This Is Our Lane: Moving Beyond ‘Model Minority:’ On AAPI Identity and Advocacy | Jhalak Dholakia, MD

Jhalak Dholakia, MD

Asian American and Pacific Islander (AAPI) heritage represents over 50 ethnic groups, 100 languages, and waves of immigration beginning in the 19th century. These diverse experiences are deeply intertwined with ongoing conversations of American identity, including how we as a country conceptualize race, ethnicity, and community. For those of us who identify as AAPI, our backgrounds often represent a source of pride and belonging grounding us to our families and values both in the US and abroad.

Growing up, my AAPI background connected me to my roots: speaking our native languages and participating in Indian traditional events bridged the distance between my family, most of whom still lived overseas. However, my identity sometimes left me wondering where I ‘fit’ here, in my own country, where I was born and yet often still seen as ‘other.’ AAPI narratives and history were not taught in school and conversations about the nuances of being AAPI were rare. Even today, I know that my responses to questions of ‘where are you from? But where are you REALLY from?,’ will be met with frustration and dissatisfaction, as if Ohio, Kentucky, and Mississippi are inadequate or incorrect. Such microaggressions are common for minority-identifying individuals, but the larger sense of isolation and stigma against voicing discomfort preclude a broader, and much overdue, conversation about AAPI identity in the United States.

The complexities of AAPI identity are poorly discussed both within our communities and in larger American society. AAPI represents an amalgam of identities and experiences, combined to create and harness political advocacy; however, the more nuanced ‘in-group’ differences are often overlooked. Model minority privilege is lauded as an indicator of success but must be reconciled with its implicit contribution to anti-black racism. This framing also erases AAPI groups such as refugee and historically marginalized populations who need more social support. Cultural expectations of professional achievement inspire pride but have demonstrated a negative impact on the psychologic wellness of second-generation immigrants, underscored when one recognizes that AAPIs have lowest rate of mental illness treatment [1]. Poverty and un/under-insurance in AAPI subpopulations are often ignored and can limit patient access to care especially among elderly or newer immigrant communities [2]. Despite a strong professional presence in healthcare, AAPIs are less likely to obtain preventative care or have an established PCP [3]. In addition, disaggregated data in medical education actually shows that specific AAPI groups are under-represented in medicine (URiM) and often struggle for inclusion in minority programming [4].

In gynecologic oncology, AAPI patients are disproportionately under-represented in surgical and clinical trials research [5, 6], limiting our knowledge of translatability and unique health concerns for these patients. For example, AAPI women are more likely to have more aggressive, non-endometrioid histologies of uterine cancer and are diagnosed at a younger age than White women; subpopulation differences are also noted within the larger group [7]. Aggregate demographic data (such as ‘Asian’) erases subpopulations such as Filipino-Americans, who experience worse cervical cancer screening, incidence, and survival [8, 9]. Disparities in higher education also continue for specific under-represented AAPI minority groups, broadening intra-group inequalities, and we can better support these individuals in the professional sphere. Recognizing AAPI heritage both in our organization and nationwide allows us to better care for those in these communities and in other historically marginalized demographics and is the only way to address the historic erasure of these populations.

After 9/11 and the COVID pandemic, increased anti-Asian racism and anti-immigrant hate crimes have complicated the lived experience of AAPI individuals and contributed to multigenerational trauma that has long-lasting health implications. We must continue to stake a stand against these trends and ensure that our patients feel safe in their communities [10].

Where, then, to go now? I for one am hopeful: the impact of AAPI groups across the country points to a strong historic foundation in intersectionality. From the Delano grape strike for workers’ rights to the role of women like Yuri Kochiyama in the civil rights movement, AAPIs have promoted justice throughout American history. Through social media and education advocacy efforts, these stories are being added to the American narrative. AAPI voices in media contribute vulnerability, imperfection, and diversity to the AAPI experience while drawing attention to contemporary issues that face community members. This is promising work against the perpetual ‘otherization’ of AAPI in the United States.

SGO is leading this change in healthcare: by electing our recent AAPI-identifying Presidents, we have bucked a trend that overlooks AAPI professionals in leadership positions [11]. In turn, Drs. Huh and Yamada have emphasized diversity and equity, empowering women and under-represented minorities to much-deserved seats at the table. SGO members are also leading the effort to re-evaluate the scientific approach to population health, including discussions at our recent Annual Meeting to disaggregate AAPI patient data and recognize under-represented groups in genetic testing and clinical trials. These are powerful, concrete examples of intersectionality and allyship in action, demonstrating how a more inclusive lens facilitates better patient care for all. I hope that we embrace AAPI Heritage Month as an opportunity to prioritize these difficult conversations and recognize how we can do better both personally and professionally, leading the way as an organization for increased equity in our communities and for our patients.

Dr. Jhalak Dholakia is a second-year Gynecologic Oncology Fellow at the University of Alabama Birmingham.

References

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   2. Yam, K. Asian-Americans Have Highest Poverty Rate In NYC, But Stereotypes Make The Issue Invisible. 2017 [cited 2022 April 28]; Available from: https://www.huffpost.com/entry/asian-american-poverty-nyc_n_58ff7f40e4b0c46f0782a5b6?msclkid=07a5c62dc65411ecbdbd6d901efa0cd8.
   3. Ma, G.X., et al., Cancer screening behaviors and barriers in Asian Americans. American journal of health behavior, 2009. 33(6): p. 650-660.
   4. Diversity in Medicine: Facts and Figures. Association of American Medical Colleges 2019 [cited 2022 April 28]; Available from: https://www.aamc.org/data-reports/workforce/interactive-data/figure-3-percentage-asian-alone-applicants-us-medical-schools-asian-subgroups-academic-year-2018.
   5. Chao, G.F., et al., Asian American Pacific Islander Representation in Outcomes Research: NSQIP Scoping Review. Journal of the American College of Surgeons, 2021. 232(5): p. 682-689.e5.
   6. Scalici, J., et al., Minority participation in Gynecologic Oncology Group (GOG) Studies. Gynecologic Oncology, 2015. 138(2): p. 441-444.
   7. Huang, Y., et al., Pathologic characteristics, patterns of care, and outcomes of Asian-Americans and Pacific islanders with uterine cancer. Gynecologic Oncology, 2022. 165(1): p. 160-168.
   8. Jun, J., Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups. Ethnicity & Health, 2020. 25(7): p. 960-981.
   9. FILIPINO AMERICANS & CANCER HEALTH BRIEF. 2009; Available from: https://www.apiahf.org/wp-content/uploads/2011/02/CD_Healthbrief08_2009-1.pdf.
   10. Beers, L.S., et al., Immunizing Against Hate: Overcoming Asian American and Pacific Islander Racism. Pediatrics, 2021. 148(1): p. e2021051836.
   11. Gee, B. and D. Peck, Asian Americans are the least likely group in the US to be promoted to management. Harvard Business Review, 2018. 31: p. 1-5.

This column is sponsored by an unrestricted grant from GSK. Sponsorship excludes editorial input. Content developed by the SGO Diversity, Inclusion & Health Equity Committee.