These days, it’s no secret that there are health disparities based on race. However, most studies focus on Black versus White health disparities. When Asian populations are included in research, they tend to be generalized into the Asian American/Pacific Islander category, overshadowing the diversity within this group. As it turns out, South Asians specifically (defined as Indian, Pakistani, Bangladeshi, Nepali, and Sri Lankan people) have abnormally high rates of heart disease and stroke that are not explained by typical risk factors like high blood pressure, diabetes, or smoking [1].

The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study was formed to help researchers understand why these rates are so high. It is one of very few long term studies, and stands out even more by looking at a range of potential risk factors from behavioral, social, and cultural to clinical [1]. 

One of the study’s most recently released articles takes a look at the associations between discrimination and measures of mental and physical health in South Asians. Racial discrimination includes negative beliefs, attitudes, actions, or behaviors against a person because of their actual or perceived race or ethnicity, and it is associated with poor mental and physical health [2]. 

Asians are often regarded as a “model minority” based on assumptions that they have high income and educational attainment, despite data proving this is just a stereotype. Though it may seem positive, it still causes discrimination and stigma by making Asians seem better than other minorities but still unequal to the White majority and undermining the struggles they experience [3]. This kind of stigma leads to negative associations with a group, in this case South Asians, which leads to discrimination against them. Typically, we think about how discrimination affects the opportunities available to people and their mental health, but now scientists are looking towards how its effects might manifest physically. 

Researchers who investigate health concerns among Asian-American populations argue: “discrimination is linked with poor health behaviors, including tobacco use and alcohol consumption, as well as health outcomes such as depression, anxiety, poor nutrition, higher body mass index (BMI), hypertension, and higher cholesterol” [2].

This study asked 1,164 participants from research sites in Chicago and the San Francisco Bay area about their everyday experiences of mistreatment. Participants were to rate how often they experienced nine specific metrics including whether they were viewed as dishonest or experienced threats or harassment. Then, the researchers measured correlations between experiences of discrimination with the health outcome variables (dependent variables) shown in Figure 3. They also tracked some mediating variables, which are factors that explain how discrimination indirectly translates to health outcomes [4]. In other words, discrimination directly affects some mediating variables that then directly affect health, like a chain of events. 

The researchers found that the more discriminatory incidents someone experienced, the more signs they showed of depression, anxiety, and anger. Then, these psychological factors had an impact on alcohol and tobacco use. They also found that discrimination directly impacted cholesterol levels. One unexpected finding was that when anxiety acted as a mediator, discrimination actually led to less alcohol and tobacco consumption [2]. The authors hypothesize that this may be due to culturally significant coping strategies for dealing with illness, like religion and instrumental or practical support [5].

Though discrimination is not directly impacting health, it is affecting it by mediation, urging clinicians to start asking about experiences of discrimination. The authors suggest moving towards integrating mental and physical health services. For example, clinicians might practice making referrals to other professionals to address risks specific to South Asians, like a nutritionist or substance abuse specialist to prevent alcohol and tobacco consumption [2].

The main takeaway is that we should care about inclusivity in healthcare because it leads to better individual and public health. Medical competency in racial health disparities leads to a foundation of trust between doctors and patients, providing a safe and comfortable environment to address health issues even though it may make patients feel vulnerable. Thanks to studies like this one, clinicians are encouraged to educate themselves about the populations they serve and adjust their actions accordingly. 

In the meantime, The MASALA Study and other dedicated researchers will continue working on increasing the knowledge base on health disparities South Asians face and how we can address them.

References:

[1] The MASALA Study. The masala study [Internet]. The MASALA Study. [cited 2023Mar28]. Available from: https://www.masalastudy.org/ 

[2] Ahmed N, De Silva D, Kanaya AM, Kandula NR. Psychological Symptoms as Mediators in the Association between Discrimination and Health among South Asian Americans. Journal of Asian health. 2022 May 18;9(e202209). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9605410/. https://creativecommons.org/licenses/by/4.0/legalcode

[3] Choi K. Not your model minority [Internet]. Kelly Choi: Not Your Model Minority | TED Talk. TEDx; [cited 2023Apr13]. Available from: https://www.ted.com/talks/kelly_choi_not_your_model_minority?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare 

[4] Hefner V. The sage encyclopedia of communication research methods [Internet]. Sage Research Methods. SAGE Publications, Inc; 2018 [cited 2023Mar28]. Available from: https://methods.sagepub.com/reference/the-sage-encyclopedia-of-communication-research-methods/i15449.xml 

[5] Tuncay T, Musabak I, Gok DE, Kutlu M. The relationship between anxiety, coping strategies and characteristics of patients with diabetes. Health and quality of life outcomes. 2008 Dec;6(1):1-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572593/