Karen E. Kim, MD, professor of medicine at the University of Chicago and director for the Center for Asian Health Equity, talks to WebMD about the health challenges facing older adults in the Asian American community.
This interview was edited for length and clarity.
WebMD: The term “Asian American” refers to people with origins from East Asia, Southeast Asia, and the Indian subcontinent. What are the limitations when we use a single category to describe such a diverse group of people?
Kim: The problem with the term is that it’s as if we’re all the same. These are people from different countries, speaking different languages with different immigration statuses. Some are born in the United States. Some are immigrants. Some are refugees. Some populations speak very little English.
Putting everyone together into one homogenous group really does a disservice because it makes it hard to understand health disparities. For example, the question of whether you’re an immigrant or a refugee has a big impact on your access to health care and basic supports. When you're lumped together, it masks the real challenges faced by different communities.
WebMD: What are some of the biggest health challenges facing the aging Asian American population?
Kim: Asian people are often unaware that there are disparities within their own communities because no one talks about it. Here are some general facts about older Asian Americans:
- Asian Americans are the only U.S. population for which cancer is the No. 1 cause of death. We can see really big differences in the prevalence of cervical cancer and cervical cancer screening within the Southeast Asian American community.
- One of the biggest disparities we see is with hepatitis B. Half of all hepatitis B diagnoses in the United States are in Asians. There’s a very high association between this disease and liver cancer.
- The other thing many people don’t know is that there’s a high prevalence of diabetes in some Asian populations, like South Asians and Filipinos. One of the first U.S. guidelines to carve out Asians as a special population was the American Diabetes Association when they realized that Asians’ risk for diabetes occurs at a much lower body mass index, at almost 30 pounds less than other people per height, than other populations.
- We also tend to be an extremely sedentary population. We have increasing rates of obesity, particularly the longer we stay in this country. The other area that I think is a real problem for older Asians – and younger Asians – is mental health. There are high rates of suicide and high rates of depression and anxiety that go underdiagnosed.
- There’s also the impact of COVID-19 and the racism and xenophobia against Asians, especially against older Asians. I worry about our older communities because they seem to be unfairly targeted.
WebMD: What are some barriers this population faces when accessing care?
Kim: Asians face structural racism when it comes to the health care system. There’s a real absence of bilingual, bicultural providers. Even though the U.S. government mandates interpreters for people who are less proficient in English at facilities that receive federal funding, it’s a real challenge to find qualified medical interpreters for the hundreds of Asian languages. Many facilities end up using available interpreters, many of whom may not have the medical fluency required for good communication.
Some communities are highly uninsured, like the Korean community. If you don't have insurance in this country, you have a hard time navigating the system. Safety net systems are not set up to work with the part of the Asian population with limited English skills.
WebMD: Does the stereotype of the “model minority” affect the way Asian American patients are treated?
Kim: Absolutely. People think that we have no problems, that we're healthy, wealthy, and wise, and that translates into delayed diagnosis. They’re told, “You’re Asian. You don’t get sick. You don’t get cancer.”
We also don’t have enough data. For many years, the federal data only collected [information] on Asians as “other,” and it was only over the last two censuses that they actually started asking for specific information on subgroups.
If you look at the National Institutes of Health, only 0.17% of their funding over the last 25 years has been devoted to Asian American health. Only 0.01% of [scientific] papers between 1966 and 2000 included Asian American, Native Hawaiian, Pacific Islanders in their study samples.
WebMD: What can members of the Asian American community do to improve their own health or the health of their loved ones?
Kim: Often, I find that Asian patients don’t ask me questions. They always say, “Yes” and I know inside their mind they're probably thinking, “No.”
One of the concepts that's important now in medicine is shared decision making, which is the ability to have a dialogue with your provider and come to a common understanding about what your goals are, what your expectations are. If you don't participate with your provider in receipt of health care, you really just get pushed aside.
If you have a question, ask that question. You need to make sure that you are treated with respect and that you're heard.