Advancing Asian Health Equity: Multimodal Approach to Translate Research into Practice and Policy

Minority populations are increasing rapidly in the United States, with the Asians the fastest growing population.^1,2 Preliminary research showed marked disparities in relationship to health and well-being, but numerous barriers also exist that prevent quality research from being conducted and disseminated.³ Of particular note, research on Asians is challenged by the aggregation of Asians as a racial group, rather than examining the experiences of specific ethnicities.⁴ The Asian racial group consists of more than 20 ethnic groups with distinct languages, cultures, histories, and experiences in the United States.^5–8 Additionally, Asians in the United States are commonly characterized as part of the so-called model minority, masking the difficulties Asians may face in the United States and projecting a message of uniform prosperity within and among each ethnic subgroup.^5,9

The largest Asian ethnic subgroup, the Chinese, has an estimated 4 million people in the United States,^1,2 but significant gaps remain in the existing research to understand the health and well-being of the Chinese population and improve their health equity despite preliminary knowledge that US Chinese face significant barriers and health disparities.^10–12 This paucity of knowledge may be exacerbated by the lack of minority representation among researchers and a lack of funding for minority aging research.^13,14 In the past 10 years, less than 1% of National Institutes of Health (NIH) funding was awarded to research focused on US Asians,^15,16 and Asian investigators were less likely to receive funding than white investigators.^17,18 In sociology, investigators of Asian descent are 74% less likely than white sociologists to receive any government funding that includes NIH and the National Science Foundation (NSF). Generally, Asians constitute a small number of behavioral and social sciences investigators relative to the size of the population.¹⁸ According to NIH and NSF, Asians are not considered a underrepresented minority, and as a result, Asians are not eligible for diversity supplements that may increase funding and support for both investigators and research focused on Asians. Both Asian investigators and underrepresented minority investigators in behavioral and social sciences compared with white investigators are less likely to receive any governmental funding (coefficient = -.436 (.120), P < .001; and -.238 (.085), P < .001; respectively).¹⁸ In a study examining clinical research projects funded by NIH between 1992 and 2018, only 0.17% of the total NIH budget went to projects focused on Asian American, Native Hawaiian, and Pacific Islander participants.¹⁹ Of those 529 projects, many projects only reference health disparity populations more broadly and may not meaningfully include Asian American populations.²⁰ Thus there are indications that not only do Asian older adults face barriers in participating in research due to linguistic and cultural issues, but also there are significant systemic research pipeline barriers to support research about Asian populations and their health and research led by Asian investigators. Given the population size and growth of Asians in the US, along with insufficiencies in our current understanding of health among US Asian populations, action at federal levels to is needed to close this funding disparity. Without additional support of research projects focused on Asian populations, our ability to improve the health and wellbeing is compromised.

To address these gaps in our knowledge and support research conducted in Asian populations, this issue of the Journal of the American Geriatrics Society compiled 17 articles that examine the health and well-being of Chinese older adults through the Population Study of Chinese Elderly (PINE) and PIETY studies, the largest epidemiological cohort studies of Chinese older adults and Chinese adult children in the United States.²¹ The articles in this issue are organized on these themes: methods of data collection, elder abuse, cognitive function, psychological well-being, social relationships, and health behaviors.

Regarding methods of data collection, Dong et al provide details on how to use mobile technologies to conduct in-person multilingual survey research with underrepresented minority immigrant populations.²² On the theme of elder abuse, four articles examine the risk factors and consequences of violence across the life course.^23–26 Pertaining to cognitive function, four articles investigate cognitive function in the context of immigration, psychological distress, social engagement, and oral health.^27–30 Another three articles focus on psychological well-being among Chinese older adults and its relationship to physical health over time.^31–33 Regarding social relationships, three articles concentrate on various facets of the social contexts of Chinese families including filial piety from the perspectives of the older adult and their adult children and older adults’ capability for social engagement.^34–36 Lastly, two articles explore patterns of health behaviors among Chinese older adults to understand potential predictors and consequences of certain health behaviors.^37,38

IMPLICATIONS

These articles not only shed light on the current experiences of the Chinese community in the United States, but they also offer solutions on improving the research participation of minority older adults in the United States and ultimately reducing health disparities. With studies like the PINE study and the recent establishment of an Asian Resource Center for Minority Aging Research (RCMAR) funded by the National Institute on Aging, we have begun to see greater support toward these efforts. The PINE study has completed three waves of data collection with more than 90% of participants completing follow-up interviews. This sustainability in participant retention has been possible through more than 10 years of continuous community outreach and engagement in Chicago Chinese communities according to the principles of community-based participatory research. This localized approach has been successful in supporting data collection for the largest epidemiological cohort study of Chinese older adults in the United States, but increased efforts should be made on national and international stages to understand the experiences of Asians and their health to fill these critical gaps in our knowledge.

The Asian RCMAR supports early-stage investigators from across the country in conducting research pilots along the themes of trauma, resilience, and health outcomes among Asian older adults. This occurs through a four-core and three-board structure to support the administration, research education, analysis and methodology, and community participation for current and future research and researchers. Executive, internal, and external board members help guide the direction of the Asian RCMAR and have backgrounds ranging from nonprofit to academic to social work, and they work with Asian populations across the world. The Asian RCMAR’s Measurement and Analysis Core provides resources in conducting secondary data analysis of large survey data sets worldwide to understand the health of global Asian populations, with support from senior statisticians. Given the high prevalence and growth of immigration, we believe an international perspective is needed to contextualize, understand, and improve the health of Asian populations. Further, the Community Liaison and Recruitment Core takes a multilevel approach to integrate community stakeholders and members in all components of research studies from design to implementation to dissemination. We hope the trajectory of the Asian RCMAR will not only support innovative research on Asian older adults and support early-stage investigators interested in these issues, but also lead national and international conversations and future initiatives to promote health equity in minority groups.

Future research and funding efforts should be dedicated to building and sustaining innovative research projects and infrastructure to improve the pipelines of Asian researchers and research on Asian older adults given the significant need and disparities. Given inequities in funding for Asian investigators in behavioral and social science and a relative dearth of funded research examining the health and well-being of US Asians, we call for the NIH and NSF to consider Asians as an underrepresented minority in funding opportunities, especially regarding behavioral and social science research. In the coming decades, the United States will likely be challenged by the growth of the minority and immigrant older adult population, and it will be increasingly critical to build on current research and expand research support in these populations to understand current inequities and how to promote health equity for all.³⁹