Study: Pandemic has generated physical, mental health challenges to Asians

BOSTON — The pandemic has generated widescale physical and mental health challenges to the Asian and Pacific Islander community, causing a public health crisis and greatly damaging the community, according to three leading public health experts.

The report, "Toward Healing and Health Equity for Asian American, Native Hawaiian, and Pacific Islander Populations," was recently released by Dr. Howard K. Koh, Juliet K. Choi and Jeffery B. Caballero, mainly focusing on the demographics of the Asian American and Pacific Island (AAPI) population, its vulnerability to COVID-19 exposure and its causes

“This study could be vital,” said Koh, a professor of the Practice of Public Health Leadership at Harvard University’s T.H. Chan School of Public Health. “It will help people learn more about the AAPI community, instead of recognizing them with simple labels.”

The report found the AAPI group has become the fastest growing racial and ethnic minority group in the U.S. for the past two decades. From 2000 to 2019, the AAPI population increased by nearly 95%, amounting to 7% of the U.S. population, and it is projected to double by 2060.

However, the rapidly expanding group also led to greater contact with COVID-19. Data developed by scientists showed the AAPI population has disproportionately higher mortality rates in certain states, such as Nevada, Utah and Nebraska.

Furthermore, among the 23 states, which reported disaggregated case rate data for AAPI population, 18 of them saw the highest case rate of COVID-19 in the Native Hawaiian and Pacific Islander community

When being asked about the possible causes, Koh said that the high case rate could result from multiple factors.

“Limited English skills, poverty, being unfamiliar with public health system or insurance … they could all be factors,” said Koh. “Also, adverse immigration actions might stop non-citizen patients from seeking help, especially those who are undocumented.”

Lack of access to public health benefits has impacted many patients, both those who seek physical or mental assistance, and has become a commonly discussed issue. At the beginning of the pandemic, very few hospitals or counseling services provided documents in any AAPI languages, causing extra difficulties when people with low English proficiency sought medical help.

Thanh Phan, then a third-year doctoral student in clinical psychology at William James College in Newton, recalled that when she was doing an internship, no hospital documents were available in Vietnamese, Mandarin or any other Asian language.

“I remember that every one of the therapists was fully booked,” said Phan. “And it was even harder when we had to spend hours to help people translate the documents.”

Phan’s fluency in Vietnamese and Mandarin enabled her to switch languages between patients, but there were many others still in need. She later co-founded the Asian Mental Health Concentration at William James, aiming to help the AAPI community with medical paperwork and help the hospitals with more inclusive documentation.

The community’s multigenerational families could also lead to high COVID-19 case rates and mortality, the report indicated. Data showed totally 27% of the AAPI population live in multigenerational households, 7% more than the general population. Among the community, Bhutanese people have the highest rate of 56%, followed by Cambodians with 42% and Laotians’ 40%.

Such households could significantly raise COVID-19 exposure risks for the elders and children, according to the report.

The public health crisis, moreover, has a mental health perspective.

Aside from the lack of access to medical benefits and income issues, the AAPI community’s misunderstanding of mental therapy played a role in stopping it from getting mental help.

“For many of the Asian families,” Phan said, “if someone needs to seek mental therapy, others might worry that this person is going crazy.”

Such misunderstanding could scare off people who did not wish to be embarrassed or to “lose face,” leaving them no leeway in combating mental issues during the pandemic.

An April Pew Research Center report found one-third of Asian Americans fear threats, physical attacks and most say violence against them is rising. The survey showed that 81% of Asian-American respondents said that violence against them has increased, 45% said they have experienced racially biased hate incidents, and only 32% said they have got help or support.

“We need to educate people that mental therapy is not a monster. It is just like a treatment when you catch cold,” Phan said.

Russell Jeung, co-founder of the Stop AAPI Hate, suggested that other people should be allowed to participate in the mental therapy process.

“I have always said that people other than doctors could also help with mental issues,” Jeung said, “such as religious leaders.”

Koh said since 2010, there has been a major advance under the Affordable Care Act in collecting data from federally funded surveys on the most populous AAPI subgroups. The data could help better define the specific needs and set stage to addressing them.

“A lot has been done. It was great,” said Koh, “but not enough. Asian American’s physical and mental well-being is still challenged. We must stop the hate and move on toward healing.”