The Impact of Structural Inequities on Older Asian Americans During COVID-19

Abstract

Structural racism manifests as an historical and continued invisibility of Asian Americans, whose experiences of disparities and diverse needs are omitted in research, data, and policy. During the pandemic, this invisibility intersects with rising anti-Asian violence and other persistent structural inequities that contribute to higher COVID-19 mortality in older Asian Americans compared to non-Hispanic whites. This perspective describes how structural inequities in social determinants of health—namely immigration, language and telehealth access, and economic conditions—lead to increased COVID-19 mortality and barriers to care among older Asian Americans. Specifically, we discuss how the historically racialized immigration system has patterned older Asian immigrant subpopulations into working in frontline essential occupations with high COVID-19 exposure. The threat of “public charge” rule has also prevented Asian immigrants from receiving eligible public assistance including COVID-19 testing and vaccination programs. We highlight the language diversity among older Asian Americans and how language access remains unaddressed in clinical and non-clinical services and creates barriers to routine and COVID-19 related care, particularly in geographic regions with small Asian American populations. We discuss the economic insecurity of older Asian immigrants and how co-residence in multigenerational homes has exposed them to greater risk of coronavirus transmission. Using an intersectionality-informed approach to address structural inequities, we recommend the disaggregation of racial/ethnic data, meaningful inclusion of older Asian Americans in research and policy, and equitable investment in community and multi-sectoral partnerships to improve health and wellbeing of older Asian Americans.

Attitudes and Actions Related to Racism: the Anti-RaCism (ARC) Survey Study

“…While our focus was anti-Black racism, there is also a pressing need to address anti-Asian racism, which has been on the rise during the pandemic. [ 31 , 69 – 73 ] Finally, our representation of Black, Latinx, or indigenous individuals is less than that of the general population but consistent with academic medical centers,[ 74 ] which may have contributed to our not finding differences between racial and ethnic groups.…”

“…[ 1 – 9 ] The impact of systemic and interpersonal racism on health and well-being has been present for centuries and was particularly illuminated in 2020, as the USA grappled with the disproportionate impact of the coronavirus (COVID-19) on Asian, Black, Latinx, and indigenous communities and the killings of Mr. George Floyd, Mr. Ahmaud Arbery, and Ms. Breonna Taylor. [ 10 – 31 ] In this context, multiple organizations, including academic medical centers, reflected on and publicly shared their commitment to equity and anti-racism.…”

Considerations of Racism and Data Equity Among Asian Americans, Native Hawaiians, And Pacific Islanders in the Context of COVID-19

“…Disaggregated data in California reveals that over 40% of COVID-19 deaths among the state’s Asian Americans are Filipino, although they make up only 20% of the state’s Asian American population The high burden of death among Filipinos may be attributed to preexisting health conditions (e.g., diabetes, hypertension), living in nursing homes or multigenerational homes, and working in essential jobs, especially in healthcare. Nursing is a common occupation among Filipino Americans, which can be traced back to the colonial history of the U.S. in the Philippines [ 58 , 59 ]. Filipinos have long been recruited to fulfill nursing shortages in the U.S. [ 60 , 61 ].…”

Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study

“…When the Philippines was formally granted independence from the U.S. after World War II, Filipinos continued to migrate to the U.S. Policies such as the Immigration and Naturalization Act of 1965 relaxed country quotas for immigration from non-European countries. As a result, many Filipinos immigrated to the U.S., with many of them working in nursing, healthcare, hospitality-related fields [ 38 – 40 ]. Today, the U.S. remains the most popular destination country for Filipino immigrants with over 436,000 Filipinos immigrating to the U.S. between 2007 and 2017, nearly 70% more than the second most popular destination, Canada (over 260,000 Filipino immigrants between 2007 and 2017) [ 39 ].…”

“…Moreover, as result of this historical imperial and colonial relationship with the U.S., Filipinos tend to be more English proficient, with lower rates of unemployment and poverty compared to other Asian ethnic groups [ 35 , 37 , 40 ]. Filipino migrants specifically tend to be of working age (18–65 years old), college educated, and mostly female [ 39 ].…”