So often, we are asked to place our entire ethnic and cultural identities into a tiny checkbox on a form. But how much of a person’s story is left out when they are viewed as part of a larger group, rather than an individual with unique needs and feelings? When it comes to health care, the answer is often: quite a lot.
Angela Chen (pictured first below) and Run Kuang, both CMS ’26, see the effects of these generalizations as medical students, and also as members of immigrant families helping non-English speaking relatives navigate the U.S. healthcare system. The two students shared insights into health-related disparities among Asian American subgroups as part of the RFU Division of Diversity, Equity and Inclusion’s Diversity Forum in January.
“The term ‘Asian American’ includes vast differences in ethnicity. A chart from the U.S. Census Bureau lists six large subgroups that make up Asian American. However, squeezed into the section labeled ‘all others’ are 15 different subgroups. We cannot generalize the whole population based on just these six subgroups,” Ms. Kuang said. She elaborated by using social determinants of health as examples of how these generalizations can lead to reporting discrepancies that obscure the needs of individual groups.
“This source lists the uninsured rate for all Asian Americans as 6%. But if we look closer, we see Japanese has a 5% uninsured rate, whereas Mongolian has a whopping 38% uninsured rate,” Ms. Kuang said. “If we’re targeting lack of insurance coverage, we don’t see that need among the Mongolian subgroup if we only look at Asian Americans as a whole.”
Ms. Chen and Ms. Kuang (pictured to the left) also explored a common generalization that Asian Americans have a higher percentage of secondary education, which is associated with a better understanding of basic health information. “Again, looking at the breakdown by subgroup, 74% of Taiwanese Americans have bachelor’s degrees compared to only 5% for the Micronesian population,” Ms. Kuang said. “Therefore, when providers counsel patients who are Asian Americans, it’s not good to assume, ‘Oh, you’re Asian American. You’re highly educated, so I’m going to spend less time counseling you.’”
Culturally Sensitive Patient Education
A successful patient-provider relationship is key to ensuring the delivery of appropriate care. As Ms. Chen explained, when a patient in the U.S. has a non-English language preference (NELP), that relationship can be fraught with miscommunication and missed opportunities. The presence of professional interpreters and multi-language patient education materials can help improve the NELP patient experience.
“Roughly half of Asian immigrants have a NELP, and this can present obstacles to obtaining health care and proper treatments if a language barrier persists. Many NELP patients have an English-speaking family member act as their proxy to translate with the healthcare provider,” said Ms. Chen. “Children in immigrant families, myself and Run included, grew up translating for our families, so accompanying family members to healthcare appointments just seemed natural.”
Sometimes, though, the relationship between the patient and family member can actually impact care. “There are things that patients are unable to tell their provider because a family member is present, even though the patient wants their family near because they provide comfort. Ideally, we would have a professional present who can interpret between patient and provider, and make sure that patient receives appropriate care.”
Ms. Chen is also taking a firsthand approach to providing culturally sensitive materials for patients. Through a partnership with the Greater Boston Chinese Golden Age Center, she is helping to create educational materials on brain health and aging, as well as a handout on nutrition for cognitive health, which Center staff will then translate. “I worked with a registered dietitian at the Center on applying the MIND diet to Chinese cuisine,” Ms. Chen said. “The handout contains simple language referring to familiar foods. I can identify everything on the diagram and so can my grandparents, which is very important.”
Sara Skoog is a staff writer with the RFU Division of Marketing and Brand Management. In addition to writing for Helix and other university publications, she also produces Pulse, RFU’s monthly e-newsletter.