May 25, 2021

Anti-Asian Racism and Its Effects on Healthcare

Racism is a Pandemic sign

In the United States, the month of May is officially designated to acknowledge and celebrate the contributions of generations of Asian and Pacific Islanders – still the fastest-growing ethnic group in the country – have made to American history, society, and culture. Ironically, Asian American and Pacific Islander (AAPI) Heritage Month in 2021 falls as America finds itself in a particularly ugly national reckoning about what it means to be Asian American. This is, of course, a much bigger topic than one article could ever encompass. But today, let’s talk about some of the many ways that anti-Asian racism today is affecting healthcare in America.

Harvard Professor Russell Jeung (and founder of discrimination data project Stop AAPI Hate) put the problem into context for the Harvard Gazette earlier this month. “Asian Americans are more worried about the other Americans next to them than they are about a pandemic that’s killed half a million people,” he said. “That’s how widespread the racism is; that’s how insidious it is; that’s how traumatizing it is. … Asian Americans are in a state of siege at this moment. We’re keeping our elderly in; we’re avoiding places; we’re arming ourselves; we’re going into fight-or-flight mode; we’re really concerned about sending our students back to school.”

This current crisis has as its foundation centuries of smoldering racism; as a PBS headline put it recently, there is a “long history of racism against Asian Americans in the U.S.

Overall health – and mental health in particular – is at risk for AAPI patients.

Those who identify as AAPI searched for mental health resources more in 2020 than ever before.

A recent study in the American Journal of Public Health found that Asian Americans experience negative disparities in disease incidence, access to care, and quality of care, with varying areas of particular concern among the subgroups that comprise the AAPI community.

Moreover, as Professor Russell so poignantly explained, a mental health crisis is underway.

Data have shown that those who identify as AAPI searched for mental health resources more in 2020 than ever before, in the highest-ever, year-over-year increase.

The issue is made worse by the fact that AAPI individuals are less likely than those from other racial groups to seek mental health treatment (inpatient care, outpatient care, or medication) – two to three times less likely than white patients, in fact. But while AAPI college students are half as likely as white students to carry a psychiatric diagnosis such as anxiety or depression, they are almost 40% more likely to have attempted suicide.

The pandemic has created a mental health crisis, but these data are years old. The crisis has been brewing for a very long time, as Harvard’s Dr. Justin Chen said recently.

Implications for AAPI HCPs
These findings are bad enough. Compounding the problem is that, of course, healthcare professionals are citizens and patients, too. While outlets like Beckers and the New England Journal Medicine have published think pieces on how HCPs can combat anti-Asian racism, HCPs can of course be targets themselves.

Many HCPs have eloquently shared their stories. Doctors like Dr. Chen Fu of NYU Langone told of finding themselves being subject, along with their families, to racist harassment and crime, while fighting the pandemic. Massachusetts General Hospital anesthesiology residents Lucy Li and Gem Manalo, Beth Israel Deaconess internist Audri Li, and many others recently shared their own experiences with the Washington Post. “I’m risking my own personal health, and then to be vilified just because of what I look like,” said Li. “I try not to think about that possibility when I’m at work taking care of patients. But it’s always there, at the very back of my mind.”

What We Must Do
This should not be the first time we’re discussing this. As Dr. Derald Wing Sue of Columbia University said, “It’s almost as if the public just discovered that there’s anti-Asian bias, discrimination, and hatred in this country. What’s upsetting is that it took so much violence for people to take the discrimination seriously.”

In the powerful words of Dr. Amanda Calhoun, a Black doctor at Yale, in her recent editorial for the New England Journal of Medicine, “I have seen racist behavior in every clinical rotation. … I love being part of the medical system, but I know it was built on racist ideas that persist today.”

It is past time to understand this reality for so many patients, caregivers, HCPs, and colleagues; and to consider, proactively address, and fight against, its implications for providing and receiving healthcare.