The Perilous History of the Model Minority in Health Care

Source: YouTube — UTD TV: “DisOriented EP03: From Yellow Peril to Model Minority”

Over the next weeks, I’m going to be sharing insights from my book, Health Care of a Thousand Slights, in this article series. Health Care of a Thousand Slights launched on 12/07/2020 on Amazon, here is the link to buy it! If you want to connect, you can reach me here via email (anjana.sreedhar@nyu.edu) or connect with me on Instagram or LinkedIn.

Increasingly, “model minority” is a term that has been assigned to describe the success of Asian Americans relative to other racial groups. However, this article will point out how this elevated status among racial minorities actually causes harm to Asian Americans when talking about health care access and outcomes.

The first time I had heard of the term “model minority” was when I saw the cover of TIME’s August 1987 issue. At first glance, there is nothing remarkable about the cover; growing up in central New Jersey, I saw that the kids featured on that cover looked a lot like my East Asian American friends. Of note, I was excited to see Asian Americans on the cover of such a prominent publication. Despite being raised in a part of town where Asians made up more than half of the population, my classmates and I were hard pressed to find people who looked like us in the news or in the media that didn’t support some terrible stereotype — terrorist, martial arts master, socially awkward and heavily accented to contrast a cool, attractive, white lead. So, to see some academically successful Asian Americans on the cover of TIME — at a time before I was born — almost felt like a triumph.

Source: TIME.com

What I learned over time, however, was the precarious way in which Asian Americans have been positioned in American society ever since. When meeting people from other states, they would always comment that I was bound to be successful because “Indians are so smart and hardworking.” As long as I wasn’t being complimented on my English, I thought that this was fine. For me, at least. Most of the Asian Americans I interacted with at school and in college were incredibly bright, so it felt accurate.

But even “positive” stereotypes can be incredibly dangerous.

As I mentioned in my first article in the series, these stereotypes mask people in the same identity group who may be facing unique challenges that don’t align with the stereotype.

Where does this stereotype of successful Asian Americans comes from?

It’s deeply rooted in immigration policy.

For a very long time, Asian immigrants were not welcome in this country — as reflected in the Chinese Exclusion Act (the only immigration act of its kind), riots against Indian workers in the 19th century, among others. For East Asian immigrants in particular (particularly those of Chinese origin), the term “yellow peril” was accorded to describe how they were a blight to American society. Images of scheming, brutalizing, and crazed Asian men — standing in contrast to helpless white women representing the Western world — abounded.

The racist cartoon of The Yellow Terror in all His Glory (1899) represents an anti-colonial Qing Dynasty Chinese man standing over a fallen white woman, who represents the Western world

Source: Wikipedia

For Indian Americans, many who emigrated to the United States in the 19th century originated from the northern state of Punjab. Identifying with the Sikh tradition, they often came to the northwest part of the United States to work on the Western Pacific Railroad. While their ability to speak English helped them build a robust Indian American community, the 1920s saw a wave of “anti-Asiatic” sentiment, resulting in the Immigration Act of 1924. This stated that the US would only permit 2% of the number of people from their origin country already in the United States.

Sikh immigrants to California posing in a group photo in 1910.
Source: California State Library

Things changed dramatically in the 1960s.
President Lyndon B. Johnson passed the Immigration Act of 1965, allowing Asians to migrate in larger numbers to the United States for the first time. Asians were allowed to come to the US in two ways:

• If they had immediate relatives already living in the United States. Given how few Asians were already living in the United States by 1965, the likelihood of emigrating in this fashion was quite low
• If they were highly skilled, qualified professionals — doctors, lawyers, business professionals, etc. — which led to a certain type of Asian being able to come to the US

Given that the first big wave of Asian migration included highly skilled, highly educated people, it was easy for the rest of American society to develop this perspective that Asians were the “model minority” — meaning that they were the minority group to which others aspire.

Over time, Americans became used to the idea of successful Japanese businessmen, industrious Pakistani scientists, and highly intelligent Filipino clinical professionals. Soon, it was easy to “justify” these foreigners coming to the United States performing value-add roles.

As migration policies began to change over time — and countries in Southeast Asia were ravaged by dictatorship and US involvement — Asians were also entering the United States as refugees and as immediate relatives of Asians already in the United States. This continued to diversify the types of Asians in the United States, but American society has still not caught up with this.

And this impacts their health care too.

Part of the unfortunate reality of being the model minority myth is that when a national crisis strikes — economic strife, a terrorist attack, the introduction of “foreign disease” in the United States — the same praise accorded by American society can quickly turn into fear-based race baiting. It doesn’t take long to turn on the “always hardworking” Asian American population and posture them as foreign and invading the United States.

From a health context, this was made especially clear when the SARS virus and the COVID19 virus arrived in America. In a Washington Post article written well before the surge in COVID cases in early March, Jenn Fang documented how the SARS virus devastated Asian businesses. Perhaps of more cultural import, Fang shares how newspapers “inextricably linked to images of the Asian body as disease vectors.” That same stereotyping has occurred during the time of the COVID19 crisis, resulting in Chinatowns being shuttered, Asian Americans being spit on and harassed, and other such discriminatory events. It doesn’t help that President Trump insisted, for a long time, on calling COVID19 “the China virus.”

Outside of the frenetic shift between “boon to the economy” and “foreign invader,” Asian Americans are largely left out of important health disparity conversations. While, on the whole, Asian Americans have better health outcomes, higher educational attainment, and higher salaries compared to other Americans of color — that does not mean that all are thriving.

Not all Asian Americans came to the United States through the 1965 legislation referred to above. Some came as refugees of violent conflicts — survivors of Cambodia’s Pol Pot regime and the Vietnam war are just some examples. For others, the United States’ military involvement in their countries became a reason for them to leave their countries for opportunities. This was true for those emigrating from countries like South Korea — afflicted by the Korean War — and the Philippines — a former American colony.

Source: Migration Policy Institute

So it makes sense that the health outcomes for such a diverse population would be diverse in nature.

We must also not forget about how broad the umbrella of “Asian American” truly is. Other communities — such as Native Hawaiians and Pacific Islanders — also fold into this category. Places like Hawaii, Guam, and the American Samoa were taken by force by the United States, with only the first of the three being granted full statehood. Even so, Pacific Islanders face unique health challenges as well, owing to the historical treatment of their people. For example, Pacific Islanders and Native Hawaiians report higher prevalence of HIV/AIDS compared to other types of Asian Americans and white Americans. Unfortunately, these communities are often a footnote in broader stories about the Asian American population.

This is clearly reflected in health outcomes as well. According to Pfizer program “Get Healthy Stay Healthy,” there are limitations in the existing health disparities research resulting in lack of representation. According to this article, Asian Americans and Pacific Islanders are less likely to have a personal doctor, to have blood pressure monitoring and pap smears, and have access to high quality care. For the most part, the prevalence of certain chronic conditions in various Asian populations — diabetes, hypertension, and others — has been attributed to culinary practices. For example, in Korea, smoking is more commonly accepted; as such, the article indicates that some of it is ostensibly linked to other social challenges, like language and cultural barriers as well as lack of health insurance.

According to a 2010 article published in American Journal of Health Behavior, it was reported that more vulnerable members of Asian American communities struggle moreso with health care due to the above barriers. In particular, the article mentions how elders are reliant on younger family members who are more fluent with English to take them to appointments and to translate. Moreover, elders and more recent immigrants were more likely to depend on alternative therapies — especially herbal remedies — to counter existing health care barriers of long wait times, concern around non-Asian doctors, and challenges with health insurance coverage. Interestingly, living in a residential area concentrated with members of the same community — also known as an “ethnic enclave” — can be inversely correlated to getting a yearly check-up for Vietnamese and Chinese Americans. Therefore proximity to peers has an impact on the social stigma associated with accessing American health care.

In my book, I had the opportunity to interview Dr. Stella Yi, a researcher with NYU Langone’s Center for Asian American Studies, who concurred the same way. In our conversation, she noted the damage that the model minority myth had done to the inclusion of Asian Americans in research about poverty and health care.

The model minority not only leaves the above communities out of larger conversations, it also leaves out a significant group: undocumented Asians. Usually dominating policy conversations in Latinx communities, the issue of emigration and legal status has become relevant in Asian spaces as well. Asian Americans often become undocumented because of overstayed visitor, student, or work visas. The model minority does not protect these Asian Americans, who struggle with added complexities to already difficult tasks like paying for college and applying for jobs. Being undocumented can also result in economic insecurity, which directly affects one’s ability to access health care meaningfully. It also means that Asian Americans without papers are also threatened under new policies like the “public charge” rule instituted by the Trump administration, stating that immigrants using public services would be deemed as “public charges” and be much more likely to be deported.

So much about health care is, in fact, not about health care. As you can see throughout this article, health care is rooted in how people from different backgrounds have been treated in this country. In the context of emigration, how people have been allowed to come over to the United States has a direct impact on the resources they are permitted to access, which ultimately affects their health care access.

Resource List:
AAPI Data — https://aapidata.com/policy/health-care/
AAPCHO — https://www.aapcho.org/
Asian & Pacific Islander American Health Forum — https://www.apiahf.org/

Interested in learning more? Feel free to purchase my book, drop a review on Amazon or Goodreads, and follow along my social media journey on LinkedIn or Instagram.