Addressing Gaps in Health Care Delivery Among Asian Americans Through Community-Driven Policy Action

Abstract

We describe the application of community engagement in addressing priorities and gaps in health care delivery among Asian American populations through community-driven action, resulting in the development of two policy briefs to be disseminated to policymakers at the local, state, and national levels. The policy briefs highlighted (1) gaps in mental health research and culturally tailored mental health education programs and care and (2) an overall gap in culturally and linguistically tailored evidence-based health care delivery among Asian American populations. (Am J Public Health. 2025;115(S2):S134–S137. https://doi.org/10.2105/AJPH.2025.308027)

In this article, we describe the application of community engagement in addressing priorities and gaps in health care delivery among Asian American populations through community-driven action. This process resulted in the development of two policy briefs to be disseminated to policymakers at the local, state, and national levels.

STUDY OBJECTIVE

Asian Americans are the fastest growing and most diverse population in the United States. The majority are foreign born, with ancestry from various Asian countries, each with distinct immigration histories, cultures, and languages.¹ Chinese are the largest group in the United States (5.2 million), followed by Asian Indian (4.5 million), Filipino (4.1 million), Vietnamese (2.2 million), Korean (1.9 million), and Japanese (1.5 million) Americans.² Of the 22.6 million Asians in the United States, more than 10% live in New York State (2 million) and New Jersey (1 million). More than 900 000 Asians reside in New York City, which has the largest population of Asians in any city outside of Asia.³

Asian Americans occupy both extremes of socioeconomic status and health indices, with higher rates of chronic disorders such as diabetes and cardiovascular disease than non-Hispanic White populations.^4–6 Although Asian Americans have a lower prevalence of mental health conditions, this may be related to underreporting and underidentification.⁷ Despite these recognized health burdens, previous research has underscored the underuse of health care services and delivery systems among Asian American populations.^8,9

RESEARCH QUESTIONS

In our study, we applied the conceptual model of the Organizing Committee for Assessing Meaningful Community Engagement in Health & Health Care Programs & Policies, which aligns with the core principles of (1) strong partnerships and alliances, (2) expanded knowledge, (3) improved health and health care programs and policies, and (4) thriving communities.¹⁰ This model highlights that meaningful community engagement requires working closely with communities to understand their preferences on how, when, and to what level and degree they want to be engaged in efforts to generate actionable and sustainable solutions.

To identify gaps in health care access and delivery among Asian American populations and build trust and create mutual value for the community partners we work with, we aimed to identify the most pressing issues facing Asian Americans through the perspective of community partners based in the New York and New Jersey area. The Community Engagement Core of the Rutgers-NYU Center for Asian Health Promotion and Equity (CAHPE) provided the infrastructure and resources to implement this community engagement project, which aligned with the four core principles of meaningful community engagement.

SAMPLE, LOCATION, SETTING, AND YEAR

In 2022, a 12-member community advisory board (CAB) was formed through the efforts of CAHPE, the first and only Asian American–focused center funded by the National Institute on Minority Health and Health Disparities. CAB members represent Chinese, South Asian, Filipino, and Korean American communities from the New York and New Jersey area. These specific ethnicities were chosen because they comprise some of the largest Asian ethnic groups in the United States and in the New York and New Jersey area and were the populations of focus for research projects sponsored by CAHPE. Building on the idea of the community as a shared partner and shared leader, the first months of CAB meetings were devoted to learning each member’s community-engaged work and developing collective trust.

CAB members are primarily leaders of various Asian American community-based organizations and individuals with lived experiences in accessing health care services for themselves and their loved ones. These community-based organizations include Homecrest Community Services, the New Jersey Indian Lions Club, Agraj Seva Kendra, the National Federation of Filipino American Associations New York Chapter, Hamilton-Madison House, the Chinese American Planning Council, Womenkind, and the New York Asian Women’s Center. Through the significant community ties of the CAB membership, CAHPE continues to recruit members from other community-based organizations serving the Asian community in the region to expand representation from various Asian subpopulations.

METHODS

CAB members actively participated in CAHPE activities to provide insight and engage in discussions regarding gaps in health care access and delivery among Asian American populations. The core investigators and staff of the Community Engagement Core planned and facilitated monthly meetings and annual retreats and conducted one-on-one interviews to clarify and further discuss issues brought up by CAB members during the meetings. A total of 15 one-hour meetings occurred between August 2022 and September 2024.

CAHPE investigators devoted three initial CAB meetings to eliciting responses from members regarding the health care and health care delivery issues they were experiencing directly on the basis of their community-engaged work and knowledge of the challenges in their communities. After these meetings, multiple pressing issues were identified and tabulated by CAHPE investigators through a summary of meeting transcripts and an open-response online survey asking about the priorities of the Asian community. These findings were reported to CAB members during an interactive presentation at the next meeting.

Members held discussions and came to a consensus on prioritizing mental health and culturally tailored services. CAHPE investigators elicited “stories” and quotes from CAB members to illustrate the lived experiences of the community, and these materials were included in the policy briefs to enhance their impact. CAHPE investigators engaged with CAB members at every stage in an iterative process, developing multiple drafts of the policy briefs and soliciting feedback from CAB members before finalizing key findings for the briefs.

KEY FINDINGS

We identified two themes related to health care access and delivery: (1) gaps in mental health research and culturally tailored mental health education programs and care and (2) an overall gap in culturally and linguistically tailored evidence-based health care delivery. These themes were used to develop the two CAHPE policy briefs. Responses from participants included a clarion call to “make mental health a priority in our communities. . . . Asian Americans may not know about case managers and mental health clinicians who speak their language and understand the issues they are dealing with.” Another CAB member emphasized “having health care delivery professionals [with] cultural diversity and [the] patience to be kind to anyone who may not be well versed with the system nuances or paperwork. . . . Legislators need to promote the policies that advocate for equality, respect, and inclusion.”

Recommendations were included to address gaps in mental health service access and delivery and the inadequacy of culturally specific services in the Asian American population. These recommendations included policy solutions addressing the underidentification and undertreatment of mental health issues among Asian Americans, such as increased funding for services in ethnic-specific Asian American communities and increased outreach to further health and mental health literacy within this population. More language-concordant and culturally tailored programs and interventions were highlighted as potential solutions that can increase engagement with ethnic-specific Asian populations, along with strategies to ensure an adequate pipeline of health care professionals from the communities served.

The policy briefs will be disseminated to legislators and leadership in executive agencies at the local, state, and national levels through connections from CAB members and community partners. Through this community-driven process, the policy briefs can be used to highlight the needs of the Asian community and communicate the stories of those affected to decision makers in the policy arena. The policy briefs can be found at the CAHPE Web site (https://cahpe.rutgers.edu/policy-briefs).

EVALUATION AND ADVERSE EFFECTS

The findings of this study are transferrable and can be scaled up to make an impact through community engagement with other underserved populations; also, they provide a model based on a culturally informed community-based participatory research framework that can enhance community-aligned, actionable solutions. CAB members played a crucial role in expanding knowledge of the most pressing issues facing their communities as well as helping the researchers refine study designs and improve participant recruitment strategies. Through this community-driven process, a feedback loop was created to amplify community voices and motivate health equity by transforming systems of health via community-engaged research and policy action.

Future efforts can include more extensive qualitative and quantitative research processes (e.g., surveys, interviews, focus groups) with a greater focus on evaluating outcomes to examine effects on communities. Although CAB members provided invaluable insights in this community-engaged initiative, soliciting voices and feedback from other leaders who hold formal positions or play informal advocacy roles in the community can provide greater richness to future endeavors.

PUBLIC HEALTH SIGNIFICANCE

Through community engagement, we aimed to actively integrate the voices of community partners to effect meaningful changes in health care delivery outcomes for Asian American populations. The narratives of CAB members and other community partners highlight that those affected often live at the intersections of Asian ethnicity and other social determinants of health such as socioeconomic status, educational level, language capacity, immigration status, occupation, access to transportation, housing stability, and other neighborhood factors. We hope to elevate community voices to policymakers in city and state governments as well as in the US Congress to advocate for much-needed improvements in mental health and culturally tailored services for diverse Asian ethnic communities.