by Phoebe Zhi-Qi Teoh, Jessica McCann, Tonantzin Juarez
Introduction
People identifying as Asian American, Native Hawaiian, or Pacific Islander (AANHPI) comprise 6.2% of the U.S. population, and Asian American and Pacific Islander populations are expected to increase by 74% and 63% respectively by 2040. These diverse cultures, though often categorized as one racial identity, actually represent a myriad of geographic regions, cultures, and traditions from across the globe. Asian Americans, Native Hawaiians, and Pacific Islanders face unique health challenges and disparities, many of which are not often prioritized due to the “model minority” myth and other racial stereotypes. In this blog, we briefly highlight three of these issues (homelessness, mental health, and other health disparities) faced by Asian Americans, Native Hawaiians, and Pacific Islanders, recognizing the need to view these communities as unique and heterogeneous subgroups, and discuss policy needs and community-led initiatives.
Homelessness
Asian Americans, Native Hawaiians, and Pacific Islanders experience homelessness very differently, yet all are historically vulnerable. Rates of homelessness among those identifying as Asian or Asian American increased by 91% between 2015 and 2023, and Asian Americans and Native Hawaiians or Pacific Islanders experiencing homelessness are more likely than the general population to be unsheltered (62% and 58% respectively, vs. 39%). While just 16% of U.S. renter households are considered severely cost-burdened, 21% of Asian Americans and 50% of Native Hawaiians or Pacific Islanders are considered so, putting them at a higher risk of homelessness. Asian Americans, Native Hawaiians, and Pacific Islanders also face unique barriers to obtaining housing assistance, including limited English proficiency and discrimination. Decades of research illustrate the association between housing instability and poor health outcomes, further exacerbating the unique health issues of Asian Americans, Native Hawaiians, and Pacific Islanders.
Mental Health
Asian Americans, Native Hawaiians, and Pacific Islanders also face unique mental health challenges, exacerbated by historical trauma and anti-Asian sentiments. Further complicating these challenges, researchers and publicly-available databases often categorize diverse Asian populations into one group. Mental health needs often vary by ethnicity, and programs and policies should recognize these diverse needs. For example, research shows that one-third (33%) of Korean Americans report feeling depressed, yet the rate of depression among Chinese Americans is about half of this (16%). Native Hawaiian and Pacific Islander populations specifically mention lack of culturally competent care, limited resources, and affordability as care barriers. Disaggregating these data can help address barriers to mental health care among diverse populations, which include stigma, language barriers, and cultural norms which may prevent people from seeking mental health care when needed.
Other Health Disparities
Asian Americans, Native Hawaiians, and Pacific Islanders face disparities in many other health outcomes as well. Asian Americans have the lowest cancer screening rates among any race or ethnicity, yet experience the highest incidence and mortality rates of liver and stomach cancers, which are largely viewed as preventable. Additionally, though comprising 6% of the total U.S. population, Asian Americans account for over half of chronic Hepatitis B cases, most of which are transmitted from mother to child during childbirth. Native Hawaiians and Pacific Islanders also suffer disproportionately from cardiovascular disease (CVD), and experience the second-highest CVD-related death rates in the U.S. (second only to those identifying as Black or African American).
Looking Ahead
The aforementioned issues facing Asian Americans, Native Hawaiians, and Pacific Islanders can intersect to exacerbate barriers to care and services, yet community strengths and promising policies and programs are working toward improving health. For example, community health center-based programs such as the Asian Health Services’ specialty mental health prevention program offers cultural-based workshops, education, and individual and family counseling to improve mental health and strengthen communities. Integrated behavioral health, which seamlessly incorporates behavioral health services into the primary care setting, is the foundation of behavioral health services within many community health centers. Integrated care has also been shown to be acceptable and improve access to mental and substance use disorder care among Asian Americans. Community-based organizations like Sakhi for South Asian Survivors in New York City, Asian Women’s Shelter in San Francisco, and Asian Services in Action (ASIA), a community health center in Cleveland, offer housing, health care, and supportive services like translation, legal assistance, and immigration aid to Asian American, Native Hawaiian, and Pacific Islander populations.
Local governments are being proactive as well. Because the health needs of Native Hawaiians and Pacific Islanders can differ from other Asian ethnicities, San Mateo County (Cal.) Health’s Pacific Islander Initiative offers resources on depression, stress, and getting started in health careers, in languages including Tongan and Samoan. At the national level, organizations like the Asian & Pacific Islander American Health Forum offer resources for researchers, policymakers, and communities on topics such as data disaggregation, Medicare reimbursement, and health issues like obesity and long Covid.
Stakeholders should continue to advocate for the disaggregation of data on Asian Americans, Native Hawaiians, and Pacific Islanders in research and other applications to ensure programs and policies are targeted accurately and are meeting these populations’ diverse needs. Despite the uncertain immigration policy landscape, communities can advocate for guaranteed refugee services, which increase access to health care and social services for immigrants, including those from Asia, the majority of whom have experienced physical (e.g., starvation, uncontrolled chronic illness) and psychological challenges (e.g., PTSD, violence, conflicts). Increasing health care access, improving the cultural relevance and responsiveness of available care, and including Asian American, Native Hawaiian, and Pacific Islander voices in policy discussions, as well as championing research-proven policies and programs, will benefit all.