A Plea to Improve Data Collection
Christina Abraham illustrates how over-simplifying racial identity influences representation, and resources for entire subpopulations.
Many of us know this familiar story: you are filling out forms requesting information on your racial identity. You review the categories – “White, Black, Asian or Pacific Islander, Native American” – and the internal struggle to determine the one that best describes who you are begins. As a South Asian American, I have often felt parts of my own identity erased each time I squeeze myself into the “Asian” checkbox on paperwork, seeking for a way to convey the diversity within myself.
Asian Americans, as a pan racial group, are the fastest-growing minority in the U.S. However, clinical researchers and public health officials often lack the empirical evidence necessary to develop and fund effective public health interventions for this population. One of the primary reasons for this is limited information on the varying subpopulations within Asians as a whole. With more than 20 languages spoken, over 30 nationalities and ethnic groups included, and numerous religions and cultures represented, Asian Americans are enormously diverse. The 2010 Federal Census sought to capture some of this diversity through the breakdown of Asian Americans into several categories including Asian Indian, Chinese, Japanese, Korean, Filipino, Vietnamese, and “other Asian” which included Thai, Laotian, Pakistani, and Cambodian. The 2020 Census has thankfully expanded on these classifications, but many states such as Connecticut, Arizona, Delaware, Florida, Iowa, Maine, Michigan, and Oklahoma aggregate this diversity into simply “Asian,” “Asian or Pacific Islander,” or “Other.” These over-simplifications not only seriously impede our ability to evaluate public health trends amongst subpopulations of Asian Americans, but it also conceals important information from leaders, decision-makers, and elected officials responsible for allocating health resources.
The COVID-19 outbreak has brought issues of data reporting amongst Asian Americans and the need for more representation into sharp focus. As of June 2020, 48 of 56 U.S. states and territories have reported race and ethnicity data for COVID-19 cases, and 43 states have released this information for COVID-19 deaths. Many states such as Kansas, Kentucky, and Minnesota have reported that Asian Americans are in the top racial groups disproportionately impacted by COVID-19. However, evaluating trends amongst Asian Americans at both state and national levels is extremely challenging when individuals from a variety of backgrounds are grouped into the “Asian” or “Other” classifications.
Without the necessary granularity of data on Asian American subgroups, how can we as public health professionals attempt to create and tailor interventions to the populations that need them most?
Moreover, although COVID-19 has rightfully captured the world’s attention, disparities in chronic disease, mental health, and socioeconomic factors have existed and persisted within Asian subpopulations for decades. In one of the few studies to focus on variations in rates of select chronic diseases experienced by Asian subpopulations, researchers saw significant differences amongst several groups including higher rates of heart disease and obesity in South Asians, lower rates of heart disease and obesity in Chinese and Korean men and women, and an overall greater health burden amongst Filipinos and Pacific Islanders.
The U.S. Dept. of Health and Human Services acknowledges that the sampling bias created by surveys being offered in a limited number of languages, lack of community outreach, and variations in data collection processes by state all contribute to the challenges of comprehensive data analysis and research for Asian individuals across the board. Even more troublesome, these biases have led to research focused on Asian Americans who are well educated, gainfully employed, and speak English, inevitably supporting the myth of the “well-adjusted” Asian American and consequently overlooking the obstacles to health faced by many within this group. Broadening survey categories, eliminating incongruent data collection methodologies, and consistent compilation of public health data on Asian Americans would shed more light on the barriers to health that this group faces.
Ultimately, this granularity will deepen our understanding of the multitude of groups within the categories we are so accustomed to seeing on paper. Armed with more comprehensive data, public health practitioners and policymakers will be able to advocate for and develop the interventions Asian Americans need to live healthier lives, in both the era of COVID-19 and beyond.
Christina Abraham is 2021 MPH candidate in the Department of Health Policy & Management. She received her Bachelor's Degree in Operations and Technology Management from Boston University.
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