Using Data to Address Health Inequities Iyanrick John Senior - PowerPoint PPT Presentation

Using Data to Address Health Inequities Iyanrick John Senior Policy Strategist February 12, 2019

About APIAHF The Asian & Pacific Islander American Health Forum is one of the oldest and largest national organizations focused on Asian American, Native Hawaiian, and Pacific Islander health equity. Since 1986, APIAHF has worked to influence policy, mobilize communities, and strengthens programs and organizations to improve the health of Asian Americans, Native Hawaiians, and Pacific Islanders.

“The Asian/Pacific Island minority, in aggregate, is healthier than all racial/ethnic groups in the United States…Yet specific problems do exist among various subgroups of this population. ”

“Today , Asian-Americans are among the most prosperous, well-educated, and successful ethnic groups in America. What gives? It couldn't possibly be that they maintained solid two-parent family structures, had social networks that looked after one another, placed enormous emphasis on education and hard work, and thereby turned false, negative stereotypes into true, positive ones, could it ?” New York Magazine, 2017

History of Invisibility in Data and Research

Asian American Population in the U.S. 5,000,000 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 - Source: 2015 American Community Survey Data

Native Hawaiian and Pacific Islander Population in the U.S. 600,000 500,000 400,000 300,000 200,000 100,000 - Fijian Chamorro Marshallese Micronesian Native Palauan Samoan Tongan Hawaiian Source: 2015 American Community Survey Data

States with Greatest Increase in States with the Largest Asian State’s Asian American Population American Populations (2017) (2010 to 2017) 1. Indiana (+48%) 1. California (6.6 million) 2. Utah (+47%) 2. New York (1.9 million) 3. Texas (+43%) 3. Texas (1.5 million) 4. North Carolina (+41%) 4. New Jersey (966,000) 5. Oklahoma (+39%) 5. Illinois (807,000) 6. Georgia (+38%) 6. Washington (804,000) 7. South Carolina (+37%) 7. Hawaii (797,000) 8. Ohio (+35%) 8. Florida (738,000) 9. Tennessee (+35%) 9. Virginia (671,000) 10. Arizona (+33%) 10. Pennsylvania (519,000) Source: Comparison of 2010 and 2017 American Community Survey Data

Arizona Asian American Population 50 45 40 35 33 33 32.5 28.8 30 28.4 25.3 25 23.2 19.2 20 18.4 17.3 14.5 15 12 11.1 10 10 8.6 8.5 8 7.6 5 0 Asian Indian Chinese Filipino Japanese Korean Vietnamese % of Asian Pop % Uninsured % LEP 10 Source: 2015 American Community Survey Data

Limited English Proficiency Among Asian Americans 6.0% White Black 3.1% AI/AN 6.0% NHPI 9.2% Latino 32.3% Asian 31.0% Japanese 14.8% 17.8% Filipino Asian Indian 20.3% Sri Lankan 20.9% 26.5% Malaysian Pakistani 26.9% Indonesian 27.2% Thai 33.0% Laotian 34.5% Mongolian 36.4% Korean 36.6% 36.7% Hmong Cambodian 38.3% Taiwanese 39.1% 40.6% Chinese Bangladeshi 44.1% Vietnamese 48.6% 51.5% Nepalese Burmese 70.4% Bhutanese 78.9% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% Source: 2015 American Community Survey Data

Below Poverty Asian 13% Latino 24% NHPI 21% AI/AN 28% Black 27% White 13% Source: 2015 American Community Survey Data 12

Below Poverty Filipino 7% Asian Indian 8% Japanese 8% Fijian 9% Melanesian 10% Sri Lankan 11% Taiwanese 13% Korean 14% Indonesian 15% Vietnamese 15% Guamanian 15% Chinese 16% Thai 17% Pakistani 17% Cambodian 17% Native Hawaiian 19% Samoan 21% Tongan 22% Bangladeshi 25% Malaysian 25% Hmong 26% Nepalese 26% Mongolian 28% Bhutanese 34% Burmese 39% Asian 13% Latino 24% NHPI 21% AI/AN 28% Black 27% White 13% 13 Source: 2015 American Community Survey Data

Bachelor’s Degree or Higher Asian 50% Latino 14% NHPI 16% AI/AN 19% Black 19% White 31% Source: 2015 American Community Survey Data 14

Bachelor’s Degree or Higher Tongan 11% Bhutanese 11% Laotian 14% Samoan 14% Fijian 15% Guamanian 16% Cambodian 17% Hmong 17% Native Hawaiian 17% Melanesian 19% Burmese 25% Vietnamese 27% Nepalese 43% Thai 44% Indonesian 48% Filipino 48% Japanese 50% Chinese 53% Pakistani 53% Korean 54% Malaysian 55% Sri Lankan 57% Mongolian 59% Aisan Indian 74% Taiwanese 75% Asian 50% Latino 14% NHPI 16% AI/AN 19% Black 19% Source: 2015 American Community Survey Data White 31% 15

Decrease in Uninsured for Selected Asian American Subgroups Since Passage of the Affordable Care Act Race/Ethnicity 2011 2013 2015 Asian 14.7 13.9 7.5 Asian Indian 12.0 10.4 5.7 Cambodian 19.6 18.9 9.3 Chinese 13.6 13.0 6.8 Hmong 16.3 15.6 8.1 Japanese 7.8 7.4 3.9 Korean 22.5 20.5 10.3 Laotian 18.6 15.7 10.0 Vietnamese 19.9 18.5 8.8 Source: American Community Survey 1-Year Data 16

APIAHF Study on Asian American Small Business Owners (2013) Uninsured 12% Chinese Small Business Ownership 11% 8% Japanese 12% 22% Korean 22% 23% Pakistani 13% 19% Thai 12% 19% Vietnamese 14% Source: 2009 American Community Survey Public Use Microdata Sample Data 17 2007-2009 American Community Survey 3-Year Estimates

Leading Causes of Death, Total U.S Adults vs. Asian or PI Adults Source: Heron M. Deaths: Leading causes for 2009. National vital statistics reports; vol 61 no 7. Hyattsville, MD: National Center for Health Statistics. 2012. 18

Percent of U.S. Adults with Selected Conditions for Major Asian Subgroups, 2004-2006 Heart Disease Hypertension Stroke Cancer 30 Diabetes Hepatitis 26.8 25.2 24.9 25 21.7 21.6 21.2 20.9 20 17.1 17 14.2 15 12.2 9.2 10 9 8.9 8.2 7.5 6.9 6.7 6.5 6.4 6.2 6.1 5.9 5.9 5.6 5.1 4.9 4.6 4.5 4.5 4.4 4.2 5 4 3.9 3.7 3.1 3 2.9 2.9 2.8 2.8 2.5 2.4 2.4 2.3 2.2 2 1.9 1.8 1.6 0 Chinese Filipino Asian Indian Japanese Vietnamese Korean Other Asian and All Asian and White NHOPI NHOPI 19 Source: Barnes PM, Adams PF, Powell-Griner E. Health characteristics of the Asian adult population: United States, 2004-2006. Adv Data 2008;22:1 – 22

PolicyLink Project on Race and Ethnicity Data - Research Reviews on American Indian & Alaska Native, Asian American, Native Hawaiian & Pacific Islander, Latino, Black, and White populations - Three Convenings in Los Angeles, Atlanta, and Washington, D.C. - Final Report: “Counting a Diverse Nation: Disaggregating Data on Race and Ethnicity to Advance a Culture of Health” (2018) http://www.policylink.org/our-work/community/health-equity/data- disaggregation 20

Federal Level Efforts to Advance Data Equity • 1988 – APIAHF begins partnership with NCHS to improve AA and NHPI data collection in federal health surveys • 1997 – Update of OMB standards to separate AA from NHPI • 2006 – First NHIS oversample of Asian Americans • 2010 – Passage of the ACA including Section 4302 data standards • 2011 and 2017 – APIAHF leads in introduction of Health Equity and Accountability Act • 2014 – First NHPI National Health Interview Survey 21

2011 HHS Standards Resulting from ACA Section 4302 22

Opportunity to Revise 1997 OMB Standards • First opportunity in 20 years to update race and ethnicity data standards • Over 3,600 public comments from 47 states submitted to OMB 23

2015 Census National Content Test Standards 24

Health Insurance Marketplace Data Highlight 25

State Level Data Advocacy 26

State Level Opposition 27

Opportunities to Address Health Inequities - Improve systems and train staff to better collect race, ethnicity, and primary language data - Use race, ethnicity, and primary language data to focus outreach and education activities - Engage in partnerships to address identified disparities 28

Additional Resources • PolicyLink Page on Data Disaggregation - http://www.policylink.org/our-work/community/health-equity/data- disaggregation • 2015 National Content Test: Race and Ethnicity Analysis Report - https://www.census.gov/programs-surveys/decennial-census/2020- census/planning-management/final-analysis/2015nct-race-ethnicity- analysis.html • PRAPARE Tool Page - http://www.nachc.org/research-and- data/prapare/

Iyanrick John ijohn@apiahf.org 415-568-3305 Follow Us Online: www.apiahf.org www.facebook.com/apiahf www.twitter.com/apiahf www.twitter.com/APIAHFpolicy http://www.youtube.com/APIAHF