Genomics and Health Equity: Reaching Asian American, Native Hawaiian, and Pacific Islander CommunitiesPosted on by
On April 29, 2022, President Biden proclaimed May as Asian American, Native Hawaiian, and Pacific Islander Heritage month to “recognize the innumerable contributions, vibrant cultures, and rich heritage” of Asian Americans, Native Hawaiians, and Pacific Islanders (AA and NHPIs). In addition, the proclamation highlights the Administration’s work reducing poverty among AA and NHPI families and addressing anti-Asian bias, xenophobia, and harassment.
While Asian American, Native Hawaiian, and Pacific Islander Heritage Month has ended, we continue to examine the health disparities AA and NHPI communities may experience. Today, we reflect on the disparities in the implementation of genomics and precision medicine. For example, a recent systematic review by Young and colleagues found that Asian American women were less likely to be referred for genetic services than White Non-Hispanic women but were more likely to undergo genetic counseling and genetic testing (GC/GT) for any genetic condition despite the access challenges. The review also revealed that Asian Americans’ family members were less likely to be informed of the results from GT and risk information than other racial groups, although they had been involved in testing decisions.
AA and NHPI people face several barriers to accessing GC/GT:
- Limited English proficiency can present significant barriers for AA and NHPI patients for whom English is a second language. The language differences can make it difficult to communicate with health care providers and understand and interpret the results of GC/GT.
- Cultural factors are important in accessing and using GC/GT services. Offering genetic counseling in a culturally sensitive and appropriate manner is critical. For example, Asian Americans expressed a wide range of concerns about genetic testing. Wang and Marsh found that Asian Americans may be reluctant to challenge physician authorities and ask questions during counseling sessions and may be uncomfortable with the “nondirective” nature of the counseling process. Furthermore, healthcare providers may have a limited understanding of AA and NHPI cultures, a gap that needs to be addressed.
- Lack of familiarity with the US healthcare system can be an issue for AA and NHPI people who are foreign-born. They can have problems identifying resources and navigating the complex system of providers and payers. A recent study using All of Us data found that Asian Americans had the lowest proportion of knowing a lot about their family health history; possible contributors could include immigration or forced relocation that disrupted the access to such information.
- Biases and stereotypes might contribute to the challenges AA and NHPI experience. Studies have shown that providers are less likely to follow evidence-based guidelines and implement standards of care in preventing or managing conditions when treating AA and NHPI patients compared with patients of other racial/ethnic groups. The “model minority” stereotype, a concept that emerged in the 1960s, posits Asian Americans as educated, law-abiding, hardworking, with high incomes, low crime rates, and close family ties. Although a seemingly positive stereotype, the “model minority” stereotype has deprived members of the AA and NHPI communities who are experiencing poverty access to resources they deserve. The stereotype that all AA and NHPI people are of the same group masks the vast heterogeneities within the AA and NHPI community, which can lead to ineffective policy interventions. An example is that while AA communities had one of the lowest prevalence of current smoking, the rate for Korean Americans more than doubled that among Whites in New York City.
A research agenda and public health action are needed to improve health equity in the implementation of genomics and precision medicine, including community engagement with AA and NHPI communities. Specifically, increasing awareness of GC/GT services among AA and NHPI communities, reducing language barriers, and increasing diversity of the genomics workforce would have an immediate impact and could lead to improved health among AA and NHPI populations. Human genomics research needs to include more people from the AA and NHPI communities. Inaction and complacency with the status quo will lead to persisting health inequities for AA and NHPI communities.
We are interested in hearing from our readers about efforts that could improve AA and NHPI health and health equity through the implementation of genomics and precision medicine.
Please submit your comments below.