For too many Americans, and for those in the Asian American and Pacific Islander (AAPI) community, the past year has presented serious challenges: a global pandemic that caused suffering at home and abroad, political and social unrest, and economic struggles. Add to all that, there has been an ongoing series of violent attacks on Asian Americans including horrific shootings in Atlanta and Indianapolis.
For many in the Asian American community—and among communities of color—the hostility is not necessarily something new but rather reflective of underlying issues that the pandemic has exacerbated. These factors concern us as advocates for the health and well-being of the AAPI community, as well as communities of color writ large and our nation’s public health. Americans have increasingly negative views about China as it becomes more of an economic competitor. On top of that, there has been scapegoating of Asian-owned businesses with regard to COVID-19. These attitudes parallel the nativism that led to events ranging from the passage of the Chinese Exclusion Act in 1882 to the Vincent Chin murder in 1982.
Some health experts warn that the COVID-19 pandemic will be followed by widespread mental health issues caused by the stressors that the pandemic has caused—social isolation, the economic anxiety, and political and social unrest that have engulfed our collective psyche. For many communities of color, these stressors have already brought to light disparities in our health care system, particularly our mental health system.
As policy makers and stakeholders envision a new system, particularly for mental health, in a post-pandemic world, we should add our voices for a more equitable system by calling out the circumstances facing the Asian American community. This is a pivotal time to not only address the coming “second pandemic” of mental health issues brought about by the COVID-19 pandemic but also to rebuild the health care system and address systemic changes that have long needed attention.
Like many other communities of color, AAPI communities are no strangers to understanding racism as a public health issue. And like other communities of color, the history of AAPIs in the United States is complicated, running the gamut as explored below between outright exclusion to elevation as a model minority and a wedge for identity politics. (The term “AAPI” may suggest misleadingly that a particular issue affects Asian Americans as well as Pacific Islanders and Native Hawaiians equally so hereinafter, I will use “AAPI” when speaking collectively about Asian Americans, Pacific Islanders, and Native Hawaiians and then “Asian American” when referring to issues pertaining solely to this still-diverse group.) The COVID-19 pandemic, however, has exacerbated these tensions with aggressors connecting the virus to China as a justification for violence against Asian Americans.
In building that more equitable system post-pandemic, we must recognize three interconnected—but not necessarily exhaustive issues: Asian cultural attitudes toward mental health, AAPIs’ station as a community of color, and understanding the long-term impact of the COVID-19 pandemic on the community.
Stoicism As A Familiar Cultural Theme
In addition to the unfair stigma associated with mental health that is general to our society writ large, many Asians share common cultural traits and circumstances that downplay mental health needs. Stoicism—seeing enduring hardships without complaints as a virtue—is a common characteristic across different Asian cultures. Observers note that treating “eating bitterness” as a virtue also can cause Asian Americans to “resist seeking out relief until the suffering becomes intolerable, we end up experiencing undue agony.”
Embracing stoicism makes it difficult, if not impossible, to acknowledge when a family member needs mental health services. For instance, some Asian American parents may miss or even ignore their children’s struggles; consequently, significant numbers of Asian American youth experience struggle emotionally at levels on par with or even higher than other teens. One college student discussed how her immigrant parents could not understand how “their daughter, who lived in a manicured middle-class suburban home and always went to bed with a full belly, complain[ed] she felt depressed.”
Identity As A Model Minority
Many in the Asian American community embrace the “model minority” myth even as others dispute its validity or its authenticity. Like the term “Asian American,” mainstream society pushed the “model minority” label on the entire Asian American community as if it were monolithic.
Of course, this label has had consequences for the entirety of the AAPI community. Advocates note that, due to the lack of data disaggregation, this myth hides many health disparities—including mental health disparities among AAPIs—and inflates AAPIs’ socioeconomic status and economic success. They also argue that the myth has divided, rather than helped to lift up, communities of color. Some advocates even opposed the COVID-19 Hate Crimes Act of 2021, in part because they argued it singled out policing as a solution for combating bias while ignoring Black and Brown communities’ concerns about over-policing.
Trying to live up to this idealized notion—particularly in a stoic culture—can lead to stressful consequences. This tension is experienced across communities, with women, particularly Black women, and people of color also reporting stress and fatigue caused by constantly needing to excel to meet expectations. Commentators have noted that to live up to this notion, some Asian women are more fearful of “keeping face”—again, eating bitterness—than call the police or social services for help, and even among Asian American women who discuss their abuse, a survey indicated more than a third felt ashamed of revealing it.
The Impact Of COVID-19 On The Asian American Community
With these two factors in mind, the COVID-19 pandemic has been devastating for many Asian Americans’ mental well-being: The pandemic’s health and economic effects would strain an identity rooted in stoicism, and the political and social reactions would shatter an identity based on being the “model minority.” As we discuss below, Asian Americans are consequently more likely to be concerned about the pandemic than the general public.
Others have noted that the pandemic’s economic impact has devastated sectors where AAPIs are overrepresented: For instance, about one in four of food and accommodation services and nearly one in five of retail businesses are Asian-owned even though Asian Americans make up only 6 percent of the United States population. Asian Americans also are a greater share of frontline and essential workers, particularly in health care.
Compounding the economic distress, violent attacks against Asian Americans rose during the pandemic, mainly driven by political attacks on China for the pandemic’s origin and a resurgence in scapegoating the Asian community. Horrifically, these political slurs have resulted in indiscriminate violence against Asian Americans.
At a time when stressors are at their peak, many Asian Americans are realizing they are caught in a Catch-22: Pathways to aid, especially for mental health needs, do not exist because of years of assuming the community is this stoic “model minority” and therefore their issues—particularly those most marginalized within the community—are invisible. As noted in a survey by the Asian & Pacific Islander American Health Forum (of which, I am on the board), this need is growing: more than a third of AAPI—particularly young adults—felt their mental health had worsened since the pandemic started.
Recommendations
As community leaders raise awareness about the broader AAPI community’s needs, policy makers are responding to the immediate needs brought on by the epidemic. For example, recently Congress passed the COVID-19 Hate Crimes Act. But some critics argue that the law does not address the underlying causes of anti-Asian sentiment nor the needs of the community.
As a next step and in recognition of that criticism, policy makers should commit to not only addressing the mental health needs of the AAPI community in the wake of COVID-19 and the uptick in violence but also bringing greater equity into mental health services for all communities of color. Here are some policies that stakeholders—policy makers, providers, and others—could adopt.
Unlock AAPI Data
As discussed, too much data on AAPIs is bundled together, but stakeholders need disaggregated data to make meaningful allocations of resources and to best understand different communities’ health and well-being.
Ensure Meaningful Coverage
Congress has restored coverage to Pacific Islanders who are part of the Compacts of Free Association, but gaps in coverage still remain for many immigrant communities. Coverage though is not enough, and stakeholders must address health literacy issues common not only in AAPIs but the larger immigrant community.
Develop A Responsive Workforce
Even for AAPIs with adequate coverage, finding a provider who is both linguistically and culturally appropriate can be challenging. As the American Psychological Association has noted, these issues have continued to result in “[m]isdiagnosis and underdiagnosis of mental illness among Asian-Americans and Pacific Islanders who have serious mental health and health implications.” Organizations such as the National Asian American Pacific Islander Mental Health Association (NAAPIMHA), the Asian Mental Health Project, and the Asian Mental Health Collective have set up online directories and other resources to help connect providers with those in need.
Recognize AAPI Needs In Delivery System Reforms
Delivery system reforms such as behavioral health integration hold great promise for improving care, but policy makers are recognizing such efforts must address health equity and the needs of communities of color. In 2012, the Department of Health and Human Services (HHS) Office of Minority Health (OMH) released a white paper on how such integration could reflect AAPI needs based on a convening hosted by the NAAPIMHA. It is nearly a decade since that OMH paper was released, and HHS ought to review it to determine what progress has been made and what must be done.
Invest In AAPI Research
AAPIs are frequently left out of discussions on health equity, and contributing to this absence is the lack of financial and institutional support for research into AAPI health issues writ large. According to The Asian American Foundation, less than half a percent of foundation giving and less than a percent of corporate giving goes to AAPI communities and causes.
Finally, the Biden administration has a unique opportunity to develop a strategic plan building on the prior administration’s work: On October 5, 2020, then-President Donald Trump issued an executive order on mental health that, among other things, called for a plan from the agency heads. Because that report was released during the lame duck session between administrations, it received little attention. However, given the billions of dollars that have been allocated toward mental health services in successive COVID-19 relief packages, an active, equitable strategy is more important than ever. In combination with the Biden executive order on advancing equity across all federal programs, such a strategy could and should recognize equity in building a new, better mental health system post-pandemic.
An Opportunity
We can learn from this pandemic and take something from the despair that it has caused. Stakeholders have the opportunity to move our health care system away from one that too often reinforces structural racism into one that roots out disparities and inequities and addresses them. We can restructure the mental health system to make it not only more responsive to our country’s needs coming out of the pandemic but also more equitable for the Asian American community specifically and communities of color writ large. Too many communities do not get the care they need, and it is past time to change that.
Author’s Note
Oliver Kim is the board chair for the Asian and Pacific Islander American Health Forum (APIAHF). This is a volunteer position. APIAHF is involved in health equity generally and supports access to mental health services but does not actively advocate in this sphere.
Article From: Health Affairs
Author: Oliver Kim
