Advancing Asian American and Native Hawaiian or Other Pacific Islander (AANHOPI) Ethnicities Health Equity Practices

Growing up in Tonga, it was all but impossible not to recognize a lack of access to education, health, and economic opportunities within my Pacific Islander family and community. These experiences have inspired me to support and promote health equity in vulnerable groups as part of my professional career and personal interests.

As we celebrate Asian American and Pacific Islander Heritage Month this May, it is useful to take a look back. Historically, the U.S. Census Bureau grouped persons of Asian ancestry into the category “Asian Pacific Islander.” During the 1990 census, the standards for collecting race/ethnicity data were under scrutiny because the categories outlined in the federal Office of Management and Budget (OMB) Directive No. 15 did not reflect the nation’s changing demographics. In 1997, OMB issued a federal register notice, Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity, which separated the Asian and Native Hawaiian or Other Pacific Islander (NHOPI) ethnicities into their own separate categories. As a result of this distinction, public health practitioners would better understand risk factors, disease prevalence, and lived experiences for each group. The revised OMB directive defines the two ethnic groups as follows:

• Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
• NHOPI. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Although OMB released these data standards, it is important to note that some entities continue to lump the two ethnic groups under “Asian Pacific Islander.” During the COVID-19 pandemic, UCLA data researchers found that only 20 states provided COVID-19 data about NHOPIs . This is a serious problem as it is difficult to understand and justify the need to intervene and/or allocate resources for specific groups during public health crises.

In President Biden’s Proclamation on Asian American and Native Hawaiian/Pacific Islander Heritage Month, 2021, he noted that AAHOPI “communities face systemic barriers to economic justice, health equity, educational attainment, and personal safety. These challenges are compounded by stark gaps in Federal data, which too often fails to reflect the diversity of AAHOPI communities and the particular barriers that Native Hawaiian, Pacific Islander, Southeast Asian, and South Asian communities in the United States continue to face.”

As seen in the figures below, when available data among ethnic groups are considered separately, we see stark differences in risk factors between AAs and NHOPIs.

Snapshot of Health Profile Measures

Adapted from the Office of Minority Health, Policy and Data, Health Profiles by Population.

As we continue to advance cultural competency under the Biden Administration’s Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, I present three important considerations for public health colleagues and researchers working/partnering to improve health in AAHOPI communities:

1. Asians and NHOPIs are distinct ethnic groups with varying cultures, lived experiences, and unique challenges that deserve their own attention.
2. Representation from Asian and NHOPI ethnic groups is critical to developing the best approaches to address health issues in their respective communities.
3. Follow federal guidance to disaggregate data among ethnic groups as a critical step in better understanding health inequities and underlying factors that may be exacerbating health disparities.

For more information about Asian American and Pacific Islander Heritage Month, please visit the OMH observance page.

Sources:

1. Revision to the Standards for the Classification of Federal Data on Race and Ethnicity https://obamawhitehouse.archives.gov/omb/fedreg_1997standards. Accessed on April 26, 2021.