The Absence of Asian Representation in Statistics and its Connection to Healthcare

Throughout the COVID-19 pandemic, acts of violence towards peoples of Asian descendance increased dramatically, with extreme acts stemming from the misinformation and unjust racial stigmas propagated by various key figures throughout society. In response to this violence, Congress was put under pressure to provide some level of response in the form of some legislation in support of these peoples; thus arose the COVID-19 Hate Crimes Act, in the hopes of tackling the increased anti-Asian violence. However, while this violence stems from a source not too long ago, the disparities and discrimination that the Asian population has faced extends far beyond the visible eye.

One key result of the discrimination the Asian population in the United States has felt is the systematic lack of information regarding the population in American federal statistical systems. The White House regards the Asian population in the United States as the Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI); this attempt at inclusion allows for a specific name to be applied to the group of people affected by this statistical loss. However, it still fails to accommodate for the 30+ Asian demographics that actually make up this group. As such, this statistical vacancy in the federal (and scientific) perspective has led to a lack of actionable information that could possibly lead to the overall benefit for this increasingly large group of people. In many studies and instances, Asian demographics were seldom included in studies regarding smoking, cancer, and sexually transmitted diseases. Even when considered, the diverse population is often reduced to simply “Asian,” an ineffective simplification.

However, this vacancy in collected and reported data is starting to be filled, with increasing representation of this diverse group in modern studies. This increasing representation has led to a variety of surprising discoveries regarding a population previously disregarded. As compared to other ethnic groups in America, the AANHPI population are less likely to have a consistent personal doctor and are increasingly likely to report poorer quality of care. While these are representative of the AANHPI population as a whole, metrics like insurance coverage vary greatly within this population. For example, the Mongolian population in the United States reports an uninsured rate of 2.5x the average rate for the entire AANHPI population. Combined with the discoveries regarding the AANHPI population as a whole, the need for data regarding the various Asian populations in the United States has become increasingly urgent.

All hope is not lost, however, due to the increased initiative by the federal government to tackle this issue of lacking representation in statistics for the diverse Asian population. The Biden Administration has created the White House Initiative on AANHPI to tackle these discrepancies; they have also started working with the Interagency Working group on Equitable Data in the hope to improve research on policy and measurable outcomes for these diverse communities. Furthermore, the National Science Foundataion has also increased funding for research with an emphasis to tackle this discrimination, to increase the available actionable data regarding this population. Increasing the quantity and quality of the data regarding this increasingly large and diverse segment of the American population is important to ensure the long term increase in the quality of care for this population. Further incorporating this data into broader statistical analyses will hopefully lead to actionable items that aim to target the inequalities faced by this broad population and create a more just and fair U.S. healthcare system.

Edited by: Kelly Ma

Graphic Designed by: Libby Gough

References

Olivia Kim

Nov 14, 20223 min read

Higher Education Access and Health Outcomes Among Undocumented Immigrants

There are over 427,000 undocumented immigrants enrolled in higher education in the U.S., and nearly 90% of them attend college as opposed to vocational school [1]. However, it is estimated that almost 1.6 of the 11 million undocumented immigrants in the U.S. are between ages of 16 to 24 years old [2]. In addition to greater socioeconomic opportunities, higher education is especially critical because many studies have found it to be a strong predictor of health outcomes.

Documentation status has been identified as a social driver of health and risk factor: those without legal documentation status are more likely to have worsened health [3]. Among non-senior adults that are noncitizens in the U.S., 42% were uninsured in 2020 [4]. This lack of healthcare coverage for undocumented adults leaves many of them only able to access healthcare through Emergency Departments (EDs), Federally Qualified Health Centers (FQHCs), and local volunteer-run clinics [5]. Another way undocumented immigrants receive care is through clinics on college campuses. Most colleges in the U.S. require students to have health insurance and likely provide subsidized plans, so higher education is a great mechanism in which undocumented immigrants may achieve better health outcomes in the short and long term.

DACA is instrumental in providing undocumented students access to higher education since attendance in higher education is a major qualifying factor for DACA recipients [5]. DACA provides a mechanism in which undocumented children may reach higher education and improve their social drivers of health. The program also relieves stressors that are generated from fear of being deported. However, those who are DACA recipients are not qualified for health insurance through the ACA, meaning they are ineligible for Medicaid and CHIP [5]. Another program that is key for young adults to achieve citizenship is the DREAM act, which permits those who have grown up in the U.S. to apply for temporary legal status and eventually become eligible for citizenship if they go to college or serve in the military. Studies have found that having a protected legal framework like DACA and DREAM leads directly to better health outcomes by bettering economic stability, increasing educational opportunities, and increasing healthcare access [6].

It is imperative that undocumented immigrants be provided the opportunity to get higher education for both immediate access to clinical care and improved long-run health outcomes. However, more can be done to support college students without legal documentation status.

Undocumented immigrants in college face a myriad of challenges and stressors, leading them to be at a higher risk for behavioral health issues. These stressors include, but are not limited to, inability to finance required textbooks, fear of performing poorly academically and being removed from the DREAM act, and concerns for one’s future and financial stability [3]. A study found that COVID-19 had a profound impact on dreamers’ mental health, more so than documented students [7]. It was identified that out of those in the study, “47% of the dreamers met the clinical cutoff for anxiety, 63% met the cutoff for depression, and 67% (2 in 3) met the cutoff for anxiety and/or depression.” Id.

Programs such as DACA and DREAM need to be protected to continue access to higher education and healthcare, but it is also important that on-campus care for undocumented immigrants includes mental health resources and financial support systems.

Edited by: Sam Shi

Graphic Designed by: Shanzeh Sheikh

References

National Data on Immigrant Students. Higher Ed Immigration Portal. (2022, November 4). Retrieved November 9, 2022, from https://www.higheredimmigrationportal.org/national/national-data/
Profile of the unauthorized population - US. Migration Policy Institute. (2022, October 1). Retrieved November 9, 2022, from https://www.migrationpolicy.org/data/unauthorized-immigrant-population/state/US
Enriquez, L.E., Morales Hernandez, M. & Ro, A. Deconstructing Immigrant Illegality: A Mixed-Methods Investigation of Stress and Health Among Undocumented College Students. Race Soc Probl 10, 193–208 (2018). https://doi.org/10.1007/s12552-018-9242-4
Published: Apr 06, 2022. (2022, April 6). Health Coverage of Immigrants. KFF. Retrieved November 9, 2022, from https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-of-immigrants/
Adams, C. (2018, December 13). How Increased Access To Higher-Ed Improves Health Outcomes for Undocumented Immigrants. University of Michigan School of Public Health. Retrieved November 7, 2022, from https://sph.umich.edu/pursuit/2018posts/higher_ed_undocumented_immigrants.html#:~:text=Bachelor's%20Student%2C%20Public%20Health%20Sciences&text=Additionally%2C%20undocumented%20immigrants%20can%20typically,education%20strongly%20influence%20these%20barriers.
Sudhinaraset, M., To, T. M., Ling, I., Melo, J., & Chavarin, J. (2017). The Influence of Deferred Action for Childhood Arrivals on Undocumented Asian and Pacific Islander Young Adults: Through a Social Determinants of Health Lens. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 60(6), 741–746. https://doi.org/10.1016/j.jadohealth.2017.01.008
Goodman, J., Wang, S. X., Ornelas, R. A. G., & Santana, M. H. (2020, January 1). Mental health of undocumented college students during the COVID-19 pandemic. medRxiv. Retrieved November 9, 2022, from https://www.medrxiv.org/content/10.1101/2020.09.28.20203489v1.full

Meera Patel

Nov 14, 20222 min read

Limitations of Hope: Lessons Learned from the Aducanumab Controversy

A year ago, the FDA fast-tracked a brilliant new therapy for Alzherimer’s disease. Alzheimer’s is a devastating neurological illness which causes slow cognitive decline over time, characterized by beta-amyloid plaques which surround neurons in the brain. This new drug, known as aducanumab, removed the plaques linked to the neurological devastation caused by Alzheimer’s disease. The only problem? There was no proof that aducanumab actually treated Alzheimer’s.

Aducanumab looked promising at first. After all, it had been shown to remove beta amyloid plaques, a key hallmark of Alzheimer’s disease. However, in clinical trials, Aducanumab hadn’t been shown to reduce the symptoms of Alzheimer’s, nor slow down the progression of the disease significantly. In other words, the FDA had fast-tracked a therapy that wasn’t actually proven to treat Alzheimer’s.

How did this happen? Pharmaceutical companies, Alzheimer’s patients, and advocates began a lobbying process for the approval of the drug, regardless of its efficacy, and once on the market, Aducanumab was marketed for $56,000 a year. After public outrage, the price was cut down to $28,000 annually. So was the other $28,000 just an upcharge by pharmaceutical companies because they could? For a therapy that wasn’t even proven to be effective? As demonstrated by the motivation of patients to approve the drug, hope must’ve been the factor they were taxing.

And yet, what would’ve happened had the FDA chosen not to approve Aducanumab, one of the more promising therapies in recent years? The lack of significant progress in the realm of Alzheimer’s therapies is causing funding for research in the field to dry up, a problem made worse by the FDA’s refusal to approve or fast-track drugs for Alzheimer’s due to lack of data demonstrating efficacy. This is a pressing problem for Alzheimer’s patients as well, many of whom see their hopes for a better future disappearing just like the potential for new treatments.

While the final approval decision for aducanumab lies squarely on the FDA, it’s also true that the drug likely would not have been approved at all had it not been for the Alzheimer’s advocates pushing for more potential treatments. It’s easy to push blame onto patients, their families, and their caregivers, or wonder why they would push for approval for a therapy that likely wouldn’t succeed anyways. But when you’ve been fighting for so long and the road ahead just keeps getting darker, it’s difficult not to reach for that tiny spark of light, no matter how faint it is. The approval of aducanumab is a lesson both on the limitations of science and the limitations of hope.

Edited by: Olivia Ares

Graphic Designed by: Sofia DiFulvio

References

DMEJ

Duke Medical Ethics Journal