Using Data to Address Health Inequities

Iyanrick JohnSenior Policy StrategistFebruary 12, 2019

About APIAHFThe 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.

Source: 2015 American Community Survey Data

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

4,500,000

5,000,000

-

100,000

200,000

300,000

400,000

500,000

600,000

Fijian Chamorro Marshallese Micronesian NativeHawaiian

Palauan Samoan Tongan

Native Hawaiian and Pacific Islander Population in the U.S.

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)

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

States with Greatest Increase in State’s Asian American Population (2010 to 2017)

10

Arizona Asian American Population

18.419.2

23.2

8 8.6

12

7.6

11.110

8.5

14.5

17.3

33 33

25.3

32.5

28.8 28.4

0

5

10

15

20

25

30

35

40

45

50

Asian Indian Chinese Filipino Japanese Korean Vietnamese

% of Asian Pop % Uninsured % LEP

Source: 2015 American Community Survey Data

Limited English Proficiency Among Asian Americans

78.9%

70.4%

51.5%

48.6%

44.1%

40.6%

39.1%

38.3%

36.7%

36.6%

36.4%

34.5%

33.0%

27.2%

26.9%

26.5%

20.9%

20.3%

17.8%

14.8%

31.0%

32.3%

9.2%

6.0%

3.1%

6.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%

Bhutanese

Burmese

Nepalese

Vietnamese

Bangladeshi

Chinese

Taiwanese

Cambodian

Hmong

Korean

Mongolian

Laotian

Thai

Indonesian

Pakistani

Malaysian

Sri Lankan

Asian Indian

Filipino

Japanese

Asian

Latino

NHPI

AI/AN

Black

White

Source: 2015 American Community Survey Data

12

Below Poverty

13%

27%

28%

21%

24%

13%

White

Black

AI/AN

NHPI

Latino

Asian

Source: 2015 American Community Survey Data

13

Below Poverty

13%

27%

28%

21%

24%

13%

39%

34%

28%

26%

26%

25%

25%

22%

21%

19%

17%

17%

17%

16%

15%

15%

15%

14%

13%

11%

10%

9%

8%

8%

7%

White

Black

AI/AN

NHPI

Latino

Asian

Burmese

Bhutanese

Mongolian

Nepalese

Hmong

Malaysian

Bangladeshi

Tongan

Samoan

Native Hawaiian

Cambodian

Pakistani

Thai

Chinese

Guamanian

Vietnamese

Indonesian

Korean

Taiwanese

Sri Lankan

Melanesian

Fijian

Japanese

Asian Indian

Filipino

Source: 2015 American Community Survey Data

14

Bachelor’s Degree or Higher

31%

19%

19%

16%

14%

50%

White

Black

AI/AN

NHPI

Latino

Asian

Source: 2015 American Community Survey Data

15

Bachelor’s Degree or Higher

31%

19%

19%

16%

14%

50%

75%

74%

59%

57%

55%

54%

53%

53%

50%

48%

48%

44%

43%

27%

25%

19%

17%

17%

17%

16%

15%

14%

14%

11%

11%

White

Black

AI/AN

NHPI

Latino

Asian

Taiwanese

Aisan Indian

Mongolian

Sri Lankan

Malaysian

Korean

Pakistani

Chinese

Japanese

Filipino

Indonesian

Thai

Nepalese

Vietnamese

Burmese

Melanesian

Native Hawaiian

Hmong

Cambodian

Guamanian

Fijian

Samoan

Laotian

Bhutanese

Tongan

Source: 2015 American Community Survey Data

16

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

17

APIAHF Study on Asian American Small Business Owners (2013)

Source: 2009 American Community Survey Public Use Microdata Sample Data 2007-2009 American Community Survey 3-Year Estimates

14%

12%

13%

22%

12%

11%

19%

19%

23%

22%

8%

12%

Vietnamese

Thai

Pakistani

Korean

Japanese

ChineseUninsured

Small Business Ownership

18

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.

19

Percent of U.S. Adults with Selected Conditions for Major Asian Subgroups, 2004-2006

5.6

6.9

9.2

5.13.9

4.4

9

6.5

12.2

17.1

26.8

20.9

25.2

21.6

17

21.221.7

24.9

2.4 2 1.62.5

1.92.4

33.7

4.6

2.31.8

2.9 3.1

8.2

6.2

8.9

14.2

4.96.1

4

6.77.5

6.45.9

4.5 4.5

2.82.2

5.9

2.9

4.2

2.8

0

5

10

15

20

25

30

Chinese Filipino Asian Indian Japanese Vietnamese Korean Other Asian andNHOPI

All Asian andNHOPI

White

Heart Disease Hypertension

Stroke Cancer

Diabetes Hepatitis

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

20

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/data-disaggregation

21

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

22

2011 HHS Standards Resulting from ACA Section 4302

23

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

24

2015 Census National Content Test Standards

25

Health Insurance Marketplace Data Highlight

State Level Data Advocacy

26

State Level Opposition

27

28

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

Additional Resources

• PolicyLink Page on Data Disaggregation -http://www.policylink.org/our-work/community/health-equity/data-disaggregation

• 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-ethnicity-analysis.html

• PRAPARE Tool Page - http://www.nachc.org/research-and-data/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