Abstract
Structural racism manifests as an historical and continued invisibility of Asian Americans, whose experiences of disparities and diverse needs are omitted in research, data, and policy. During the pandemic, this invisibility intersects with rising anti-Asian violence and other persistent structural inequities that contribute to higher COVID-19 mortality in older Asian Americans compared to non-Hispanic whites. This perspective describes how structural inequities in social determinants of health—namely immigration, language and telehealth access, and economic conditions—lead to increased COVID-19 mortality and barriers to care among older Asian Americans. Specifically, we discuss how the historically racialized immigration system has patterned older Asian immigrant subpopulations into working in frontline essential occupations with high COVID-19 exposure. The threat of “public charge” rule has also prevented Asian immigrants from receiving eligible public assistance including COVID-19 testing and vaccination programs. We highlight the language diversity among older Asian Americans and how language access remains unaddressed in clinical and non-clinical services and creates barriers to routine and COVID-19 related care, particularly in geographic regions with small Asian American populations. We discuss the economic insecurity of older Asian immigrants and how co-residence in multigenerational homes has exposed them to greater risk of coronavirus transmission. Using an intersectionality-informed approach to address structural inequities, we recommend the disaggregation of racial/ethnic data, meaningful inclusion of older Asian Americans in research and policy, and equitable investment in community and multi-sectoral partnerships to improve health and wellbeing of older Asian Americans.
Highlights
The disproportionate impact of COVID-19 among racially and ethnically diverse older adults has shed light on the persistent inequities against these marginalized populations [1]
Asian Americans aged 45 years and older had higher COVID-19 attributable mortality compared to non-Hispanic whites [2], and Asian Americans had 35% more deaths in 2020 than their average for the
Emerging research literature has demonstrated that structural inequalities underlie COVID-19 disparities among Black and Latinx older adults [7, 8] but few have included older Asian Americans [6]
Summary
The disproportionate impact of COVID-19 among racially and ethnically diverse older adults has shed light on the persistent inequities against these marginalized populations [1]. Having LEP is associated with greater COVID-19 infection risk and presents barriers to accessing health services/insurance and understanding health information, especially when interpreters, culturally and linguistically matched providers, and in-language information are not available [41] Compared to their counterparts who are fluent in English, Asian Americans with LEP are more likely to not have a usual source for care, not have regular check-ups, have unmet medical needs and experience patient-provider communication problems, resulting in underutilization of healthcare services and diminished quality of care [40, 42, 43]. Many older Asian Americans who live in ethnic enclaves have substandard broadband Internet access due to historical place-based racism [44] They have been experiencing difficulties in obtaining accurate and timely information in their native language about COVID-19 safety precautions, testing and vaccines; locating testing or vaccination sites; scheduling physician and vaccine appointments; maintaining communication with providers; and applying for public assistance programs that support individuals impacted by the coronavirus (e.g., rental and unemployment assistance) [45]. State, local, and philanthropic resources and funding should be equitable allocated to support multi-pronged and multi-level approaches to meet the needs of diverse older Asian Americans [12, 47, 61], and will require commitment, action and accountability to advance health equity
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