A National Health Agenda for Asian Americans and Pacific Islanders

Abstract

HISTORICALLY, RESEARCH SPECIFIC TO THE HEALTH OF Asian Americans and of Pacific Islanders has been withoutfocusandsignificantfinancialsupport.AvailabledataonanyAsianAmericanandPacificIslander subgrouphavetendedtobecatalogedthebroaderAsianAmericanandPacific Islandercategorywithoutmoreextensivespecificity. Subsequently, clinicians, insurance companies, public health practitioners, and policy makers have had few opportunities tomakeevidence-baseddecisions for thesesubgroups. More recently, as Asian Americans and Pacific Islanders have become one of the fastest growing and most heterogenic ethnicities, this lackofavailabledatahasprevented theestablishmentofhealthobjectives specific to thispopulation.Togather pertinentAsianAmericanandPacific Islanderhealthdata, support necessary research, and administer successful interventions,medical leaders shouldestablishandpromoteanational Asian American and Pacific Islander health agenda. Since the 1990s, researchers have been warning that Asian Americans and Pacific Islanders, rather than being a “model minority”thatexperiencesfewhealthproblems,havehighrates ofhepatitisB, liver cancer, tuberculosis, lungcancer, and thalassemia, amongotherconditions. A2003studyshowedthat the federal government has scant data on the health of Asian AmericansandPacificIslanders.The23applicablefederalhealth surveys generally aggregate data under the scientifically unuseful category of Asian or Pacific Islander. The vast diversity within this broad category and the small numbers relative to the full population in the United States prevent effective data collection, stratification, and analysis. Compounding this are the fewgrants the federal governmenthasallotted for research on Asian American and Pacific Islander populations. According to the same 2003 study, from 1986 to 2000, only 0.2% of federal grants involved Asian American and Pacific Islander health directly or tangentially. Presidents Clinton and George W. Bush signed executive orders establishing the President’s Advisory Commission on Asian American Pacific Islanders. In 2003, the commission, concerned about the state of available Asian American and Pacific Islander health information, released its report with recommendations to create a national “strategicplan for improving thehealthofAsianAmericanPacific Islander populations [that reflects] the diversity of Asian American Pacific Islander communities.” With warnings about the lack of health data, the Asian American and Pacific Islander medical and public health communities galvanized to encourage existing organizations and establish new ones to support and conduct Asian American– and Pacific Islander–related health research. For example, New York University School of Medicine established its Center for the Study of Asian American Health in 2003. The National Cancer Institute renewed funding for the Asian American Network for Cancer Awareness, Research, and Tobacco at the University of California Davis Cancer Center and funded Asian Tobacco Education, Cancer Awareness, and Research at Temple University in Philadelphia, Pennsylvania, in 2005. In 2006, the W. K. Kellogg Foundation, Battle Creek, Michigan, committed $16.5 million to the elimination of Asian American and Pacific Islander health disparities with the Health Through Action program. The US Department of Health and Human Services (HHS) responded by funding Asian American and Pacific Islander health initiatives through the National Institutes of Health, Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, Health Resources and Services Administration, and Office of Minority Health. These efforts have led to research reinforcing that Asian American and Pacific Islander subpopulations experience health disparities relative to the rest of the US population in areas such as stomach and liver cancers, cervical cancer screening, hepatitis B infection and death rate, diabetes, infant mortality, tuberculosis, mental health, osteoporosis, smoking rates, and health insurance coverage. Federal entities are beginning to understand the need for disaggregated data on Asian Americans and Pacific Islanders. Since 2000, the US Census Bureau has reported on 25 Asian and 23 Pacific Islander subgroups. However, the Centers for Disease Control and Prevention, which administers the national health surveys that the federal government uses to make policy decisions, collects data on Asian Americans and Pacific Islanders inconsistently, differing survey to survey. The HHS National Committee on Vital and Health Statistics recommends that HHS move toward gathering microdata, defined as nonaggregated data containing variables that make the respondents potentially identifiable, and not overlook small Asian American and Pacific Islander subpopulations scattered inconsistently throughout the United States. The committee also urges that HHS collect better race/ethnicity data in programs such as Medicare, Medicaid, and federal employee health plans. Although government, academia, and community organizations have sharpened focus on Asian American and Pacific Islanderhealth, toincreaseresearch, implementevidence-based