a stereotype that paints all Asian Americans as successful and problem-free. Asian Americans are not the focus of health equity research, or the target for culturally specific resources, because they are not considered a population facing challenges by those who incorrectly accept this myth.
For example, Asian Americans are not even mentioned in the 2020 “Framework for the Equitable Allocation of COVID-19 vaccines,” a report by the National Academies of Sciences, Engineering and Medicine commissioned by the Centers for Disease Control and Prevention and National Institutes of Health.
Although the COVID-19 mortality rate is only one metric, the emerging pattern is a warning sign for the distinctive and diverse health-care needs of Asian Americans. We cannot succeed in our goal of achieving health equity without explicitly taking steps to address health disparities for this population.
First, we must collect complete and disaggregated data. Asian American data are more likely to be missing or misclassified as “other,” and usually only available in aggregate. With more than 20 ethnicities, Asian Americans are not a monolith. While Asian Americans may appear healthier as a single category, some ethnic subgroups fared much worse than their white counterparts.
Lumping data together masks disparities and reinforces the model minority myth at the expense of Asian American wellness, and ultimately lives. Collecting fuller data including national origin and preferred language is essential to understanding the needs, assets, disparities and opportunities of the nation’s fastest-growing population.
Second, we need to invest in Asian American focused research and community organizations. Health disparities revealed by COVID-19 are just the tip of the iceberg of historic underinvestment in this community.
Asian Americans account for 6% of the nation’s population, yet the National Institutes of Health, the nation’s foremost health research agency, spends only 0.17% of its budget to fund clinical research focused on Asian American, Native Hawaiian and Pacific Islanders. Philanthropic giving to AAPI communities is also abysmal. For every $100 awarded by foundations, only $0.20 are designated for this group. Sufficient funding is required for researchers to examine the health issues facing Asian Americans and for community organizations to support people in need.
Additionally, we must provide culturally and linguistically appropriate services. Asian Americans trace their roots to more than 20 countries, each with diverse cultures, languages, immigrant histories and economic backgrounds. Around 60% of Asian Americans are foreign-born, and more than 30% speak limited English, creating barriers to accessing health care and social services. We need to create a culturally competent health care system to help improve quality of care and health outcomes for all.
Finally, we must address racism. Asian Americans are fighting two pandemics: COVID-19 and the virus of racism. Over the past year, Stop AAPI Hate documented 6,603 anti-Asian hate incidents.
The long history of racism against Asian Americans — and the more recent spike in attacks — is harming the physical and mental health of Asian Americans. Viewing racism as a public health issue offers legislators, health officials and communities the opportunity to examine structural policies that reinforce inequities and to ensure that Asian Americans have a fair and just opportunity to be as healthy as possible.
It’s long overdue to prioritize public efforts to address health disparities facing Asian Americans. Health equity must include Asian Americans to improve care, address unmet needs and ensure good health for all.
Lanlan Xu (firstname.lastname@example.org) is a health services researcher in Howard County.