Asian Americans and racial justice in medicine

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AAPI Heritage Month Logo

“I don’t see how that’s relevant to healthcare.”

At the end of March 2021, an (non-Asian American) Associate Dean for Equity, Diversity and Inclusion at a prominent U.S. medical school asked the Dean if they could plan a statement and educational activity about the Atlanta shootings in which 8 people were murdered, 6 of whom were Asian women. At this time, American rhetoric around the COVID-19 pandemic, including language from the former U.S. president, had spawned an exponential growth in anti-Asian hate since 2020. Asian American healthcare workers were experiencing discrimination, harassment, rejection and even violence, from patients, staff and colleagues.

The renewed racial justice movement following the murders of Brianna Taylor Ahmad Arbery and Breonna Taylor had also ushered a wave of discussion about racism in the nation- including in medicine. Medical schools set up anti-racism initiatives, doubled-down on anti-racism commitments, and announced new positions and offices of equity, diversity and inclusion.

The Dean did not see the event- a tragic signifier of the broader issue of anti-Asian American racism in the country- as relevant to the community in their school of medicine.

The continued erasure of Asian Americans within medicine, who make up approximately one-fifth of all medical students, trainees and physicians, and constitute the largest racially minoritized group, will block overall progress on racial justice.

Holding up Asian Americans as a “model minority,” allows for white dominant narratives to deny the existence of racism within the profession. Simultaneously, ignoring Asian American concerns and perpetuating ongoing discrimination will continue to those in healthcare more broadly (not just physicians).

With this commentary in NEJM, we hoped to start a more nuanced conversation about the positionality of Asian Americans in medicine and in the larger movement for racial justice.

Asian Americans and Racial Justice in Medicine

 

 

Equity and inclusion in higher education: Access to health care

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Equity and inclusion in higher education should, at minimum, involve making sure your students’ and trainees’ basic needs are met. The University of California has increased its attention towards food and housing security needs amongst its students (if not actually making a lot of progress).

However, we have very little insight on students’ access to healthcare, and how lack of access, and the stress of financial costs impact student well-being, health and academic outcomes. Healthcare needs are not included in the University of California Undergraduate Experience Survey, and the literature on college student health in general is incredibly limited as well.

UCD alum Vicky Vong, BA ’22, and Johns Hopkins MSPH ’24, reflecting on her and her sister’s experiences as low-income students at two different UC campuses, wanted to see how other low-income UC students were faring.  Vicky led the literature review, design, and analysis of a focus group study, with the guidance of (then doctoral student) Jenny Wagner, and the findings were recently published in the Journal of American College Health.

Vong V, Wagner JL, Ko M. Experiences of low-income college students in selection of health insurance, access, and quality of care. J Am Coll Health. 2023 Dec 1:1-10. doi: 10.1080/07448481.2023.2283741. Epub ahead of print. PMID: 38039417.

Takeaway: University administrators- and the world of college health research- assume that students have equitable, timely affordable access to healthcare, perhaps because universities provide student health insurance, student health services, and so on. However, that doesn’t account for the realities of Medicaid, co-payments, health insurance literacy,  navigating private sector healthcare…and more.

Check out Vicky’s paper to see how this shows up, and how students’ lives are impacted.

Equity and inclusion for our future health workforce: What can we do right now?

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The UC Davis Food Access Map shows food and resources on UCD Campus and surrounding community

When we talk about diversity, equity and inclusion, there’s a lot of emphasis on diversity, and less so on equity and inclusion.  Sometimes they sound (and in policy, are treated) as an afterthought. Sometimes it feel vague- what do we mean by “equity” and “inclusion”?

For the future health workforce, in higher education, one critical component- the bare minimum- is ensuring students’ basic needs are met, so that they have the opportunity to participate in education itself. Or in other words, what is the point of admitting students to college or graduate school if we can’t guarantee they have enough to eat, a place to live, to pay their bills, or get healthcare when they need it?

We surveyed “under-represented” (including first-generation, low income, racially and ethnically minoritized, students with disability, sexual orientation and gender identify minorities) pre-health students from 2020-21, and found:

  • Over half had trouble paying rent and bills
  • One quarter went hungry because they didn’t have enough money for food.

What does that mean for their professional and educational aspirations?

  • Nearly 3/4 had concerns about the costs of attending and applying to graduate school in the health professions
  • Over 60% reported: application fee waivers did not meet their cost needs, that fee waivers did not help them apply to more programs, and that fee waivers did not arrive in the time needed.

Since the onset of the COVID-19 pandemic, the widening gap in economic inequity has been weighing down upon our future health workforce. While education programs have traditionally focused on academic preparation, mentorship and admissions, we need to be mindful about both their basic needs, and then how our own programs and policies are creating barriers.

Students who need to search for their next meal cannot perform their best at school– nor do they have the financial resources to take standardized tests, submit multiple applications, and for those who need them, get assessments and approvals for accommodations. The processes for applying for, and receiving, fee waivers, as well as the amount, if any- needs to shore up these gaps, not create more barriers.

Reducing financial precarity is critical for ensuring equity- and creating inclusive institutions.

 

*For more projects on student basic and economic needs, check out Student Affairs page.