Championing Health Equity: SAPHA’s Focus on South Asian American Healthcare Priorities

31 May Championing Health Equity: SAPHA’s Focus on South Asian American Healthcare Priorities

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By Samira Khan, MPH, President; Amish Doshi, MPH, Partnership Coordinator; Ayesha Azam, MSHIA, Vice President; Anto Ayinikal Paul, RN-BC, MS, MPH, CDCES, BC-ADM, CPHQ, Research Co-Chair; Sheikh Rubana Hossain, MPH, Advocacy Co-Chair

South Asian Public Health Association

Highlighting Healthcare Priorities for South Asian Americans

As Asian American Native Hawaiian Pacific Islander (AANHPI) Heritage Month concludes, we at the South Asian Public Health Association (SAPHA) want to shed light on the unique health needs of the fastest-growing subgroup within the AANHPI community—South Asian Americans (SAA).1  With a population of nearly 5.7 million individuals tracing their roots to Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka,  understanding the diverse cultural, linguistic, religious, and social landscapes of this community is crucial to promoting health equity.2

Addressing Health Equity Challenges

SAA face significant barriers to health equity, often exacerbated by a lack of disaggregated data as well as the illusion of their universal social, and economic success and assimilation through the harmful application of the “model minority myth” to Asian Americans, 3,4 which obscures the real challenges faced by this community. Since its inception in 1999, SAPHA’s mission has been to promote the health and well-being of South Asian communities in the United States through advocacy, collaboration, and communication. SAPHA supports the notion that a population-based approach – centered on principles of prevention, equity, social justice, and leadership – is the optimal means to improve the well-being of people and the communities in which they live.

SAPHA’s Current Priorities

For 2024, SAPHA has identified several priority areas critical to the health of SAA:

  1. Data Disaggregation One of the most pressing issues in addressing health disparities within the South Asian community is the lack of detailed, disaggregated data.5 Aggregated data often masks the significant variations in health outcomes among South Asian subgroups. For instance, health conditions prevalent in Indian Americans might differ considerably from those affecting Pakistani or Bangladeshi Americans. With specific data on these subgroups, it becomes easier to identify and address the unique health needs of these populations. Disaggregated data is crucial for tailoring public health interventions that are effective and culturally appropriate.

The recent update to Statistical Policy Directive No. 15 by the Office of Management and Budget (OMB) marks a step forward in recognizing the need for more detailed data collection. However, there is still a long way to go to ensure this data is consistently collected and reported. Policymakers, researchers, and healthcare providers need access to detailed demographic information to develop targeted health interventions and policies that can effectively address the distinct health challenges faced by South Asians. This data is not only essential for understanding current health disparities but also for monitoring progress and making informed decisions about resource allocation and public health strategies.4

  1. Chronic Diseases: Cardiovascular Disease and Diabetes SAA have a disproportionately high risk of chronic diseases, particularly cardiovascular disease, and diabetes. Studies have shown that South Asians are more likely to develop Type 2 and gestational diabetes compared to the general U.S. population.6 This increased risk is due to a combination of genetic, lifestyle, and environmental factors. For instance, South Asians tend to develop diabetes at lower body mass indices and younger ages compared to other groups.7 Additionally, they are more likely to experience complications from these diseases, emphasizing the need for culturally tailored prevention and management strategies.

Cardiovascular disease is another significant concern, with South Asians having a higher prevalence of conditions such as coronary artery disease and hypertension. Factors contributing to this increased risk include dietary habits, physical inactivity, and genetic predispositions. Traditional South Asian diets, which are often high in refined carbohydrates and saturated fats, along with sedentary lifestyles, contribute to these health risks. Addressing these issues requires a multifaceted approach that includes public health education, community outreach, and the promotion of healthy lifestyle changes. Healthcare providers must also be equipped with the knowledge and tools to offer culturally competent care that considers the unique needs of South Asian patients.8

  1. Mental Health Mental health is a critical concern within the South Asian community. Approximately one in five South Asians experience a mood or anxiety disorder in their lifetime.9 However, cultural stigma around mental illness often prevents individuals from seeking help. The stigma can be attributed to traditional beliefs that mental health issues should be handled within the family, rather than seeking external assistance. This leads to underreporting and untreated conditions, exacerbating the mental health crisis.10-14 To combat this, it is essential to promote mental health awareness, reduce stigma, and provide accessible, culturally competent mental health services.

The challenges related to mental health are compounded by a lack of culturally competent mental health services and providers who understand the unique stressors faced by SAA. These stressors include the pressure to conform to cultural expectations, experiences of discrimination, and the struggle to balance traditional values with the demands of life in the United States. Community-based interventions, mental health education programs, and support groups can play a vital role in addressing these issues. Additionally, training healthcare providers to recognize and address the mental health needs of South Asian patients can help improve access to and the quality of mental health care for this population.9, 14

  1. Social Determinants of Health: Climate Health and Gender-Based Violence Social determinants of health play a crucial role in shaping the well-being of SAA. Factors such as neighborhood social cohesion, cultural and religious practices, immigration status, and experiences of racism and discrimination significantly impact health outcomes.15 For example, many South Asians live in densely populated urban areas with limited access to green spaces, which can affect their physical and mental health. Additionally, cultural norms and gender roles can influence health behaviors and access to healthcare services. Addressing these social determinants requires a multifaceted approach that considers the intersectionality of these factors and their impact on health.

Climate health is becoming an increasingly important social determinant, especially in light of the environmental challenges faced by many South Asian communities. Poor air quality, extreme weather events, and the impacts of climate change can exacerbate existing health issues and create new health challenges.16 Furthermore, gender-based violence remains a critical issue within the South Asian community, with cultural and societal factors often hindering the reporting and addressing of such violence.17 It is essential to develop comprehensive strategies that address these social determinants through community engagement, policy advocacy, and the provision of resources and support services that are culturally sensitive and accessible.

Recent Initiatives from the South Asian Public Health Association (SAPHA)

Over the past few years, SAPHA has made significant strides in advancing the health and well-being of SAA across several key areas:

Educational Outreach: SAPHA has actively promoted awareness and education around issues affecting South Asians through various initiatives. These include webinars such as “Mental Health Challenges and Interventions Among South Asian Youth,” workshop series like “Imagining Health Equity as South Asians,” and multiple social media campaigns on topics like South Asian mental health and National Diabetes Awareness Month. Most recently, In March, SAPHA hosted a town hall in partnership with the OurHealth study focusing on South Asian cardiovascular health. This event highlighted the importance of tailored public health interventions and the need for ongoing research to better understand the specific health risks faced by South Asians. In celebration of our 25 year anniversary, we also launched the “South Asian Public Health Association Spotlight Series” podcast to engage the community on critical health issues and amplify the work being done by notable South Asians working in public health.

Research: SAPHA has contributed valuable research to the field of public health. The publication of our Brown Paper in 2002, a groundbreaking compendium and review of health research and literature on South Asians in the US, which was later advanced on and published as a book, which included recommendations for policymakers, health care providers, and community outreach workers, has been cited by researchers over the past many decades. We’ve continued to contribute to the field through various publications on COVID-19 in the South Asian community; the impacts of racialized state violence on health, and also have a forthcoming comprehensive report highlighting the current state of South Asian health disparities. The organization has presented findings at notable conferences such as the American Public Health Association (APHA) conference and the Center for the Study of Asian American Health (CSAAH)’s Biennial Conference.

Advocacy: SAPHA has been a strong advocate for health equity, participating in various roundtables and panels, including discussions with the Secretary of Health and Human Services. The organization has joined several coalitions, supported health legislation, and engaged in national advocacy campaigns. Key advocacy efforts include contributions to the NCAPA 2024 Policy Platform, participation in the White House 2024 National Strategy for Suicide Prevention event, and partnerships for initiatives like AANHPI Mental Health Day.

Looking Ahead

SAPHA remains dedicated to addressing these critical health issues and advocating for policies that promote health equity for SAA. By fostering collaborations, raising awareness, and pushing for improved data collection, we aim to bridge the gaps in healthcare access and outcomes for our community.

References:

  1. https://aapidata.com/blog/facts-south-asians-2023/
  2. S. Census Bureau. (2020). TOTAL POPULATION. Decennial Census, DEC Detailed Demographic and Housing Characteristics File A, Table T01001. Retrieved May 27, 2024, from https://data.census.gov/table/DECENNIALDDHCA2020.T01001?q=south asian.
  3. Walton, J., & Truong, M. (2023). A review of the model minority myth: understanding the social, educational and health impacts. Ethnic and Racial Studies, 46(3), 391–419. https://doi.org/10.1080/01419870.2022.2121170
  4. Gordon, N. P., Lin, T. Y., Rau, J., & Lo, J. C. (2019). Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record-based cohort study. BMC Public Health, 19(1), 1551. https://doi.org/10.1186/s12889-019-7683-3
  5. Bhakta S. (2022). Data disaggregation: the case of Asian and Pacific Islander data and the role of health sciences librarians. Journal of the Medical Library Association : JMLA, 110(1), 133–138. https://doi.org/10.5195/jmla.2022.1372
  6. Gujral, U. P., & Kanaya, A. M. (2021). Epidemiology of diabetes among South Asians in the United States: lessons from the MASALA study. Annals of the New York Academy of Sciences, 1495(1), 24–39. https://doi.org/10.1111/nyas.14530
  7. Araneta, M. R., Kanaya, A. M., Hsu, W. C., Chang, H. K., Grandinetti, A., Boyko, E. J., Hayashi, T., Kahn, S. E., Leonetti, D. L., McNeely, M. J., Onishi, Y., Sato, K. K., & Fujimoto, W. Y. (2015). Optimum BMI cut points to screen asian americans for type 2 diabetes. Diabetes care, 38(5), 814–820. https://doi.org/10.2337/dc14-2071
  8. Shah, K. S., Patel, J., Rifai, M. A., Agarwala, A., Bhatt, A. B., Levitzky, Y. S., & Palaniappan, L. (2022). Cardiovascular Risk Management in the South Asian Patient: A Review. Health sciences review (Oxford, England), 4, 100045. https://doi.org/10.1016/j.hsr.2022.100045
  9. Masood, N., Okazaki, S. and Takeuchi, D.T. (2009). Gender, family, and community correlates of mental health in South Asian Americans. Cultural Diversity and Ethnic Minority Psychology, 15(3), 265.
  10. Loya, F., Reddy, R., & Hinshaw, S. P. (2010). Mental illness stigma as a mediator of differences in Caucasian and South Asian college students’ attitudes toward psychological counseling. Journal of Counseling Psychology, 57(4), 484.
  11. Mokkarala, S., O’Brien, E. K., & Siegel, J. T. (2016). The relationship between shame and perceived biological origins of mental illness among South Asian and white American young adults. Psychology, Health & Medicine, 21(4), 448-459.
  12. Arora, P. G., Metz, K., & Carlson, C. I. (2016). Attitudes toward professional psychological help seeking in South Asian students: Role of stigma and gender. Journal of Multicultural Counseling and Development, 44(4), 263-284.
  13. Chaudhry, T., & Chen, S. H. (2019). Mental illness stigmas in South Asian Americans: A cross-cultural investigation. Asian American Journal of Psychology, 10(2), 154.
  14. Karasz, A., Gany, F., Escobar, J., Flores, C., Prasad, L., Inman, A., … & Diwan, S. (2019). Mental health and stress among South Asians. Journal of Immigrant and Minority Health, 21(1), 7-14
  15. Min, L. Y., Islam, R. B., Gandrakota, N., & Shah, M. K. (2022). The social determinants of health associated with cardiometabolic diseases among Asian American subgroups: a systematic review. BMC health services research, 22(1), 257. https://doi.org/10.1186/s12913-022-07646-7
  16. Rocque, R. J., Beaudoin, C., Ndjaboue, R., Cameron, L., Poirier-Bergeron, L., Poulin-Rheault, R. A., Fallon, C., Tricco, A. C., & Witteman, H. O. (2021). Health effects of climate change: an overview of systematic reviews. BMJ open, 11(6), e046333. https://doi.org/10.1136/bmjopen-2020-046333
  17. Tripathi, S., & Azhar, S. (2022). A Systematic Review of Intimate Partner Violence Interventions Impacting South Asian Women in the United States. Trauma, Violence, & Abuse, 23(2), 523-540. https://doi.org/10.1177/1524838020957987