Celebrating Asian/Pacific American Heritage Month: Why Diversity Matters in Health Care
Alex Ky-Miyasaka, MD, Professor of Surgery at The Mount Sinai Hospital, seeing patients at the Chinatown clinic in Manhattan.
Asian American, Native Hawaiian, and Pacific Islander Heritage Month, also known as Asian/Pacific American Heritage Month, is observed in May in the United States. It celebrates the culture and historical contributions of Asian Americans and Pacific Islanders (AAPI) to the country, as the month marks the arrival of the first Japanese immigrants in 1843 and commemorates the completion of the transcontinental railroad in 1869, whose tracks were largely laid by Chinese immigrants.
AAPI people in this country are extremely diverse and represent a wide range of races and ethnicities, socioeconomic and educational backgrounds, and ability to access health care. In New York City, this group encompasses more than 1 million people from more than 30 different ethnicities, speaking more than 50 different languages. Providing effective health care to such a varied group can be challenging, but it is important for health care institutions and providers to keep diversity at top of mind as they connect with patients.
“It is our responsibility to ensure we’re evaluating how we can best provide care to all of our patients,” says Amanda Rhee, MD, Professor of Anesthesiology, Perioperative and Pain Medicine, and Inaugural Director of the Center for Asian Equity and Professional Development at Mount Sinai. “There’s a growing body of evidence that people receive different care based on gender, disability, and language spoken.” When it comes to conversations about the differences in care that patients receive, AAPI communities are often left out—for example, some may not know that 24 percent of AAPI individuals in New York City live in poverty, and as a result might be unable to access appropriate care, says Dr. Rhee, citing a report on poverty in New York City.
“Specifically for Asian Americans and Pacific Islanders, from our patient satisfaction surveys, we know that our patients are telling us that we have room to improve, and how we can deliver care for them better,” says Dr. Rhee. “I say this in the overarching context of approaching all our patients with an open mind, so that we can understand anyone’s background better, and do our best to meet people where they are.”
In this Q&A, Dr. Rhee explains the importance of culturally sensitive and compassionate care, and how Mount Sinai is working to improve that competence.
Why is it important to consider cultural needs of a patient when providing care? Might there be consequences for failing to do so?
Communication between our clinical teams and patients is so critical, not only for the medical side of the care, but also compassion and empathy. Cultural and language barriers could present a challenge for some of our AAPI patients. There could be certain sorts of traditions that may seem different to our clinical providers or teams, which could appear obstructive.
For example, in some Asian cultures, there’s a belief that drinking warm fluids can help people who are feeling ill, and they or their family members might want to bring in warm soups and drinks for the patient. But if the patient is in a situation where they should not eat or drink anything, such as before a procedure, these well-intentioned family members may not understand that, and conflicts and challenges in communication can lead to confusion and dissatisfaction. It would be better if our clinical teams, patients, and family members could better align expectations and help understand each other better.
What does it take for a health system or organization to provide culturally sensitive and inclusive care?
Normalizing things or traditions that seem different, and highlighting the diversity of the people whom we take care of, is an important way to do that. Having really engaging educational sessions or tabling events at an institution are effective ways to help providers understand how these different traditions are meaningful in these different cultures—and understanding these differences can have an impact on whether a patient gets better or not. And I think that better understanding also leads to more empathy and improved connections between provider and patient.
What work might be needed to improve AAPI communities’ care experience?
An important piece boils down to building trust. Patients and their families want to know they are being listened to. Our clinical teams have to be open-minded to cultural differences and communicate to patients and their families that they’re there to help and receive feedback. Once that trust is established, when we need to explain how certain rituals or traditions might run counter to care, that advice might be better received by the patients and family members.
What has Mount Sinai been doing toward providing culturally sensitive care for AAPI communities?
In recent months and years, Mount Sinai Health System has dedicated resources and launched initiatives toward improving competence and cultural sensitivity for its AAPI patients. Here’s a snapshot of what we have done:
- Asian Health Services
Initially launched at Mount Sinai Beth Israel to serve the population in Chinatown and lower Manhattan, the team providing personalized care for AAPI communities has been expanded systemwide, across all eight hospitals. Asian Health Services includes multilingual Asian providers in different medical specialties, medical interpreters, and culturally competent staff to help patients navigate health care. The website has been updated to include information about specialists, their locations, and languages spoken.
- Guidance on translation services
Mount Sinai has been working with its Language and Communication Access Services to provide more culturally competent translation and interpretation services for AAPI patients, including guidance on cultural differences and cues. The service is provided free of charge and can be arranged through clinical teams to be made available during care. - Cultural cue handouts for providers
Cultural cue handouts that were originally available for providers under Asian Health Services are in the process of being rolled out systemwide. These resources include information about differences between traditional remedies and Western health care and various cultural norms that might affect decision-making. - Educational events
For Asian/Pacific American Heritage Month, there is a series of events to celebrate and raise awareness of AAPI culture, held across all eight hospital campuses. These seek to deploy education in a meaningful way, by highlighting similarities and differences across cultures. The Center for Asian Equity and Professional Development also hosts webinars and events throughout the year. - Curriculum for cultural sensitivity training
In its early stages, the Center for Asian Equity and Professional Development is developing a program to train providers who wish to be more informed about caring for AAPI patients. The goal is to eventually improve health equity among AAPI communities. - Partnerships with community organizations
Mount Sinai is working with community partners, such as the Chinatown YMCA, to provide health information and education. These include preventive care, tips on healthy living, and resources to access care at Mount Sinai.
“I hope that what we can build is heightened awareness about the specific needs of our AAPI patients,” says Dr. Rhee. “I would hope these efforts will create a way of thinking for all of our care providers to identify any kind of disparity that a patient may be experiencing, so that we can address challenges in this space for all of our patients.”
Amanda Rhee, MD, Professor of Anesthesiology, Perioperative and Pain Medicine, and Inaugural Director of the Dean’s Center for Asian Equity and Professional Development at Mount Sinai
Who are the Asian Americans/Pacific Islanders in New York City?
Asian American/Pacific Islander (AAPI) is a broad term, but it is not a monolithic description of their experiences and situations. In New York City, the largest and one of the most diverse cities in the country, understanding the diverse socioeconomic and health access conditions of AAPI people is crucial to population health. Pulling from two city agency reports, here’s a snapshot of Americans and immigrants of Asian and Pacific Islander descent in New York City.
>1 million
AAPI people in NYC; 14 percent of the city’s 8.5 million population.
>30 different ethnicities
A group speaking more than 50 different languages.
13 percent
of immigrants of Asian/Pacific Islander descent are undocumented, compared to 16 percent of NYC immigrants overall.
46 percent
of AAPI households report having limited English proficiency, compared to NYC’s overall average of 23 percent. For Asian/Pacific Islander immigrants specifically, that number is 59 percent.
40 percent
of AAPI individuals in NYC on average have income below 200 percent of the federal poverty level, compared to the city’s average of 39 percent. However, subgroup variances are large, with lows including Filipino (20 percent) and Japanese (23 percent) individuals, and highs including Bangladeshi (58 percent) and Pakistani (53 percent) individuals.
AAPI people in NYC by the numbers
You may have seen recent news reports about the bird flu virus and the possibility that this virus could affect humans and our food supply, notably with milk from cows. Government health officials say there is no reason for concern, and experts at Mount Sinai agree.
