Contradicting the Myth of the Model Minority Through a Population Health Equity Approach

This neglect seems to be linked to the “model minority” stereotype of Asian Americans, promoted in American culture and media, which portrays them as uniformly hardworking, affluent, and healthy. Yet, Asian Americans are not all alike: There are substantial differences in language, migration, and social experiences across Asian subgroups whose ancestral heritages hail from East, South, and Southeast Asia, and health concerns and risks vary across and within these communities.³

The model minority myth systemically influences how health care is provided to Asian Americans. In fact, the evidence suggests the following:

• Aggregated data mask important differences—such as diet and health risks—that may affect health outcomes among more than 30 Asian ethnic subgroups.
• Diabetes rates are strikingly high for South Asians and Filipinos.⁴
• Suicide is one of the leading causes of death among Korean American males,⁵ suggesting difficulties in accessing and seeking mental health services.

For these reasons, the Center for the Study of Asian American Health at NYU School of Medicine’s Department of Population Health was established in 2003 and is the only National Institute on Minority Health and Health Disparities Center of Excellence devoted to Asian American health in the United States. Our center seeks to counter the model minority stereotype by employing a population health framework to advance the health of Asian Americans in New York City and nationally.^6–8 We have focused on three key development areas:

• Data Disaggregation: We have led data collection and analyses efforts to support the disaggregation of data on Asian Americans into subgroup to better understand the nature and prevalence of certain health conditions.⁹
• Community and Clinical Linkages: Our studies prioritize patient-centered care that aims to bridge communities with poor access to care to doctors and clinics. The DREAM (Diabetes Research, Education, and Action for Minorities) Project, a culturally tailored intervention for Bangladeshi Americans with uncontrolled type 2 diabetes, has demonstrated efficacy in reducing HbA1c and increasing physical activity.¹⁰ Community health workers (CHW) lead sessions on diabetes management in Bengali and work with community members to overcome a range of barriers, such as how to use the subway to get to doctor’s appointments and how to ask the right questions. One study participant said, “I only knew [previously] that if I was feeling bad, I should go to the doctor. Now, I have my own doctor—myself.”
• Multi-level Strategies: We are developing multi-level strategies that integrate health information technology as well as policy, systems, and environmental changes to address major disparities that Asian Americans experience. One focus area of our work is on developing culturally adapted interventions with CHWs and electronic health records in safety net clinical settings to improve adherence to preventive treatments against stomach cancer in high-risk Asian American communities.

As we celebrate Asian American and Pacific Islander Heritage Month, health care systems increasingly face the challenges of ensuring culturally and linguistically relevant care. We hope more resources will be dedicated to the health of Asian Americans—the fastest growing minority population in the United States¹¹—and meaningful evidence-based strategies will inform policy and practice. As patients and medical professionals, we must mindfully approach Asian Americans as we would any other population—with the intention of addressing complex health challenges and risks experienced by all Americans.

References

1. Tung, E.L., Baig, A.A., Huang, E.S., Laiteerapong, N., & Chua, K.P. (2017). Racial and ethnic disparities in diabetes screening between Asian Americans and other adults: BRFSS 2012–2014. Journal of General Internal Medicine 32(4), 423–429. doi: 10.1007/s11606-016-3913-x

2. Islam, N.S., Kwon, S.C., Wyatt, L.C., Ruddock, C., Horowitz, C.R., Devia, C., & Trinh-Shevrin, C. (2015). Disparities in diabetes management in Asian Americans in New York City compared with other racial/ethnic minority groups. American Journal of Public Health, 105(Suppl. 3), S443–S446. doi: 10.2105/AJPH.2014.302523

3. Yi, S.S., Kwon, S.C., Sacks, R., & Trinh-Shevrin, C. (2016). Commentary: Persistence and health-related consequences of the model minority stereotype for Asian Americans. Ethnicity and Disease, 26(1), 133–138. doi: 10.18865/ed.26.1.133

4. King, G.L., McNeely, M.J., Thorpe, L.E., Mau, M.L., Ko, J., Liu, L.L., . . . Chow, E.A. (2012). Understanding and addressing unique needs of diabetes in Asian Americans, native Hawaiians, and Pacific Islanders. Diabetes Care, 35(5), 1181–1188. doi: 10.2337/dc12-0210

5. Hastings, K.G., Jose, P.O., Kapphahn, K.I., Frank, A.T., Goldstein, B.A., Thompson, C.A., . . . Palaniappan, L.P. (2015). Leading causes of death among Asian American subgroups (2003–2011). PLoS One, 10(4), e0124341. doi: 10.1371/journal.pone.0124341

6. Trinh-Shevrin, C., Sacks, R., Ahn, J., & Yi, S.S. (2017). Opportunities and challenges in precision medicine: Improving cancer prevention and treatment for Asian Americans. Journal of Racial and Ethnic Health Disparities. Advance online publication. doi:10.1007/s40615-016-0334-9

7. Trinh-Shevrin, C., Islam, N.S., Nadkarni, S., Park, R., & Kwon, S.C. (2015). Defining an integrative approach for health promotion and disease prevention: A population health equity framework. Journal of Health Care for the Poor and Underserved, 26(Suppl. 2), 146–163. doi: 10.1353/hpu.2015.0067

8. Trinh-Shevrin, C., Kwon, S.C., Park, R., Nadkarni, S.K., & Islam, N.S. (2015). Moving the dial to advance population health equity in New York City Asian American populations. American Journal of Public Health, 105(Suppl. 3), e16–e25. doi: 10.2105/AJPH.2015.302626

9. Islam, N.S., Khan, S., Kwon, S., Jang, D., Ro, M., & Trinh-Shevrin, C. (2010). Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: Historical challenges and potential solutions. Journal of Health Care for the Poor and Underserved, 21(4), 1354–1381. doi: 10.1353/hpu.2010.0939

10. Islam, N.S., Wyatt, L.C., Patel, S.D., Shapiro, E., Tandon, S.D., Mukherji, B.R., . . . Trinh-Shevrin, C. (2013). Evaluation of a community health worker pilot intervention to improve diabetes management in Bangladeshi immigrants with type 2 diabetes in New York City. Diabetes Educator, 39(4), 478–493. doi: 10.1177/0145721713491438

11. Colby, S.L., & Ortman, J.M. (2014). Projections of the size and composition of the U.S. population: 2014 to 2060. Washington, DC: U.S. Census Bureau.