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Racial equity in health must include Asian Americans

Racial equity in health must include Asian Americans
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On May 20, President BidenJoe Biden 64 percent of Iowans say 'time for someone else' to hold Grassley's Senate seat: poll Philadelphia shooting leaves 2 dead, injures toddler Ron Johnson booed at Juneteenth celebration in Wisconsin MORE signed into law the COVID–19 Hate Crimes Act to counter anti-Asian violence. This law is important but should only be the tip of the iceberg in the administration’s response to anti-Asian racism. To root out anti-Asian bias, the president needs to look within his own federal agencies. 

The National Institutes of Health, the nation’s foremost health research agency, spends less than one penny of every dollar on research with Asian Americans and Pacific Islanders each year. The agency currently has a $42 billion annual budget. Yet according to a study in the Journal of the American Medical Association, only 0.17 percent of its funding over the past quarter century has supported research with these communities. 

Despite this dismal track record, the agency overlooked Asian Americans once again when it launched UNITE, an initiative to address structural racism and racial inequities in health research. The initiative came five weeks after Biden issued his memorandum on combatting anti-Asian racism and calling on agencies to “ensure that official actions, documents, and statements do not exhibit or contribute to racism, xenophobia, and intolerance against Asian Americans and Pacific Islanders.”

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Sad to say, the ongoing omission of Asian Americans is not surprising.

Asian Americans have often been ignored in research, sometimes unintentionally but more often because they are (dis)regarded as less in need than other groups or labelled “White adjacent.” The NIH UNITE initiative refers to the marginalization of “Indigenous peoples, African Americans, and Latinos” in its statement on structural racism, and perhaps the agency intended to fold Asian Americans into the nebulous category “other communities of color.”

Without explicit attention to Asian Americans, NIH perpetuates the invisibility of a population facing mounting risks. Last year saw more than 6,000 anti-Asian hate incidents, as documented by the nonprofit STOP AAPI Hate. Even as hate crimes in large cities decreased overall in 2020, those targeting Asian Americans increased by 150 percent.

NIH’s reluctance to acknowledge anti-Asian bias shrouds the devastating toll on individuals and communities, including the chronic and acute impacts of racism on mental and physical health, including depression, cardiovascular disease, risk for diabetes, obesity, and high cholesterol.

In announcing the UNITE initiative, NIH Director Francis Collins acknowledged that “identifying and dismantling racist components of a system that has been hundreds of years in the making is no easy task.” True, but the first step is clear: Ensure that Asian American populations receive an adequate share of research attention. Whether Thai, Vietnamese, Chinese, Bengali, Indian, Japanese, Malay, Pakistani, Taiwanese, Korean, Cambodian, or Lao, people become “Asian American” when they arrive to this country and face American racism. The federal government’s support for research would go a long way toward dispelling the notion that Asian Americans are a monolith, or a white-adjacent model minority, when it comes to their health and wellbeing.

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Without a deeper recognition of Asian Americans, government cannot succeed in its goal to address systemic racism in the scientific community. NIH must recruit staff and grant reviewers with expertise on AAPI communities, require anti-bias training for all grant reviewers, and develop accountability mechanisms to ensure racial equity in its funding. The agency should also broaden its focus on biomedical treatments to direct more funding to research on the social determinants of health — including the impacts of systemic racism and everyday acts of discrimination on physical and emotional wellbeing.  Research is also needed on preventive interventions to disrupt the impacts of racism and discrimination on health outcomes. NIH should report annually to Congress and the public the proportion of its funding that supports research with AAPI communities. 

President Biden has made anti-Asian violence a part of his policy platform, a clear signal to NIH to make this priority real by ensuring meaningful engagement with Asian American communities in the agency’s work. That is why the American Psychological Association, the Society for Research in Child Development, and the Federation of Associations in Behavioral and Brain Sciences have called for full inclusion of Asian American communities in NIH funding and its UNITE initiative.

Asian Americans occupy a central place in American history and contemporary life, and their health and wellbeing should be government priorities.

Vivian Tseng is a senior vice president at the William T. Grant Foundation.