How the Monolithic “Asian” Identity Is Killing Us in Healthcare
From an open heart surgery at 6 months to an appendectomy at three years old to two separate ACL replacement surgeries in the past two years, the hospital has almost become my second home. As an adoptee, I have no family medical history records, which are essential to predicting and preventing potential diseases that run in a family. When I was younger, it didn’t really matter to me. However, as I’ve gotten older, this information gap has encouraged me to learn more about the general health problems of Asian Americans.
In light of all of the physical and verbal attacks aimed at our community, it’s invaluable to understand that the American healthcare system is dominated by, and made for, white people. This has devastating (but preventable) consequences for many minorities, including countless Asian Americans. I want to make it clear that Western healthcare systems have historically ignored the real medical needs of BIPOC communities, something that continues to this day. This fact is foundational for addressing the current disparity in our healthcare system.
Approximately 10.2% of the adult population in the United States has type 2 diabetes. You might be wondering, “Do Asian Americans even have a problem with diabetes in the first place?” Asian Americans with diabetes are often ignored because they have a lower diabetes rate (9.2%) than other minority groups —compared to Hispanic Americans (12.5%), Black Americans (11.7%), and Native Americans (14.7%). Asian Americans have the second-lowest obesity rate out of any racial group in the United States—white Americans have the lowest (7.2%). However, these statistics are misleading because it is rooted in the monolithic view of Asians and Asian Americans, brushing aside the intricate and personal medical struggle of specific groups that make up the greater community.
Asians account for 60% of all diabetes diagnoses in the world. While Asian countries tailor their healthcare system to their respective populations, Asian Americans aren’t afforded this luxury. I’m going to break down the reason why the problem of diabetes for Asian Americans is so serious—despite the average rate being deceivingly low—and the dangers of even having an “Asian” or “Asian American” category in medical research studies in general.
“We began with, diabetes is not a big problem in the Asian community to now thinking simply being Asian is a risk factor.”
— Dr. Edward Chow
“Doctors’ message to Asian Americans: Watch out for diabetes even if you’re young and thin”
The Social Explanation
The model minority myth applies to the healthcare field as well, though it does look a little different. For example, doctors are less likely to follow up with their Asian American patients who are suffering from chronic disease. Doctors sometimes overestimate the knowledge Asian American patients have when it comes to understanding their health. This translates into briefly going over a specific diagnosis or not simplifying medical concepts, due to the stereotype that all Asians are “smart.” Moreover, the University of Chicago Medical Department conducted a study in 2014, revealing that Asian Americans are 34% less likely to receive diabetes screenings from their pediatricians than any other group. In another study, Asian Americans, especially those who are foreign-born, reported that doctors generally don’t take the time to explain test results, procedures, and specific diagnoses.
The category “Asian” is too broad for something as personal and as important as health. When we use this all-encompassing term, it doesn’t do justice to specific age groups, regional groups, or economic groups that are impacted in their own ways.
“If it’s all clustered together as ‘Asian’ — then that would mask rates of obesity for specific populations.”
— Kathy Ko Chin
President and CEO of the Asian & Pacific Islander American Health Forum
While East Asian Americans are 40% more likely to be diagnosed with diabetes than white Americans, South Asians are 70% more likely. When we take into account age groups, the data is further complicated. For instance, Japanese American men over the age of 70 had a diabetes rate of 40%, almost double that of white Americans at this age.
We also have to take into consideration the intersectionality between health and socioeconomic class. Studies have shown that there is a correlation between diabetes and poverty. A Canadian study suggests that impoverished people are four times more likely to become diabetic. With this in mind, the Asian American community faces one of the largest wealth gaps out of any racial group in the United States. While the average Asian American household makes $73,000 (approximately $3,000 more than the average American household) annually, Hmong American households, some of the poorest among all Asian American households, have an average income of only $48,000 per year. Moreover, Hmong Americans have one of the highest obesity rates in the United States at almost 35% for young people and it’s predicted that over 60% of the Hmong population has undiagnosed prediabetes or diabetes. Diabetes is also a very expensive disease to live with, as the average cost of diabetes treatments in the United States is $16,752 per year. Millions of people skip purchasing their prescription medications and physician visits because they can’t afford them.
The Biological Explanation
In the West, Body Mass Index or BMI is still used by doctors to show patients where they lie in terms of a healthy weight. However, East Asians and South Asians have on average 7-8% more body fat than white people. This means Asians have more body fat for the same amount of weight, yet many doctors don’t consider this when using this measurement. While a BMI of 25 for a white person is considered healthy, for an Asian American this is considered obese. BMI measures weight, and it’s one of the tests used to determine if a patient needs a diabetes screening. However, since it doesn’t account for body fat, they aren’t accurate for many Asian Americans— and many live with diabetes undiagnosed. There are also biological changes immigrant groups face when moving to America that are worth noting. For example, a study following Hmong and (Burma) Karen immigrant women showed that their microbiome had become less diverse, thus increasing the risk of obesity as a result of adapting to a more western lifestyle.
The Cultural Explanation
When we look at Asian Americans, those who are foreign-born have a much lower diabetes rate than their American-born counterparts While we have lived in America for over 300 years, there is still little extensive medical research about our community. However, it should be noted that the role of traditional medicines is sometimes seen as a cultural barrier between doctors and their Asian patients. One such study notes that some Chinese American patients will turn to traditional remedies before they reach out to their physician in an attempt to address a diabetes diagnosis. Language barriers as an obstacle to quality medical care are is not unique to Asian Americans. However, Asian Americans have the highest rate of Limited English Language Proficiency (LELP) at 19%. A strong doctor and patient relationship is required to fight diabetes, so when valuable medical information is lost in translation, the likelihood of complications increases.
On the other hand, obesity and diabetes increase dramatically for second and third-generation Asian Americans. This makes sense, as American food is high in calories, fat, and sugar. Compared to our ancestor’s home nations, Asian Americans are consistently more obese and diabetic. Furthermore, we are the fastest-growing minority in the nation, as more Asian Americans lay down their roots, it’s only a matter of time before more people face these health problems.
Our Bodies Need to Be Prioritized
If it’s not clear enough already, the main takeaway is: our bodies need to be prioritized in the same way white people are. On the continent where many of our ancestors called home and where over half of the world lives, it’s clear that we are different from each other physiologically, culturally, and socioeconomically. Yet we are continually put into the same category: Asian, in research studies. Our individual circumstances are not understood or prioritized by healthcare professionals. Not only does creating and perpetuating an artificial label like Asian American simply downplay the rich and proud history of the various communities we are a part of, but it’s also killing us.
Despite this scary reality, there has been work to push younger people, often Asian Americans, to screen for type 2 diabetes. Currently, a body mass index of 25 is the national benchmark for a diabetes screening, but San Francisco, Los Angeles, and New York City have either passed or are in the process of passing legislation that will make the new benchmark for screening at a body mass index of 23 because of their large Asian American populations.
Here are some things you, your family, and your friends can do to address this problem.
BMI is less predictive of diabetes for Asians because of the naturally higher levels of body fat we have. The Asian Diabetes Initiative (ADI) has its own “Asian BMI Calculator” that gives a more accurate BMI.
Ask your physician to get a diabetes screening, even if you aren’t overweight, young, or consider yourself healthy.
Tell your physician when you are confused, as it’s their job to explain what is going on. For non-English speakers, some interpreters specialize in medicine that can help during appointments and some apps can help translate medical concepts as well.
Prediabetes can be reversed and the side effects of diabetes can be mitigated through a healthy diet and regular exercise.
The inequality that minority patients face in America is further amplified with incredibly serious repercussions in the medical field. Every one of these issues—whether it be income inequality, language privilege, and the ever-looming model minority myth—are their own separate issues that when combined, culminate in this health crisis.
To further decolonize our minds:
NBC News | New Study Reveals Previously Invisible Health Issues Among Asians in US
CDC | Health of Asian or Pacific Islander Population
American Bar Association | Implicit Bias and Racial Disparities in Health Care
If you liked what you read, be sure to subscribe and follow us on Twitter and Instagram @invisibleasians to stay updated on Politically Invisible Asians!
Wow! Thank you for shedding light on this issue 🤗
Wow, thank you for this piece! As someone who has diabetes in my own family, this was so interesting to read and learn about!