Using Data to Address Health Inequities Iyanrick John Senior Policy Strategist February 12, 2019
About APIAHF The Asian & Pacific Islander American Health Forum is one of the oldest and largest national organizations focused on Asian American, Native Hawaiian, and Pacific Islander health equity. Since 1986, APIAHF has worked to influence policy, mobilize communities, and strengthens programs and organizations to improve the health of Asian Americans, Native Hawaiians, and Pacific Islanders.
The Asian/Pacific Island minority, in aggregate, is healthier than all racial/ethnic groups in the United States Yet specific problems do exist among various subgroups of this population.
Today, Asian-Americans are among the most prosperous, well-educated, and successful ethnic groups in America. What gives? It couldn't possibly be that they maintained solid two-parent family structures, had social networks that looked after one another, placed enormous emphasis on education and hard work, and thereby turned false, negative stereotypes into true, positive ones, could it? New York Magazine, 2017
History of Invisibility in Data and Research
Asian American Population in the U.S. 5,000,000 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 - Source: 2015 American Community Survey Data
Native Hawaiian and Pacific Islander Population in the U.S. 600,000 500,000 400,000 300,000 200,000 100,000 - Fijian Chamorro Marshallese Micronesian Native Hawaiian Palauan Samoan Tongan Source: 2015 American Community Survey Data
States with the Largest Asian American Populations (2017) 1. California (6.6 million) 2. New York (1.9 million) 3. Texas (1.5 million) 4. New Jersey (966,000) 5. Illinois (807,000) 6. Washington (804,000) 7. Hawaii (797,000) 8. Florida (738,000) 9. Virginia (671,000) 10. Pennsylvania (519,000) States with Greatest Increase in State s Asian American Population (2010 to 2017) 1. Indiana (+48%) 2. Utah (+47%) 3. Texas (+43%) 4. North Carolina (+41%) 5. Oklahoma (+39%) 6. Georgia (+38%) 7. South Carolina (+37%) 8. Ohio (+35%) 9. Tennessee (+35%) 10. Arizona (+33%) Source: Comparison of 2010 and 2017 American Community Survey Data
Arizona Asian American Population 50 45 40 35 33 33 32.5 30 28.8 28.4 25 23.2 25.3 20 18.4 19.2 17.3 15 10 7.6 11.1 10 8 8.5 8.6 14.5 12 5 0 Asian Indian Chinese Filipino Japanese Korean Vietnamese % of Asian Pop % Uninsured % LEP Source: 2015 American Community Survey Data 10
Limited English Proficiency Among Asian Americans White Black AI/AN NHPI Latino Asian Japanese Filipino Asian Indian Sri Lankan Malaysian Pakistani Indonesian Thai Laotian Mongolian Korean Hmong Cambodian Taiwanese Chinese Bangladeshi Vietnamese Nepalese Burmese Bhutanese 6.0% 3.1% 6.0% 9.2% 14.8% 17.8% 20.3% 20.9% 26.5% 26.9% 27.2% 32.3% 31.0% 33.0% 34.5% 36.4% 36.6% 36.7% 38.3% 39.1% 40.6% 44.1% 48.6% 51.5% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 70.4% 78.9% Source: 2015 American Community Survey Data
Below Poverty Asian 13% Latino 24% NHPI 21% AI/AN 28% Black 27% White 13% Source: 2015 American Community Survey Data 12
Below Poverty Filipino Asian Indian Japanese Fijian Melanesian Sri Lankan Taiwanese Korean Indonesian Vietnamese Guamanian Chinese Thai Pakistani Cambodian Native Hawaiian Samoan Tongan Bangladeshi Malaysian Hmong Nepalese Mongolian Bhutanese Burmese Asian Latino NHPI AI/AN Black White 7% 8% 8% 9% 10% 11% 13% 14% 15% 15% 15% 16% 17% 17% 17% 13% 13% 19% 21% 22% 21% 24% 25% 25% 26% 26% 28% 28% 27% 34% 39% Source: 2015 American Community Survey Data 13
Bachelor s Degree or Higher Asian 50% Latino 14% NHPI 16% AI/AN 19% Black 19% White 31% Source: 2015 American Community Survey Data 14
Bachelor s Degree or Higher Tongan Bhutanese Laotian Samoan Fijian Guamanian Cambodian Hmong Native Hawaiian Melanesian Burmese Vietnamese Nepalese Thai Indonesian Filipino Japanese Chinese Pakistani Korean Malaysian Sri Lankan Mongolian Aisan Indian Taiwanese Asian Latino NHPI AI/AN Black White 11% 11% 14% 14% 15% 16% 17% 17% 17% 19% 14% 16% 19% 19% 25% 27% 31% 43% 44% 48% 48% 50% 50% 53% 53% 54% 55% 57% 59% 74% 75% Source: 2015 American Community Survey Data 15
Decrease in Uninsured for Selected Asian American Subgroups Since Passage of the Affordable Care Act Race/Ethnicity 2011 2013 2015 Asian 14.7 13.9 7.5 Asian Indian 12.0 10.4 5.7 Cambodian 19.6 18.9 9.3 Chinese 13.6 13.0 6.8 Hmong 16.3 15.6 8.1 Japanese 7.8 7.4 3.9 Korean 22.5 20.5 10.3 Laotian 18.6 15.7 10.0 Vietnamese 19.9 18.5 8.8 Source: American Community Survey 1-Year Data 16
APIAHF Study on Asian American Small Business Owners (2013) Chinese Uninsured Small Business Ownership 12% 11% Japanese 8% 12% Korean 22% 22% Pakistani 13% 23% Thai 12% 19% Vietnamese 14% 19% Source: 2009 American Community Survey Public Use Microdata Sample Data 2007-2009 American Community Survey 3-Year Estimates 17
Leading Causes of Death, Total U.S Adults vs. Asian or PI Adults Source: Heron M. Deaths: Leading causes for 2009. National vital statistics reports; vol 61 no 7. Hyattsville, MD: National Center for Health Statistics. 2012. 18
Percent of U.S. Adults with Selected Conditions for Major Asian Subgroups, 2004-2006 Heart Disease Hypertension Stroke Cancer 30 25 26.8 25.2 Diabetes 24.9 Hepatitis 20.9 21.6 21.2 21.7 20 17.1 17 15 14.2 12.2 10 5 5.6 8.9 9.2 6.9 6.25.9 5.1 4.5 4.5 4.64.9 3.7 3 2.4 2.8 2 1.6 3.9 2.3 6.1 2.2 4.4 1.8 4 5.9 9 6.7 6.5 7.5 4.2 2.52.9 2.9 3.1 1.9 8.2 6.4 2.4 2.8 0 Chinese Filipino Asian Indian Japanese Vietnamese Korean Other Asian and NHOPI Source: Barnes PM, Adams PF, Powell-Griner E. Health characteristics of the Asian adult population: United States, 2004-2006. Adv Data 2008;22:1 22 All Asian and NHOPI White 19
PolicyLink Project on Race and Ethnicity Data - Research Reviews on American Indian & Alaska Native, Asian American, Native Hawaiian & Pacific Islander, Latino, Black, and White populations - Three Convenings in Los Angeles, Atlanta, and Washington, D.C. - Final Report: Counting a Diverse Nation: Disaggregating Data on Race and Ethnicity to Advance a Culture of Health (2018) http://www.policylink.org/our-work/community/health-equity/datadisaggregation 20
Federal Level Efforts to Advance Data Equity 1988 APIAHF begins partnership with NCHS to improve AA and NHPI data collection in federal health surveys 1997 Update of OMB standards to separate AA from NHPI 2006 First NHIS oversample of Asian Americans 2010 Passage of the ACA including Section 4302 data standards 2011 and 2017 APIAHF leads in introduction of Health Equity and Accountability Act 2014 First NHPI National Health Interview Survey 21
2011 HHS Standards Resulting from ACA Section 4302 22
Opportunity to Revise 1997 OMB Standards First opportunity in 20 years to update race and ethnicity data standards Over 3,600 public comments from 47 states submitted to OMB 23
2015 Census National Content Test Standards 24
Health Insurance Marketplace Data Highlight 25
State Level Data Advocacy 26
State Level Opposition 27
Opportunities to Address Health Inequities - Improve systems and train staff to better collect race, ethnicity, and primary language data - Use race, ethnicity, and primary language data to focus outreach and education activities - Engage in partnerships to address identified disparities 28
Additional Resources PolicyLink Page on Data Disaggregation - http://www.policylink.org/our-work/community/health-equity/datadisaggregation 2015 National Content Test: Race and Ethnicity Analysis Report - https://www.census.gov/programs-surveys/decennial-census/2020- census/planning-management/final-analysis/2015nct-race-ethnicityanalysis.html PRAPARE Tool Page - http://www.nachc.org/research-anddata/prapare/
Iyanrick John ijohn@apiahf.org 415-568-3305 Follow Us Online: www.apiahf.org www.facebook.com/apiahf www.twitter.com/apiahf www.twitter.com/apiahfpolicy http://www.youtube.com/apiahf