Health disparities for Filipinos are obscured by aggregation of data

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AWhile some nurses across the country are choosing to stop working rather than comply with immunization mandates, some hospitals are recruiting nurses in the Philippines to fill their staffing gaps. This will only further increase the burden on Filipino nurses and other Filipino healthcare workers in the United States.

Since the start of the pandemic, it has become very clear that social and economic factors shaped by the history of structural racism in the United States have caused a disproportionate number of deaths among racial and ethnic minority groups due to Covid-19 . The experiences of Asian-American communities, and Filipinos in particular, were lost in the conversation.

While official figures show Asian Americans have lower death rates from Covid-19, the few states where data is broken down by Asian ethnicity reveal significantly higher proportions of Filipinos who have contracted the disease and died. In Hawaii, Filipinos represent 16% of the population but more than 20% of Covid-related deaths. In California, where Filipinos make up 20% of non-elderly Asian adults, they account for 42% of Covid deaths in this category.

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As several colleagues and I argued recently in the JAMA Health Forum, the lack of disaggregated Covid-19 data for Asian Americans has contributed to these disparities and has hampered a fair response for Filipinos.

As a Filipino American healthcare worker, I am not surprised by the shocking numbers of Covid-19 in my community. Growing up in the United States, I have often heard that health care, especially nursing, provides stable, well-paying jobs. I had parents in the United States and the Philippines who trained as nurses. When I went to college and joined a Filipino organization, having a nursing family member was part of the members’ shared cultural and diasporic experience.

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The connection between American nursing and the Philippines, however, is no accident. The United States established nursing schools in the Philippines during the American colonial period from 1898 to 1946 and implemented an immigration policy that recruited Philippine-trained nurses to the United States to fill labor shortages. of work. This story still resonates today, as nurses in the Philippines make up the largest share of American nurses who have been trained overseas. They are also more likely to work in intensive care units, where the most serious Covid-19 patients are treated.

So when the Covid-19 pandemic began in March 2020, I had a hunch that Filipinos would be disproportionately affected. The first nurse to die from Covid-19 in Los Angeles was Filipino, and soon after, more and more stories emerged about the plight of Filipino healthcare workers.

Yet the general narrative was that Asian Americans fared better during the pandemic and were less likely to die from Covid-19 than black and Latino communities. This misperception set in because the data that could provide a more complete picture was lacking.

Even now, 20 months after the start of the pandemic, the lack of disaggregated data for Asian Americans continues to be a persistent problem. It has been left to non-governmental organizations and the media to draw attention to the burden of Covid-19 on the Filipino community. For example, the transnational feminist organization AF3IRM used media reports to follow the deaths of Filipino nurses and other healthcare workers on the poignant online tribute Kanlungan.net. The National Nurses United also released a report showing Filipinos account for around 26% of Covid-19 deaths among nurses while making up 4% of nurses nationwide.

Why has the impact of Covid-19 on Filipinos and other Asian communities been ignored even though they are one of the fastest growing racial groups in the United States? A powerful explanation is the myth of the model minority, which suggests that Asian immigrants perform well on social, economic and health indicators due to advantageous and desirable cultural characteristics such as attendance and a strong work ethic. When examined in more detail, the myth of the model minority collapses because it reflects an aggregate average. Despite a relatively higher average income, for example, income inequality among Asian Americans is higher than among other racial or ethnic groups. Over the past half-century, the myth of the model minority has obscured the inequalities facing the Asian American community while reinforcing anti-black racism.

In healthcare and public health, the myth of the model minority has perpetuated an oversimplification that Asian Americans face no health issues or disparities. By treating multiple groups alike, health care settings ignore the diverse experiences of immigrant communities across a wide geographic area and, ultimately, their unique health needs. Problems aren’t limited to Covid-19: Analyzes examining disaggregated health data for Asian Americans also found Filipinos face high rates of chronic diseases, like high blood pressure or diabetes , which also increase the risk of severe Covid-19.

The failure of government institutions and public health authorities to collect detailed and disaggregated race / ethnicity data has allowed disparities in Covid-19 mortality among Filipinos to go unaddressed and corrected.

The way forward is for healthcare organizations and public health surveillance systems to invest in processes and infrastructure to collect detailed data on self-reported race and ethnicity that include distinct Asian ethnicities. To do this, three concrete steps must be taken. First, states should enact legislation similar to California’s AB-1726 requiring state public health departments to collect disaggregated data. Second, health care providers should seek the expertise of community partners experienced in best practices for data disaggregation. For example, the Asian and Pacific Islander American Health Forum has long supported such efforts. Third, as recommended by the forum, providers of electronic health records should also ensure that their products allow for the collection of disaggregated data.

While these steps do not include all the actions that can promote data disaggregation, they are a start. The inability to collect disaggregated data for Asian Americans should no longer be seen as an oversight, but as an active choice that directly contributes to structural racism in the American healthcare system.

Certainly, collecting and publishing detailed disaggregated data on Asian Americans may require new investment, workflow, and training. But as other data collection efforts, such as those in Hawaii and California, have shown, the immediate availability of this information ensures that resources can go to communities in need. In addition, improving the detail and quality of data collected on race and ethnicity in health is in line with the provisions of the Affordable Care Act and ongoing national efforts to improve the quality of care. health for all.

As the pandemic continues to challenge the public health and healthcare systems of the United States, health equity must be a central part of the response. For Filipinos, health work in the United States is a lasting legacy of American colonialism, the health consequences of which played out predictably during the Covid-19 pandemic. Ensuring that disaggregated race and ethnicity health data is collected is a necessary step in advancing equity now and in the future.

Carlos Irwin A. Oronce is a primary care physician, researcher at UCLA David Geffen School of Medicine and the VA Greater Los Angeles Healthcare System in Los Angeles, and president-elect of the Filipinx / a / o Community Health Association. The opinions expressed here are solely those of him and do not necessarily reflect those of his employers.


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