Photo Credit: Samantha Hamilton, Photo Editor
The importance of diversity and how Anti-Asian discrimination manifests in the healthcare system
Fatima Azam, Mike Contributor and Jennifer Zhong, News Editor
Doctors, lawyers, and engineers. This is the trifecta for Asian career options. Everyone knows Asians are successful, talented, and above all—unobtrusive. They’re the accountant behind the desk, the nurse that notes down your symptoms for the doctor, and the pharmacist who gives you your medications. The quiet ones you met and forgot about, until the COVID-19 pandemic hit. Asians are now under the spotlight—not to praise their commitment, but to make them the scapegoats. They’re the ones responsible for COVID-19, for the lockdowns, for the mask mandates, and for the poor economy. There’s a problem going on? Blame the Asians.
Amidst the pandemic, healthcare forces are being praised globally as heroes, but the Asian staff are being treated as if they sent the pandemic here themselves. Racial harassment and verbal abuse became commonplace and expected for our Asian frontline workers. In Canada, around 1 in 10 cases of harassment reported between March 10 to Dec. 31, 2020 involved victims being coughed on or spat on. From 2019–2020, anti-Asian hate crime incidents rose by 717% in Vancouver, BC, known for its large Asian population. That’s not counting the incidents unreported due to fear of persecution or language barriers.
It is clear that there is an anti-Asian problem, but that’s nothing new. COVID-19 only brought it into the spotlight and made it easy to justify. Systemic racism and inequalities are deep-rooted problems.
East and South-East Asian Healthcare Professionals
Despite the stereotype of successful Asian doctors, statistics have shown this is not necessarily the case. In 2020, although 23% of medical school students in the US were Asian or of Asian descent, they only made up 6% of hospital leadership and 13% of medical school leadership. This is in contrast to white people who only make up 49% of medical school students, but 88% of hospital leadership and 74% of medical school leadership. There might be a lot of Asian doctors, but they’re not the ones making the decisions.
Doctors aren’t the only ones involved in our care—nurses are equally important. In North America, there’s a popular stereotype that Filipinos are all nurses. That makes sense since approximately 1 in 4 working Filipino adults in the USA are frontline healthcare workers. When recruited to the USA, Filipino nurses are locked into predatory contracts that require them to work a certain number of hours within a time limit at a certain location. The stress of being within a demanding job, in a field that is well-known for underpaying its workers, and (to put it lightly) a strict contract, leads to burnout for these essential workers. This puts the COVID-19 toll on Asian healthcare workers into perspective. Filipino nurses make up around 4% of all nurses within the US but account for 26.4% of nurses who have died from COVID-19 and related health complications.
The Model Minority Myth
Asians are portrayed in the media as a uniformly successful group. In reality, that isn’t true. They don’t all have great salaries and stable careers. Data collected in the 2016 American Community Survey revealed that Asians are the most economically divided racial or ethnic group in the US. In 2016, Asians in the 90th percentile earned approximately 10.7 times more than Asians in the bottom 10%. When compared to the median income gap across the nation of 8.7 times, this is a huge difference. This trend is not changing anytime soon. In recent years, the income growth of the bottom 10% has been slower than the top 10%, thus increasing the income gap. This economic diversity is hidden by the model minority myth that paints Asians as a monolithic group.
Asia itself is the most populous and diverse continent on earth, with a population of 4.6 billion in 2018 and 2300 languages, not including uncounted dialects. It’s difficult to wrap your head around how large and diverse Asia is, and so this is often unaccounted for during data collection where the categories available are very broad. Instead, all of Asia—East, South, South-East, Middle-East and more—is lumped together as “Asian”. In some cases, other groups such as Native Hawaiians and Pacific Islanders are grouped in as well. As a result, specific ethnic groups are overlooked and their concerns are swept under the rug. Although it is understood that some illnesses and conditions are more prevalent within specific ethnic groups than others, this is not reflected in studies. For example, Asian Americans are the only ethnic group in which cancer is the leading cause of mortality. However, there is very little research involving Asian Americans in general. Despite being the fastest-growing ethnic and cultural group in the US, from 1992-2018, only 0.17% of the research funded by the National Institutes of Health to examine health disparities was focused on Asian Americans, Native Hawaiians, and Pacific Islanders. Without more detailed studies, we are left with a very broad picture of the situation, blurring the differences between different Asian ethnic groups, and making it difficult to tailor preventative care.
The model minority myth perpetuates the idea that all Asians are a homogenous group that has achieved the American Dream, while ignoring those who do not fit society’s mold. The stereotype that few Asians live in poverty or require social services has led to lack of funding for Asian community organizations and Asian-specific services. In 2014, Asian Americans made up 17.9% of the population living in poverty in New York City, but Asian American specific community organizations and services only received 1.4% of the funding from the Department of Social Services. This means that Asians may receive insufficient or indirect support compared to other groups, further entrenching the inequality. This can manifest in many different ways, such as language barriers, lack of culturally appropriate services, and insufficient community outreach.
Asian Patient Experience
Unfortunately, Asian healthcare workers aren’t the only ones who face discrimination. On the other side of the fence, Asian patients also deal with racism from physicians and other difficulties from a healthcare system that makes their lives harder, not easier.
Asian patients have to face several obstacles, such as language barriers and lack of culturally-sensitive care. Without interpreters trained in medical terminology, many patients aren’t able to understand what they have been diagnosed with, why, and what’s next in terms of treatment. Due to this language barrier, patients cannot give informed consent and are vulnerable to being misled into consenting without understanding. Instead, they have to blindly trust that the physician is making decisions in their best interest. They are kept in the dark about their own medical conditions, which takes away their autonomy and leaves room for medical malpractice. When trained interpreters are unavailable, patients’ family members may choose or be forced to interpret instead, which can create misunderstandings as well as inefficient communication between doctor and patient. Patients may interpret a doctor’s opinion and come to a different understanding about the treatment than the doctor intended. Having someone not only trained in medical terminology, but who is familiar with the culture and nuances of medical care, will allow for greater accountability and more equitable treatment.
On top of the language barrier, many patients also receive culturally-insensitive care. For example, patients from collectivist Asian cultures would like to consult family prior to making a decision regarding a treatment plan. In regards to holistic healthcare plans involving a patient’s diet, physicians might recommend changes and suggest Western cuisines unfamiliar and/or unappetizing to Asian patients. There is also a cultural tradition of using herbal supplements and other traditional treatments in addition to seeking Western healthcare which may not be understood by healthcare professionals. It is important for healthcare professionals to respect and understand how these healthcare beliefs and practices work, as they are often very important to the patient. Without a culturally-sensitive treatment plan, the patient may not benefit from the physician’s advice, resulting in limited progress in their healthcare journey. Given the diverse population in North America, medical personnel should be trained to treat different patients that arrive at their hospital or clinic with respect.
Due to the many obstacles Asian patients face, many may choose to avoid seeking healthcare until they have no choice. Health conditions and problems, that could have been screened or treated, worsen before the patient seeks help. Numerous testimonials from Asian patients have cited the lack of language interpreters or health literacy as a factor in delaying treatment or healthcare. In addition, there is also stigma against mental health conditions and disorders in Asian cultures. A study in 2012 found that Asian Americans are 3 times less likely than white Americans to seek mental healthcare. Having more representation within the mental health field, as well as culturally-sensitive professionals, would allow for Asian patients to feel more comfortable speaking about certain issues despite societal stigma. When speaking to someone who can empathize with them and their struggles, they’ll feel empowered to overcome these social barriers. This may increase the likelihood that patients will consult mental health professionals about different problems and stresses in their life.
Discrimination, and Chronic Stress
Asians, both in the medical field and in daily life, have to live in a difficult and unchanging system that has been brought under greater scrutiny following the racism that has occurred in the COVID-19 pandemic. Even after living in North America for multiple generations, Asians are still seen as the “perpetual foreigner”. Asians are “otherized”, set apart from regular Americans, and treated differently. As seen during the COVID-19 pandemic, this makes them an easy scapegoat for a variety of different problems.
Experiencing long-term discrimination and racism results in chronic stress which can lead to even larger health complications. A study found that Asian Americans who have been living in the US for more than 10 years have higher rates of chronic illness than recently arrived immigrants. The longer they are in environments that contribute to these stresses, the worse these conditions can get. This produces a snowball effect with terrible consequences, but not an inevitable conclusion. Changes can still be made to improve the quality of life and ensure equitable treatment for all.
Representation and Accountability
In a breakdown of the 2019 Parliament of Canada, visible minorities and Indigenous Members of Parliament (MPs) made up only 17.8%, but account for 27% of the total Canadian population (as of 2016). MPs of Asian descent make up 12.7% of the Parliament but account for 16.5% of the total Canadian population. This is especially notable for Filipino and South-East Asian Canadians, who make up 3.2% of the population but have no representation within the Parliament at all. Given the demographics of our political system, it is unsurprising that there is little to no support for Asian Canadian issues. Even though the COVID-19 pandemic has brought Asians and Anti-Asian discrimination into media attention, it remains an unaddressed concern. There can’t be real change to these systems without greater representation in leadership positions nationally.
How do we hold politicians and other leaders accountable for their plans, decisions, and actions? Even with greater representation in higher levels, accountability is a major issue. Empty apologies and promises to change only goes so far without actions. This needs to start at the basic level of education, as well as at the highest levels of policy and legislation. Schools need to teach about Canada’s history of discrimination and its present-day effects. Anti-Asian discrimination isn’t something limited to our history books, but something alive and very present today. Canadians are stereotyped as nice, friendly, and apologetic. The COVID-19 pandemic has brought Anti-Asian discrimination to light, and we can’t hide behind this mask anymore. Let’s take the chance to make a change for the better, and hold ourselves accountable.