AMERICAN MEDICAL ASSOCIATION 

MEDICAL STUDENT SECTION

Resolution:

(A-17)

Introduced by:        Region 1; Region 2; Region 3; Region 4; Region 6;

Yeahwa Hong, University of Toledo College of Medicine;

Abhishek Desai, Boston University School of Medicine

Subject:        Disaggregation of Data Concerning the Status of Asian-Americans in Medicine

Referred to:        MSS Reference Committee

        (_____, Chair)

Whereas, The pan-ethnic, umbrella term "Asian-American" masks the significant disparities in health outcomes and socioeconomic realities, especially in individuals from Laotian, Cambodian, Indonesian, and other backgrounds;1,2,3 and

Whereas, Overall, data on health conditions for Southeast Asian communities have not been as revealing on the state or federal level, possibly due to low numbers of individuals being studied;3,4 and

Whereas, Southeast Asians have lesser access to healthcare services compared to their White or English-speaking counterparts, and Southeast Asian women participate less in health screenings compared to their White counterparts;5 and

Whereas, While Chinese American and Asian Indian Americans experience relatively low aggregate poverty rates, at 12.2% and 8.5% respectively, the ethnic groups with the most people in poverty in 2010 were Chinese Americans, with 449,356 people living in poverty, and Asian Indian Americans, with 246,399 people living in poverty, primarily due to the large size of their populations;6 and

Whereas, The 2006 to 2010 aggregate poverty rate by population group was reported as 65% of Bhutanese Americans, 27% for Hmong Americans, and 21% for Bangladeshi Americans;6,7,8 and

Whereas, Among the 281,000 Hmong in the United States, 38% have less than a high school degree, about 25 percentage points lower than both the Asian-American and U.S. averages, and just 14% have at least a bachelor’s degree, less than half the national average;9 and

Whereas, The homogenization of Asian-American populations undermines efforts for increased inclusion and representation of students from under-represented Asian countries and cultures;7,10 and


Whereas, AB-1726 became law in California, requiring that the Department of Public Health collect disaggregate demographic data to better expose disparities in healthcare for Pacific Islanders and Southeast Asians, serving as an example for other states to model;
10 and

Whereas, Although the Association of American Medical Colleges defines Underrepresented in Medicine as African-Americans, Latinos, and Native Americans, Southeast Asian groups, including individuals from Hmong, Cambodian, and Laotian American backgrounds, also face disparities within the pipeline to medicine and are considered underrepresented relative to other ethnic groups;11 and

Whereas, Cultural diversity brings strength to the healthcare team due to the presence of a multiplicity of perspectives and therefore competency in serving a wide range of patient populations;12 and

Whereas, Current AMA policies H-350.970 and H-350.960 encourage medical schools to outreach and support minority students, which does not traditionally include Southeast Asians, and policy H-350.966 asks agencies and institutions to improve public health data collection on Asian Americans but not the disaggregation of this data; therefore be it

RESOLVED, That our AMA advocates for the disaggregation of data regarding Asian-Americans in order to reveal the within-group disparities that exist in health outcomes and representation in medicine.

Fiscal note:

 

Date received:

 

References:

  1. Portes A and Rumbaut RG. Children of immigrants longitudinal study (CILS). Inter-university Consortium for Political and Social Research. 2012. http://doi.org/10.3886/ICPSR20520.v2.
  2. Portes A and Rumbaut RG. Immigrant America: A Portrait. 2014;4,544. www.jstor.org/stable/10.1525/j.ctt7zw0nw.
  3. Tackling Asian American health disparities. NPR Southern California Public Radio. 2010. http://www.npr.org/templates/story/story.php?storyId=127091480.
  4. Um K. Southeast Asian American health: socio-historical and cultural perspectives. Handbook of Asian American Health. 2012:117-127. https://link.springer.com/chapter/10.1007%2F978-1-4614-2227-3_9.
  5. Yee B. Health and health care of southeast Asian American elders: Vietnamese, Cambodian, Hmong, and Laotian elders. Department of Health Promotion and Gerontology. 2017. https://web.stanford.edu/group/ethnoger/Southeastasian.html.
  6. Poverty by Detailed Group (National). AAPI Data: Demographic Data & Policy Research on Asian Americans and Pacific Islanders. Retrieved from http://aapidata.com/stats/national/national-poverty-aa-aj/
  7. Ramakrishnan K and Ahmad F. State of Asian Americans and Pacific Islanders. Center for American Progress. 2014. https://www.americanprogress.org/issues/race/reports/ 2014/04/23/87520/state-of-asian-americans-and-pacific-islanders-series.
  8. Chow, K. 'Model Minority' Myth Again Used As A Racial Wedge Between Asians And Blacks. April 2017. Retrieved from http://www.npr.org/sections/codeswitch/2017/04/19/524571669/model-minority-myth-again-used-as-a-racial-wedge-between-asians-and-blacks
  9. Who Are Hmong Americans? Center for American Progress. April 2015. Retrieved from https://cdn.americanprogress.org/wp-content/uploads/2015/04/AAPI-Hmong-factsheet.pdf
  10. Fuchs C. California governor signs bill to disaggregate Asian-American health data. NBC News. 2016. http://www.nbcnews.com/news/asian-america/California-governor-signs- bill-disaggregate-asian-american-health-data-n655361.
  11. Underrepresented in medicine definition. Association of American Medical Colleges. 2017. www.aamc.org/initiatives/urm/.
  12. Saha S, Guiton G, Wimmers PF, Wilkerson L. Student body racial and ethnic composition and diversity-related outcomes in US medical schools. JAMA. 2008;300(10):1135-45.

RELEVANT AMA AND AMA-MSS POLICY:

Medical Education for Members in Underserved Minority Populations H-350.969

Our AMA: (1) actively opposes the reduction of resources and opportunities used to increase the number of minority medical and premedical students in training; (2) uses its influence in states and local communities to increase the representation of minority group members in medical education, as long as domestic health care disparities exist between minority populations and the greater population at-large; and (3) supports the need for an increase in the participation of under-represented minorities as investigators, trainees, reviewers, and subjects in peer review biomedical research at all levels. Reaffirmed in lieu of Res. 311, A-15

Underrepresented Student Access to US Medical Schools H-350.960

Our AMA: (1) recommends that medical schools should consider in their planning: elements of diversity including but not limited to gender, racial, cultural and economic, reflective of the diversity of their patient population; and (2) supports the development of new and the enhancement of existing programs that will identify and prepare underrepresented students from the high-school level onward and to enroll, retain and graduate increased numbers of underrepresented students. Reaffirmed in lieu of Res. 311, A-15

Reducing Racial and Ethnic Disparities in Health Care D-350.995

Our AMA's initiative on reducing racial and ethnic disparities in health care will include the following recommendations:

(1) Studying health system opportunities and barriers to eliminating racial and ethnic disparities in health care.

(2) Working with public health and other appropriate agencies to increase medical student, resident physician, and practicing physician awareness of racial and ethnic disparities in health care and the role of professionalism and professional obligations in efforts to reduce health care disparities.

(3) Promoting diversity within the profession by encouraging publication of successful outreach programs that increase minority applicants to medical schools, and take appropriate action to support such programs, for example, by expanding the "Doctors Back to School" program into secondary schools in minority communities. Reaffirmation: A-16

Health Initiatives on Asian-Americans and Pacific Islanders H-350.966

Our AMA urges existing federal agencies, commissions and Asian American and Pacific Islander health organizations to study how to improve the collection, analysis and dissemination of public health data on Asian Americans and Pacific Islanders. Reaffirmed: CSAPH Rep. 1, A-10

Diversity in Medical Education H-350.970

Our AMA will: (1) request that the AMA Foundation seek ways of supporting innovative programs that strengthen pre-medical and pre-college preparation for minority students; (2) support and work in partnership with local state and specialty medical societies and other relevant groups to provide education on and promote programs aimed at increasing the number of minority medical school admissions; applicants who are admitted; and (3) encourage medical schools to consider the likelihood of service to underserved populations as a medical school admissions criterion. Reaffirmed in lieu of Res. 311, A-15

Improving the Health of Black and Minority Populations H-350.972

Our AMA supports:

(1) A greater emphasis on minority access to health care and increased health promotion and disease prevention activities designed to reduce the occurrence of illnesses that are highly prevalent among disadvantaged minorities.

(2) Authorization for the Office of Minority Health to coordinate federal efforts to better understand and reduce the incidence of illness among U.S. minority Americans as recommended in the 1985 Report to the Secretary's Task Force on Black and Minority Health.

(3) Advising our AMA representatives to the LCME to request data collection on medical school curricula concerning the health needs of minorities.

(4) The promotion of health education through schools and community organizations aimed at teaching skills of health care system access, health promotion, disease prevention, and early diagnosis. Modified: CSAPH Rep. 1, A-11

Racial and Ethnic Disparities in Health Care H-350.974

Our AMA recognizes racial and ethnic health disparities as a major public health problem in the United States and as a barrier to effective medical diagnosis and treatment. The AMA maintains a position of zero tolerance toward racially or culturally based disparities in care; encourages individuals to report physicians to local medical societies where racial or ethnic discrimination is suspected; and will continue to support physician cultural awareness initiatives and related consumer education activities. The elimination of racial and ethnic disparities in health care an issue of highest priority for the American Medical Association.

The AMA emphasizes three approaches that it believes should be given high priority:

(1) Greater access - the need for ensuring that black Americans without adequate health care insurance are given the means for access to necessary health care. In particular, it is urgent that Congress address the need for Medicaid reform.

(2) Greater awareness - racial disparities may be occurring despite the lack of any intent or purposeful efforts to treat patients differently on the basis of race. The AMA encourages physicians to examine their own practices to ensure that inappropriate considerations do not affect their clinical judgment. In addition, the profession should help increase the awareness of its members of racial disparities in medical treatment decisions by engaging in open and broad discussions about the issue. Such discussions should take place in medical school curriculum, in medical journals, at professional conferences, and as part of professional peer review activities.

(3) Practice parameters - the racial disparities in access to treatment indicate that inappropriate considerations may enter the decisionmaking process. The efforts of the specialty societies, with the coordination and assistance of our AMA, to develop practice parameters, should include criteria that would preclude or diminish racial disparities

Our AMA encourages the development of evidence-based performance measures that adequately identify socioeconomic and racial/ethnic disparities in quality. Furthermore, our AMA supports the use of evidence-based guidelines to promote the consistency and equity of care for all persons. Reaffirmed: BOT Rep. 4, A-03

Minorities in the Health Professions H-350.978

The policy of our AMA is that (1) Each educational institution should accept responsibility for increasing its enrollment of members of underrepresented groups.

(2) Programs of education for health professions should devise means of improving retention rates for students from underrepresented groups.

(3) Health profession organizations should support the entry of disabled persons to programs of education for the health professions, and programs of health profession education should have established standards concerning the entry of disabled persons.

(4) Financial support and advisory services and other support services should be provided to disabled persons in health profession education programs. Assistance to the disabled during the educational process should be provided through special programs funded from public and private sources.

(5) Programs of health profession education should join in outreach programs directed at providing information to prospective students and enriching educational programs in secondary and undergraduate schools.

(6) Health profession organizations, especially the organizations of professional schools, should establish regular communication with counselors at both the high school and college level as a means of providing accurate and timely information to students about health profession education.

(7) The AMA reaffirms its support of: (a) efforts to increase the number of black Americans and other minority Americans entering and graduating from U.S. medical schools; and (b) increased financial aid from public and private sources for students from low income, minority and socioeconomically disadvantaged backgrounds.

(8) The AMA supports counseling and intervention designed to increase enrollment, retention, and graduation of minority medical students, and supports legislation for increased funding for the HHS Health Careers Opportunities Program. Reaffirmed: CLRPD Rep. 1, A-08

Guiding Principles for Eliminating Racial and Ethnic Health Care Disparities D-350.991

Our AMA: (1) in collaboration with the National Medical Association and the National Hispanic Medical Association, will distribute the Guiding Principles document of the Commission to End Health Care Disparities to all members of the federation and encourage them to adopt and use these principles when addressing policies focused on racial and ethnic health care disparities; (2) shall work with the Commission to End Health Care Disparities to develop a national repository of state and specialty society policies, programs and other actions focused on studying, reducing and eliminating racial and ethnic health care disparities; 3) urges medical societies that are not yet members of the Commission to End Health Care Disparities to join the Commission, and 4) strongly encourages all medical societies to form a Standing Committee to Eliminate Health Care Disparities. Appended: Res. 416, A-11

Addressing Immigrant Health Disparities H-350.957

1. Our American Medical Association recognizes the unique health needs of refugees, and encourages the exploration of issues related to refugee health and support legislation and policies that address the unique health needs of refugees.

2. Our AMA: (A) urges federal and state government agencies to ensure standard public health screening and indicated prevention and treatment for immigrant children, regardless of legal status, based on medical evidence and disease epidemiology; (B) advocates for and publicizes medically accurate information to reduce anxiety, fear, and marginalization of specific populations; and (C) advocates for policies to make available and effectively deploy resources needed to eliminate health disparities affecting immigrants, refugees or asylees. Appended: Res. 409, A-15

Improving the Health of Minority Populations H-350.961

Our AMA urges Congress to re-evaluate and expand the federal race and ethnicity categories to include additional ethnic subgroups in order to analyze and uncover racial and ethnic health and healthcare disparities. Res. 906, I-08

Cancer and Health Care Disparities Among Minority Women D-55.997

Our AMA: (1) encourages research and funding directed at addressing racial and ethnic disparities in minority women pertaining to cancer screening, diagnosis, and treatment; and (2) will work with the National Cancer Institute's Center to Reduce Cancer Health Disparities, the American Cancer Society, and other organizations to promote the use among minority women of educational materials that are culturally sensitive and at the appropriate literacy level.​ Res. 509, A-08

Strategies for Eliminating Minority Health Care Disparities D-350.996

Our American Medical Association will continue to identify and incorporate strategies specific to the elimination of minority health care disparities in its ongoing advocacy and public health efforts, as appropriate. Modified: CCB/CLRPD Rep. 4, A-12​