Looking Back: The Contested Whiteness of Arab Identity

In 2019, Abboud et al.¹ published a commentary that garnered considerable attention. The authors called for the US Census Bureau and the National Institutes of Health (NIH) to add “Arab” as a discrete identity group. They proposed that this would aid in characterizing members of this unique population and would promote research to better understand and improve their health status. Here we provide some thoughts as to why their compelling piece sparked such interest and what it may mean moving forward. Before doing so, we first provide a bit of background and summarize their essential thesis.

TERMINOLOGY

Abboud et al. focused their thoughts largely on the US Arab population, typically defined as people having origin from an Arabic-speaking country. There is also a broader, partially overlapping group, the Middle Eastern and North African (MENA) population, of which Arab individuals compose the largest segment. MENA individuals are generally defined as having heritage from one of the 22 Arab League nations and a few non-Arabic-speaking countries such as Iran, Turkey, and Israel.

In addition, the MENA category includes ethnic groups such as Assyrians and Chaldeans, who have origins in Arabic-speaking countries but do not often identify as Arab.^2–4 Finally, MENA is the ethnoracial category the US census adopted as a means to provide an identity for those of Arab ancestry.^2,5,6 Although Abboud et al. focused on Arab identity, we believe that their observations, as well as our comments, relate to the broader MENA identity. Thus, for purposes of our editorial, we address both Arab and MENA populations, acknowledging that Abboud et al. may have intentionally limited their scope to Arab Americans.

The US Arab community numbers between 2 and 3.7 million; the primary countries of origin are Lebanon, Egypt, Syria, Iraq, Yemen, and Palestine.^2,3,7,8 The lower population figure represents the US census estimate,² whereas the upper estimate is adjusted for undercounting. When the broader MENA parameters (e.g., Iran, Morocco, Turkey) are considered, the US MENA population likely exceeds 4 million. The two largest US Arab/MENA populations are found in California and southeastern Michigan.

According to Abboud et al., members of Arab/MENA communities reside in a state of demographic purgatory. De facto they are classified as White, which Abboud and colleagues argue is both conceptually dubious and practically harmful. Because of this misclassification, Abboud et al. assert, Arab/MENA communities are demographically and epidemiologically invisible. Moreover, classifying Arab/MENA individuals as White can mask the disproportionate discrimination and health disparities they experience.⁵

The US census continues to be bound by the 1997 Office of Management and Budget standard known as Directive 15 (NOT-OD-15-089). The Office of Management and Budget defines White individuals as those “having origins in any of the original peoples of Europe, the Middle East, or North Africa.” In the 2020 census, respondents were allowed to indicate their origin in a free text field located below their selected racial category. However, given that the “origin” field is optional, it cannot be used to accurately enumerate the MENA population because many respondents ignore it. It is increasingly recognized that a separate MENA option, be it under race or ethnicity, will yield a more accurate count of this population.^5,6

PAST EFFORTS TO ADD A MENA RESPONSE OPTION

Since the 1980s, members of the Arab American/MENA community have been advocating for a separate identity category on the decennial US census, and MENA was almost included as a separate check box in 2020. In the early 2000s, the US Census Bureau was receptive to calls for a MENA option and in fact performed a National Content Test in 2015 that, among other areas, explored the logistics and impact of adding a discrete MENA category.^5,9 The results showed that when a MENA category is present, 70% to 80% of MENA individuals select the box.⁹ Another recent study similarly indicated that as many as 88% of MENA individuals will select the MENA option if offered.⁶

These findings suggest that this option, if implemented, would not only result in a more precise enumeration of Arab/MENA communities but would reduce the number of people selecting “some other race,” leading to a more granular census.⁹ These pilot results led the Census Bureau to recommend inclusion of the MENA category in future census administrations.⁹

However, this recommendation was never implemented by the Office of Management and Budget, and the reasons have not been fully articulated.^5,6 Census staff have continued to meet with MENA community leaders and scholars (including the authors of this editorial) to discuss the inclusion of a MENA category. In September 2021 the authors, along with other scholars convened by ACCESS,¹⁰ the largest Arab American nonprofit health and social service agency in the country, submitted a series of recommendations for including a MENA option in federal data collection efforts to the Equitable Data Working Group. This working group, formed through Executive Order 13985, is tasked with developing equitable measurements throughout the federal government. Although national inclusion of the MENA category remains elusive, local implementation of a MENA option on surveys has begun in Michigan, California, Massachusetts, and Chicago, Illinois.

In addition to the US census, federal health research provides another opportunity to enumerate Arab/MENA communities. These efforts could include the Centers for Disease Control and Prevention and the NIH, which has a robust minority health portfolio and funds the National Institute on Minority Health and Health Disparities. The NIH, as part of its minority health and health disparities research framework, identifies eight health disparity populations: American Indians/Alaska Natives, Asian Americans, Blacks/African Americans, Hispanics/Latinos, Native Hawaiians and other Pacific Islanders, sexual and gender minorities, socioeconomically disadvantaged populations, and underserved rural populations. Neither the MENA nor the Arab population is included in the list.

Absence from the list of disparity populations does not preclude the NIH from funding MENA research, as investigators can apply for funds to conduct such research under general calls for proposals (i.e., investigator-initiated proposals); it can, however, impede MENA research from being funded under announcements that fall under the “minority” or “disparity” rubric. Calls for proposals targeting minority or disparity research may consider Arab/MENA-focused applications to be nonresponsive. This is not a criticism of the NIH or the Department of Health and Human Services, because they are bound by federal regulations. Nonetheless, expanding the definition of what constitutes minority and disparity at the federal level would provide important recognition of Arab/MENA communities and would likely lead to more health research and health services for these communities.^5,11

Abboud et al. concluded that the absence of a discrete Arab/MENA identity option and omission from the list of disparity populations leave this population undercounted and underresearched. This may also, albeit unintentionally, communicate that these individuals’ struggles and challenges are not worthy of our attention despite clear evidence that they exhibit significant health disparities, including lower cancer screening rates as well as higher rates of discrimination and stress over deportation (Paul J. Fleming, unpublished data, 2022).^5,12–14

A CONFLUENCE OF EVENTS

At that time, US president Donald Trump expressed anti-immigrant and anti-Muslim rhetoric and proposed policies consistent with these sentiments. Among his first presidential actions (Executive Order 13769, eventually reissued as 13780) was the so-called “Muslim ban,” which limited immigration from several predominantly Muslim (although not all Arab) countries.^6,15 Citizen outrage and judicial intervention limited its impact on actual immigration, but the psychological and health repercussions in the MENA community were nonetheless immense.¹⁶ Subsequently in 2019, deriding four female members of Congress, all of whom were women of color and two of whom were Muslim (and MENA), Trump declared that they were “free to leave” the country and accused them of “hating” America. He later tweeted that they should “go back” to the “places from which they came.” One was born in Somalia; the other three were all born in the United States.

Looking back, we propose that Trump’s anti-Arab/anti-Muslim rhetoric may have unintentionally mobilized many Americans to rally to the defense of the MENA community.⁶ He may have triggered a social “reactance,” an opposite reaction of tolerance incited by his intolerance. His attacks on these communities may have spurred public empathy and interest in such issues on the part of researchers and public health practitioners. Finally, during this time, Americans were becoming more aware of the plight of refugees displaced to the United States and elsewhere as a result of the wars and political strife that had torn through the Middle East, some of which were due to US policies and actions. Interest in the Abboud et al. article may have been intertwined with these cultural forces.

Beyond the anti-Muslim sentiments that were circulating at that time, 2019 may have been a major inflection point in our national social justice debate.¹⁷ Americans were confronting persistent unfairness, and this may have predisposed us to empathize with the plight of the MENA population. The Abboud et al. commentary may have coincided with these awakenings. An article calling for American demographers and researchers to offer MENA communities the dignity of being counted was timely.

It is interesting that, for those of us at the University of Michigan Rogel Cancer Center, 2019 marked the beginning of our MENA research initiative. The initiative was driven in part by feedback from external advisors that we were ignoring an important disparity population in our own backyard: the Dearborn enclave, the largest visible and most concentrated MENA community in the United States. This ongoing initiative has led to numerous publications documenting unique health and social issues facing the local MENA population^{12,14,18–21} and to the development of several culturally tailored interventions, including the Yallah Quit! smoking cessation program and home-based human papillomavirus testing, which aimed to assuage modesty concerns that discourage some MENA women from seeking health services.

Although not the focus of the Abboud et al. commentary, an outstanding issue regarding assessments of MENA identity is to what extent, if MENA were ultimately listed as a discrete ethnic or racial category, individuals who are members of this population would actually check the MENA box. Overall, it appears that 70% to 80% of eligible respondents would use the MENA checkbox^6,9; however, these percentages may vary by subgroup. For example, Maghbouleh et al. found that respondents who identified as Muslim were more likely to check the MENA box than those who identified as Christian.⁶ Similar variations in MENA affiliation by country of origin were observed in the US census pilot.⁹

Thus, some individuals who may have Arab or Chaldean origin may nonetheless still prefer to report White identity either instead of or in addition to their MENA identity. This preference may be due to the status and privilege it conveys as well as a desire to dissociate from an identity that has been viewed with suspicion and derision,^6,22–24 particularly since the War on Terror prompted by 9/11.²⁴ Perhaps over time, when the MENA identity becomes widespread and more normative, more members of the community will check the MENA box.

The fact that affiliation with MENA identity varies within the MENA population was addressed in a letter to AJPH submitted by Ford and Sharif²⁵ that was prompted by the Abboud et al. article. Ford and Sharif proposed that MENA identity and related disparities are better understood through an intersectional framework. They posited that the status of MENA individuals in American society is driven not only by whether they are perceived as White but also by their gender, clothing, religion, socioeconomic status, experience with discrimination, and nationality.²⁶ Thus, there are multiple, often interacting dimensions of identity that affect MENA communities.²⁶ For example, MENA individuals who practice Islam may have very different lived experiences in US society than those who identify as Christian. These multiple influences affect whether they identify as MENA.

Abboud et al. challenged us to reconsider what constitutes a disparity population. Health disparity is defined by the National Institute on Minority Health and Health Disparities (https://www.nimhd.nih.gov/about/strategic-plan/nih-strategic-plan-definitions-and-parameters.html) as a higher incidence, higher prevalence, or earlier onset of a disease or its risk factors, as well as disproportionate consequences or burdens. Disparity populations (the eight earlier-defined groups) are characterized by key criteria including racial/ethnic minority status, low socioeconomic status, residence in an underserved rural area, and membership in a sexual or gender minority group. Currently MENA health disparities, although substantial, are not fully appreciated because the MENA population is not an officially recognized race or ethnic minority group. Creating a unique MENA identity separate from White and adding MENA to the list of disparity populations seems a reasonable remedy to this problem.

Recognizing MENA as a unique demographic group and including it as a disparity population are critical steps in achieving social and health equity.⁵ However, while we wait for these broader fixes, we can address MENA health issues outside the official disparity rubric. For example, researchers can conduct epidemiological and intervention research on these communities without labeling the work as “minority” or “disparity.” The rationale for the research can still be based on the need to understand the unique health issues of MENA communities without the research being framed as disparity or minority.

Disparities, of course, arise from the interplay of numerous factors from biology and socioeconomics to structural and interpersonal discrimination. Although it is critical to identify and understand these root causes and intervene upon them at societal levels, we can address some of these adverse consequences through tailored interventions.¹⁰ Formally recognizing MENA in demographic counts will alleviate some of the problems caused by the status quo. However, tailored interventions will still be needed moving forward to address the unique culture and social experiences of MENA communities.

Several conceptual and logistic issues regarding MENA identity remain unresolved. For example, whether Arab/MENA should be considered a racial group or an ethnic group (as we currently classify Hispanic origin) is still up for debate.⁵ Also, if MENA is granted unique status, other groups such as Afro-Caribbean Americans or Central Americans may seek discrete status. Finally, an interesting, perhaps more philosophical question is whether MENA individuals should in fact check the MENA box, an imperative reflected in the “Check it Right; You Ain’t White” campaign.²⁷

The answer to this question has significant implications. If endorsing the MENA option is considered objectively beneficial for the MENA community and broader society, then perhaps campaigns encouraging individuals to identify as such may be warranted. By contrast, if using the MENA option is considered simply a personal preference, then perhaps it should be approached with equipoise. Although we are not certain where Abboud et al. would land on this issue, we believe that MENA communities should be provided with information about the benefits of using the MENA option and support for their personal autonomy in choosing their identity.

In summary, Abboud and colleagues’ timely piece appeared to coincide with a rising national consciousness regarding the invisibility of our MENA communities and the need to fully count them and address their health and social needs. Abboud et al. also raised important issues around how we measure and conceptualize race and health disparities that can guide our public health agenda moving forward. The addition of a unique MENA identity in the census and public health systems is a critical first step. Future efforts can focus on incorporating an intersectional perspective of MENA identity and including MENA communities within our health disparity service and research endeavors.