Asian American and Pacific Islander Heritage Month - May 2022

The inauguration of Asian American and Pacific Island Heritage Month in the United States ensued from a conversation that Frank Horton, a representative from New York, had with a Capitol Hill staffer, Jeannie Jew, who brought the idea to him over 15 years before it was authorized by former President Jimmy Carter on March 28th, 1979. It was initially dated for the first week of May due to two historical reasons: 1) It commemorated the first known Japanese immigrant to the U.S. on May 7, 1843, and 2) to honor the completion of the transcontinental railroad on May 10, 1869, wherein 20,000 Chinese workers who participated in this construction[1]. From 1992 onward, Asian American and Pacific Island Heritage Month is remembered and celebrated. This historical precedence shapes our thoughts today as we acknowledge the two specific yet distinct racial groups for their significant contributions to this day. But we also remember and celebrate with other underrepresented minorities from different racial and ethnic backgrounds who also helped pave the way yet traditionally were assigned as AAPI and not in their unique representation. While there are multiple reasons for the broad classification of AAPI of these subgroups, it poses a unique challenge to recognize the complexity of identifying individuals and cultures accurately represented and reported within the broad category of Asians and Pacific Islanders in their own right. Contributing to this challenge is the lack of consensus in terminology in reporting standards by the Office of Management and Budget (OMB) (ref 3), but also socio-political factors that continue to underpin the discussion between aggregation vs. disaggregation of data. Not surprisingly, this broad view provides us with data on the larger population of Asians: Chinese, Indian, Filipino, Vietnamese, Korean, then Japanese [2]. What it potentially overlooks are the smaller populations of which there are nearly 50 others (Burmese, Pakistani, Tibet, Kazakhstan, Tajikistan, Azerbaijan, Iran, and Armenia to name a few). This broad view of all Asians is somewhat similar while related cultures, impacted policies, unique forms of celebrations, and recognitions are narrowly focused on these larger groups that demonstrate a paradoxical definition of the term “Asian.”


There have been many discussions, different perspectives, and rationale for aggregating and for disaggregating the data. Each perspective holds a legitimate case with the thoughtful intention for or against data disaggregation. Those who oppose disaggregation have legitimate concerns for breach of privacy and re-identification of smaller subpopulations of data, especially those with historically underrepresented minorities. Others advocate for data aggregations for the reasons of political strengths and in pursuit of establishing larger clout of solidarity among smaller racial/ethnic groups who share the benefits that derive from overlapping values and cultures within the political sphere. Other concerns for disaggregation are unintended consequences of potentially pitting groups against each other within the AAPI group and perpetuating discriminatory behaviors toward a certain race and ethnicity[3]. While these are only a few challenges mentioned among other potential issues of disaggregation, we must first consider everyone as a representative of a unique identity and socially influenced and constructed being. There is no doubt that all voices, no matter how small or big in numbers need to be acknowledged and heard. Therefore, we need to continue to engage in our local communities that may be misrepresented or “misclassified” from our limited perspective and from the data quality standpoint, especially from the US federal race and ethnicity categories. Not doing so, will perpetuate the cycle of the unknowns of “others” race categories and fail to address those who are critically medically underserved[4]. We must foster appropriate “systems thinking” that takes account of multiple layers of individual systems that evolve from micro (individual level) to meso (group level) to macro (community level) when reflecting on delivering equity healthcare. We must also be culturally mindful about not assuming that certain subgroups all share the same values and come from similar socially constructed places. We know that AAPI is not all the same nor share the same culture and values: for example, there are significant differences between U.S.-born Asian-Americans and second-generation immigrants[5].


Appropriate consideration of the various cultures and having the means to assess individuals without glossing over these individuals provide us with a richer story that more appropriately allows us to celebrate the many cultures. We are fortunate that at UCSF, we are already in early discussions with a thoughtful approach to disaggregating data when possible through early groundwork at the education data council. This will help us with identifying overlapping categories of race and ethnicity but also other demographic data that are collected and thoughtfully used to gain further understanding of our learners and to create actionable items. Furthermore, the UCSF Health Equity Council, our admissions committee, and our program assessment committee are considering how data is collected and utilizing this to identify gaps and ultimately provide equitable solutions. Representation matters, and to appropriately represent the unique cultures that exist, we need to reflect on how we think about groups and how we collect information on those groups.

In solidarity,


Sam Pak, PT, DPT, cert MDT and Alex Dien, PT, DPT


References
[1] About Asian/Pacific Heritage Month [Internet]. [cited 2022 May 22]. Available from: https://asianpacificheritage.gov/about/
[2] Budiman, A, Ruiz, N. Key facts about Asian Americans, a diverse and growing population [Internet]. [cited 2022 May 22]. Available from: https://www.pewresearch.org/fact-tank/2021/04/29/key-facts-about-asian-a...
[3] Disaggregating Race/Ethnicity Data Categories: Criticisms, Dangers, And Opposing Viewpoints | Health Affairs [Internet]. [cited 2022 May 24]. Available from: https://www.healthaffairs.org/do/10.1377/forefront.20220323.555023
[4] Lee, S., Martinez, G., Ma, G. X., Hsu, C. E., Robinson, E. S., Bawa, J., & Juon, H. S. (2010). Barriers to health care access in 13 Asian American communities. American journal of health behavior, 34(1), 21–30. https://doi.org/10.5993/ajhb.34.1.3
[5] Ye, J., Mack, D., Fry-Johnson, Y., & Parker, K. (2012). Health care access and utilization among US-born and foreign-born Asian Americans. Journal of immigrant and minority health, 14(5), 731–737. https://doi.org/10.1007/s10903-011-9543-9
Resources
Liu, Clifford Z. MS1; Wang, Eileen MD2; Nguyen, Don3; Sun, Mary D.4; Jumreornvong, Oranicha5 The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment, Academic Medicine: February 22, 2022 - Volume - Issue -
doi: 10.1097/ACM.0000000000004639