Q&A: Grouping statistics on Asian American populations masks health disparities — Aggregating data on diverse Asian populations perpetuates ‘model minority’ myth, says Ninez Ponce ============================================================================================================================================================================================= * Aaron Warnick ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/51/7/10/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/51/7/10/F1) According to the U.S. census and the American Community Survey, Asian Americans comprise at least 20 groups. But during data collection, information on the varying groups is often aggregated into a single category, which can mask health differences with the populations. Photo by Fly View Productions, courtesy iStockphoto In 1985, the U.S. Department of Health and Human Services released the landmark Heckler Report, which showed wide disparities in U.S. life expectancy and health between the majority white population and people of color — with the notable exception of Asians. The findings exasperated some Asian American, Pacific Islander and Native Hawaiian leaders, who found the “Asians” category too broad to accurately reflect the diversity of people it represented. Among them was APHA member Ninez Ponce, PhD, MPP, director of the University of California-Los Angeles Center for Health Policy Research and a professor at the university’s Fielding School of Public Health. Since the Heckler Report, there has been improvement in collecting and reporting more targeted health data on Asian Americans, Pacific Islanders and Native Hawaiians, but issues remain. The COVID-19 pandemic, which has disportionately impacted some populations, has provided ample evidence of why more focused data is needed. ## Who is considered to be an Asian American, statistically speaking? For statistical purposes, or at least what has been recordable in the U.S. census and the American Community Survey, there’s at least 20 groups…but there are more than 20 Asian countries. And also within countries, there are also some subdesignations. So, for statistical purposes, it is anyone who has origins from East Asia, Southeast Asia and the Indian subcontinent. However, in 1997, the U.S. Office of Management and Budget Directive 15 specifically “unlumped” Asian with Native Hawaiian and Pacific Islander. Prior to that, Asians and people from Pacific islands and Native Hawaiians were all put together in what we were calling the API, the Asian Pacific Islander category. It’s a construct from the federal government. ## Are there any benefits to having a larger, aggregate group? I think there is a benefit of strength in numbers. You have the unity of having a large, aggregated community. It helps Asian Americans, Native Hawaiians and Pacific Islanders gain this political voice that is loud enough to be heard and ensures that this group is not overlooked. There is an argument for the unity of large numbers and, if you’ve done organizing, the benefit of collaboration for fueling social movements. ## What are the drawbacks? This aggregate category perpetuates the “model minority” myth. The larger group tends to be better off in health and socioeconomic opportunities and education. These might then present statistically and hide what’s going on in the constituents of that area category. Many of the health and socioeconomic statistics are vastly different (between subgroups). For example, the Native Hawaiian Pacific Islander population is so small compared to the wider Asian American population that…their needs were hidden in this aggregate group. An example: I gained access to disaggregated data for a study on COVID- 19 deaths in California in 2020. If you have the Asian Pacific Islander group lumped together for death rates, it was 75 per 100,000 — lower than the state overall, which was about 84 per 100,000. So, policymakers were going to say, “Oh, that group is doing much better than the state average. So, we’re not going to necessarily spend as much to fund dedicated outreach or recovery.” But if you if you unlock that group, the Asian American death rate is 74 per 100,000 — not much different than overall the API aggregate group. However, the Native Hawaiian and Pacific Islander death rate is 123 per 100,000 — much higher than the state overall. That’s why access to disaggregated data is critical. You have groups that are hidden within the broader Asian American category. ![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/51/7/10/F2.medium.gif) [Figure2](http://www.thenationshealth.org/content/51/7/10/F2) Trends in health disparities can be missed when all Asian Americans are put in one category. Photo by Azndc, courtesy iStockphoto ## What are the implications of these hidden health statistics? I had heard from my colleagues, my community, my aunties — many of whom are nurses — that there are high (COVID-19) death rates among Filipino nurses. And yet that was unseen in this aggregate public health data, but we were hearing it in online memorials and tributes and stories from *The New York Times* and *The Los Angeles Times*. There were so many stories about Filipino nurses being front liners and having very high case rates and death rates, but it’s unnoticed by public health statistics. It feels sometimes like this group feels really let down. And sure enough, when I got restricted data, it did show that the Filipinos had the highest proportion of the cases and the deaths among Asians in California. There’s such a cost, particularly during the pandemic, of not having this information to really address the specific pain points, losses in communities. And that’s why I’m a champion for disaggregating this data. The pandemic was a portal to seeing the huge opportunity cost of not disaggregating. But this had been happening before the pandemic and even more so now as we try to get into this period of recovery. ## What should public health do to address this problem? Public health has an influential voice and should push to make public health data systemshellipseparate Native Hawaiian, Pacific Islanders from Asians. But that’s just a floor. There’s encouragement to go more granular, particularly if you live in a city or a state where the population is more diverse and has a high population of a specific group. Public health is local, and granularity will of course differ across different places. Another piece of this problem is that there are agencies that are compliant because they collect (data), but they don’t report it. Part of the reporting dilemma — or what you might get from public health officials — is that they are guarding the privacy of the data, and guarding the reliability of the results. When you start splitting and splitting, that becomes too small to be reliably reported. As a data producer, I wholly understand that. But it doesn’t mean that you can’t present something, that doesn’t mean then that you revert and just say, “OK, we can’t do that, now we just revert to presenting as all the allAsian aggregate group.” There are intermediary categories. *— Interview conducted, edited and condensed by Aaron Warnick* *For more information on Asian American, Pacific Islander and Native Hawaiian health, visit [www.aapcho.org](http://www.aapcho.org) and [www.apicaucus.org](http://www.apicaucus.org)*. * Copyright The Nation’s Health, American Public Health Association