Wednesday, March 30, 2022

How does the model minority myth harm Asian American aspirations and health?

The medical profession, including family medicine, benefits from having a racially and culturally diverse workforce. In my current practice, I care for a disproportionate number of older Chinese American patients even though I was born in the United States and know fewer than a dozen words of Mandarin. Yet my common heritage allows me to relate to these patients in ways that my non-Chinese colleagues cannot and improves their comfort and trust in my clinical recommendations.

In the mid-1990s, I applied for an 8-week summer laboratory research program at an Ivy League university that explicitly recruited college students from minority groups. Although I am a child of Chinese and Taiwanese immigrants, there was then, and is now, no shortage of Americans of east Asian descent in medical and other health care professions, including in my own extended family. I wondered if being a member of an "overrepresented" group would work against my being accepted to the program. As it turned out, it did not. Although the majority of my fellow students were African American or Latino, there were several other Asian Americans and even one white student. Looking back, the program was a great success, as most of us ended up becoming doctors. A few years ago, I began mentoring underrepresented in medicine (URM) college students in a similar program at my own institution.

Asian Americans are often mischaracterized as the "model minority" to contrast us with other non-white groups that have not achieved comparable economic success and health status on a population level. But lumping all Asian Americans together obscures the fact that many subgroups are actually URM. In a Letter to the Editor in Family Medicine, Dr. Oanh Truong highlighted the importance of data disaggregation to reveal these disparities:

When Asian American data are aggregated, the conclusions misleadingly suggest that Asian Americans as a singular population are thriving, perpetuating the harmful myth of Asian Americans being the model minority, where they are assumed to be doing better than other minority groups. ... However, data disaggregation would reveal that while Filipinos make up 18% of the nation’s Asian American population, they made up only 4.3% of the Asian American medical school applicants in 2019. Additionally, Laotians, Indonesians, and Cambodians altogether made up only 0.5% of the Asian American applicants.

The National Institutes of Health (NIH) highlighted "knowledge gaps, challenges, and opportunities in health and prevention research" for Asian Americans, Pacific Islanders (AAPI) and Native Hawaiians in a 2021 workshop whose proceedings were reported in the Annals of Internal Medicine. Although these groups collectively comprise nearly 8% of the U.S. population, the NIH spent just 0.17% of its budget on researching them between 1992 and 2018. The most telling figure in the report was a "heatmap" that illustrated the known prevalence of chronic health conditions in various AAPI subgroups compared to the U.S. white population. Some were lower, the same, or higher, but nearly half of the cells were blank, indicating insufficient data. We can't take action to reduce a health disparity if we don't even know if it exists.

Recent commentaries in Health Affairs and the Milbank Memorial Fund Blog expanded the argument that poor data quality combines with racial stereotypes to "fuel scientific and societal misperceptions that Asian Americans do not experience health disparities, [codifying] racist biases against the Asian American population in a mutually reinforcing cycle." According to the Milbank Fund, "one in four Pacific Islander adults report problems paying medical bills ... and there is wide variation in uninsurance rates across Asian American subgroups."

An article in press in Academic Medicine by a group of medical students and residents traces the history of discrimination and racism that AAPI have experienced from the 1882 Chinese Exclusion Act to the rise in anti-AAPI rhetoric and hate crimes since the start of the COVID-19 pandemic. The authors point out that discrimination is associated with underutilization of health care services and increased risk of chronic illnesses among non-elderly AAPI immigrants. They recommend that U.S. medical schools implement antiracist policies that recognize unconscious biases against AAPI patients, students, and faculty (e.g., the "bamboo ceiling") and "use disaggregated AAPI data so that the designation of [URM] is appropriately used to recruit diverse individuals who are collectively representative of the whole AAPI disapora."