Advancing Health Equity for Asian Americans in the time of COVID-19

Advancing Health Equity for Asian Americans in the time of COVID-19

Across the United States, states and communities are struggling to overcome a global pandemic. At the same time, Black, Indigenous, and other people of color are facing the elevated effects of systematic and institutional racism. For Asian Americans, racism in the era of COVID-19 has meant an explosion of racist and xenophobic incidents blaming people perceived to be Asian—particularly Chinese—for the disease, and a lack of public information about the toll COVID-19 has had on Asian American communities.

The current state of affairs presents a cruel irony for Asian Americans: we are both hyper-visible in our communities as the “source” of the Coronavirus, while also invisible from most state and local public health department reports tracking the disease. A health equity approach requires advocates to address both of these challenges.

According to Stop AAPI Hate, a joint initiative that has been tracking Coronavirus-related incidents of harassment, hate speech, and/or violence against Asian Americans and Pacific Islanders, there were nearly 1,900 reported incidents in the U.S. as of May 13, and over 800 reported incidents in California alone. Undoubtedly, many more go unreported. Many of the discriminatory statements included anti-China and/or anti-Chinese rhetoric.

There is a long history of racism and xenophobia against Asian Americans in the U.S., particularly during times of economic hardship, threats to national security, and/or disease.  “Yellow Peril”—the scapegoating of Asian immigrants as undesirable, untrustworthy, and unclean—prompted national policies such as the Chinese Exclusion Act and decades of discriminatory labor, housing, and economic abuses against Asian American workers.

In 1942, President Roosevelt signed E.O. 9066 authorizing the incarceration of over 110,000 Americans of Japanese descent—anyone with “1/16th or more” of Japanese heritage—after the bombing of Pearl Harbor.

And in 1982, a Chinese American man, Vincent Chin, was beaten to death at a Detroit bar by two white men who mistakenly believed Chin was Japanese. The assailants were autoworkers who had been laid off and blamed Japanese auto manufacturers for rising unemployment in the U.S. auto industry. At trial, the killers were fined $3,000 and no prison time. These incidents repeatedly drew on racist beliefs that serve to exclude or “other” Asian Americans as un-American and perpetual foreigners in their own communities.

The COVID-related hate incidents of today perpetuate this history of othering of Asian Americans. And it is a narrative that President Trump and leaders in his party invoke every time they use terms like “Chinese virus,” “Wuhan virus,” and “Kung Flu” to talk about COVID-19. Even President Trump’s attempt to express support for Asian Americans used “us” vs. “them” language, which had the effect of further othering Asian American communities.

Throughout the pandemic, Asian Americans, Pacific Islanders, and other groups of color have also been noticeably absent from COVID-19 data reporting and public health response efforts. Data collection and reporting on race and ethnicity can be wildly inconsistent across state, county, and local health systems.

For example, Asians are sometimes classified as “Other” and/or aggregated with other racial groups due to their smaller population size. And even when Asian American population data is collected and reported, it often fails to disaggregate the data by Asian ethnicity, which ignores the variations in economic, social, and cultural diversity among Asian subgroups.

These differences have an effect on whether certain Asian populations are likely to have health insurance coverage, whether they may be at increased risk of certain chronic conditions or diseases, and what interventions may be more successful.

In some Asian subgroups, half or nearly half are limited English proficient, a critical demographic that is vulnerable to being overlooked when it comes to public health communication efforts to share information about COVID-19, and can lead to misunderstandings during testing and treatment. In addition, many Asian households are multi-generational and include family members of varying immigration statuses.

Older family members living in these households may be at increased risk of exposure, and immigrant family members—particularly those who are undocumented or lack permanent status—may be fearful of seeking testing or care. The CARES Act seeks to address part of the data problem by mandating all laboratory testing data to including the age, sex, race, and ethnicity of the person tested, effective August 1.

Data collection, monitoring, and reporting efforts should be more robust because it is a critical tool for identifying patterns and trends in health conditions and outcomes. In San Francisco, Asian Americans account for nearly half of coronavirus deaths, despite accounting for one-third of the city’s population. Researchers investigated further and pulled data from the few state and county sources that include Asian Americans in their reporting and found that Asian Americans have a case fatality rate that is four times higher than the overall population.

Asian Americans, like other people of color, continue to fight for dignity, survival, and recognition. Our history is not just defined by acts of oppression, but stories of resilience and resistance. To advance health equity, we need allies in the fight against Anti-Asian racism and racial justice for all people of color. We also need policy makers at all levels of government to prioritize the needs of communities that are most impacted by racist and harmful practices.


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