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Markkula Center for Applied Ethics

The Ethics of Health and Ethnic Identity Through an Asian American Lens

Pan Asian Classifications in Health Care Associated Press, Ng Han Guan

Pan Asian Classifications in Health Care Associated Press, Ng Han Guan

Jasmine Jaing ’22

Ng Han Guan/Associated Press 

Jasmine Jaing ‘22 is a biology and public health science double major at Santa Clara University and a 2021-22 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.

In 2020, the world was hit by the COVID-19 pandemic. Along with this rampant, widespread disease came another phenomenon: the spread of Asian and Asian American hate. COVID-19 was dubbed the “Chinese Virus” and anyone of Asian descent, whether they identified as Chinese or not, were subject to hate crimes and xenophobia as they were thought to have brought the virus to the United States. This led to the Stop AAPI Hate movement that highlighted the panethnic identity of the Asian American community and rallied people all over the United States to end violence against Asians and Asian Americans. 

The panethnic Asian American identity encompasses all groups of Asian descent through unique shared experiences. When fighting for social justice issues, having this unified identity is crucial in bringing awareness to discrimination and fighting against it. However, the panethnic identity cannot be fully embraced without acknowledging the unique experiences of the different Asian ethnic groups, especially when considering health outcomes. 

In 2011, the U.S. Centers for Medicare and Medicaid Services (CMS) urged health care organizations to track race and ethnicity when allocating funds in an attempt to identify health disparities. According to CMS, the panethnic Asian category was sufficient enough for data analysis of all Asian ethnic groups. This may be due to two reasons: the model minority myth and different cultural practices in health care. The model minority myth theorizes that the Asian American population are model minorities due to their apparent success in academics and the workforce. While this may seem positive, it dismisses health disparities such as mental health concerns that have arisen due to this perceived success. In addition, health data for Asian Americans is aggregated because there is scarce data to begin with. Cultural practices of those of Asian descent prefer non-Western medicine and are less likely to seek medical care from health professionals. Language barriers also play a role in deterring Asian Americans from visiting a doctor. Thus, the general lack of data within the Asian American community may contribute to viewing the group as one entity. 

Viewing the Asian American community as a monolithic group, however, has the potential to mask important health differences in medical and public health research. A cohort study of Northern California Kaiser Permanente patients examined electronic health records of the major Asian American ethnic groups (Chinese, Filipino, Japanese, Korean, Southeast Asian, South Asian, other) to analyze the prevalence of these diseases and their risk factors. 

The results highlighted significant differences in disease prevalence of the All Asians category compared with individual ethnic categories. For example, the prevalence of diabetes for All Asians was 23.1% compared to 15.6% for Chinese and 31.9% for Filipinos. Figure 1 shows meaningful differences in disease prevalence for different Asian ethnic groups in relation to specific diseases. 

It is evident that almost every ethnic group has health outcomes that differ from the aggregated Asian group and between individual ethnic groups. These differences prove that the panethnic Asian American identity cannot be used to aggregate health data. 

The principle of nonmaleficence is violated as the failure to acknowledge the aggregation and extrapolation of Asian American data essentially causes harm by not recognizing the unique experiences of these groups and the repercussions that such denial can have on health outcomes. Not only does it mask differences in health, it also may lead to unequal allocation of health resources and insufficient research on the Asian American population. 

The lack of data on Asian American health and health disparities is inexcusable given that Asian Americans are the fastest growing ethnic group in the United States. Justice calls for fair and equitable treatment for all. 

Few studies investigate health disparities and causes of mortality within Asian American subgroups. This may allude to the incorrect but widely held notion that Asian Americans have a lower risk of disease compared to other ethnic groups. Epidemiologic surveys and clinical trials are especially vulnerable to these errors. A health disparity that disproportionately affects those of Asian descent is gastric cancer. Gastric cancer is the fifth most common cancer and the third leading cause of cancer death worldwide. East Asian countries alone account for 60% of gastric cancer cases, showing the pressing need to increase research and clinical studies on these populations. 

In the United States, between 1998 and 2002, it was found that the age-adjusted gastric cancer incidence and mortality rates were 18.3 in Chinese men and 29.3 in Japanese men, compared to a rate of 9.9 in non-Hispanic White men. However, the rates of Asian Indian and Filipino populations were not significantly different from non-Hispanic white men. 

With there being over 17 million Asian Americans, health data within the Asian American population cannot be aggregated as East and Southeast Asians exhibit a higher incidence of gastric cancer compared to those of Indian and Filipino descent. With that being said, there should be a targeted approach to the identification, prevention, and treatment of gastric cancer by health professionals who work closely with these populations. Making this health data more widely available to health professionals and researchers can be beneficial in early screening and detection of gastric cancer and initiating preventative interventions targeted towards Asian Americans. 

Both the panethnic and ethnic identity of the Asian American community has the potential to help and hinder the population in terms of health outcomes. As a panethnic identity, the Asian American community has banded together to fight the injustices that spurred from the COVID-19 pandemic, highlighting the power of social solidarity within the Asian American identity. However, it is only ethical to recognize Asian ethnic groups as individual groups when considering health outcomes and disparities. As COVID-19 regulations are loosening, the unity and support within the Asian American community must remain strong, but we must also recognize the value of individualizing Asian ethnic groups for the sake of better health.

Apr 29, 2022

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