NYC Report Outlines Asian and Pacific Islander Health Disparities

New York is home to nearly one million Asians and Pacific Islanders (API), who account for 14% of the city’s population. From 2000 to 2017, the Asian population grew by 48% and in that same time period, the Native Hawaiian and Pacific Islander (NHPI) community grew by 25% nationwide, becoming the fastest-growing racial group in the U.S. between 2000 and 2019.

In an effort to better understand the needs of each API group, the New York City Department of Health released a first-of-its-kind report that broke down the health data in the city by API ethnic groups, rather than lumping all groups together.

The report notes that a history of racism and exclusionary immigration policies, such as the establishment of Japanese internment camps in 1942, the 1882 Chinese Exclusion Act, and more recently, the rise in anti-Asian violence and hate crimes have trickled down into API communities, impacting their overall health and well-being.

“This report aims to highlight how the historic inequities and structural racism in our system have led to the health inequities among API groups today," Liza King, MPH, a communications research analyst in the Bureau of Epidemiology Services at the New York Department of Health and Mental Hygiene and developer of the report, told Verywell. "From the measures of economic stress and education attainment, we are shown how this differs across API ancestry groups, many of whom immigrated in large waves."

The report examined key determinants of health, such as:  

• Social and economic conditions 
• Healthy living 
• Health care and access 
• Mental health 
• Health outcomes 

Social and Economic Conditions 

The report found that Chinese (61%), Bangladeshi (56%), and Korean (50%) people had the highest rates of limited English-speaking households. The overall percentage for New York City was 23%.

“One aspect might be how the language inaccessibility in our health systems is affecting their ability to get care that is linguistically and culturally appropriate," King said. "This may lead to not getting screened for colon cancer, and this may also lead to not getting appropriate mental health services for themselves or their families."

This section of the report also looked at income levels 200% below the poverty line and discovered that Bangladeshi (58%), Pakistani (55%), Chinese (45%), and Native Hawaiian and Pacific Islanders (45%) had the highest rates of poverty in NYC. This finding defies the model minority myth, a stereotype that portrays Asians as a successful and rich racial group despite racism and other struggles.

“But when we looked at rent burden or education, we can see that that’s not necessarily true. There’s just a lot of economic stress among lots of different subgroups, specifically among a lot of South Asian communities,” Christina Lee, MPH, public health professional based in New York and contributor to the report, told Verywell.  "[For example,] the Bangladeshi and Pakistani communities have the highest rent burden among all of the API subgroups.”

As the report notes, language barriers and low-income levels can negatively impact the economic security of API New Yorkers and limit their access to education, steady jobs, health insurance, and more.

Healthy Living 

Physical activity plays a role in maintaining brain health, weight management, and bone and muscle strength.

API adults (66%) are less likely to have participated in physical activity in the past 30 days when compared to White adults (78%). API teens (18%) in public high school were less likely to be physically active for at least 60 minutes per day compared to White teens (26%).

When it comes to smoking, which is a risk factor for heart disease, stroke, and over 10 types of cancer, API men were six times more likely to smoke than API women.

“Because of this difference, API smoking rates do not look different from the NYC average unless you disaggregated them by sex,” King said.

Health Care and Access

Compared with White adults, API adults were twice as likely to be uninsured. Native Hawaiian and Pacific Islander (18%), Filipino (14%), Chinese (12%), and underrepresented South Asian (12%) people had the greatest percentages of being uninsured.

The report suggests that legislative barriers and high out-of-pocket costs can prevent API populations from seeking medical care.

Additionally, API groups may not have access to culturally competent mental health services or providers. Other barriers include mental health-related information and questions that may not translate into all dialects, making it harder for mental health providers to interpret mental health needs and make it harder for API to speak about their issues.

The report shows that API (18%) experienced higher rates of postpartum depression compared to NYC overall (14%). And, “rates of suicides among Korean and Japanese New Yorkers were higher than the citywide rate,” King explained. 

The Role of Community 

In the face of adversity, whether it was during the COVID-19 crisis or experiencing racism and discrimination, API in the city looked to community organizations, faith-based networks, and social media for guidance.

King said that people may not see a doctor when they have health problems so they may go to a house of worship, check their phones, or speak to friends in their communities to obtain health information.

“These resources have been vital in connecting API to the resources and health information they need, she added. 

Importance of Breaking Down the Data

Despite years of lumping API groups together, there is a myriad of ethnic groups that make up New York’s population, including but not limited to people of Chinese, Indian, Korean, Filipino, Bangladeshi, Pakistani, Japanese, Vietnamese, and Thai ancestry.

“Within research communities, there is a just a complete lack of data disaggregation when it comes to looking at Asian American and Pacific Islander populations,” Lee explained. Because each ethnic group has sub-differences, breaking down the data by different groups allows for researchers to explore each group’s needs thoroughly, she said. 

King said that categorizing the data by Asian and Pacific Islander ancestry shows heterogeneity in the health and well-being of API New Yorkers and can help community organizations better understand the needs of each group.

“This supports the argument that APIs are not a monolith and will enable our community partners to better serve the needs of their specific API populations,” King said. 

According to Lee, the report helped prioritize and contextualize different health measures. Ultimately, King and Lee hope this report informs policies and aid community partners in providing the services that API communities need.

“While this report is the first of its kind for API health in NYC, we know that it is only a first step," King said. "More work needs to be done to be able to collect and analyze data for marginalized populations who are not able to see themselves in the data."