- [Female 1] In June of 1991, I found a lump in the upper quadrant of my right breast and I decided that I ought to get this thing checked out - [Iyanrick] One story that we often recount at the Asian & Pacific Islander American Health Forum is the story of Susan Shinagawa, who is the founder of the Asian & Pacific Islander National Cancer Survivors Network.

It took her repeated doctor's visits before she ultimately was told that she had breast cancer.

And the reason for that is one of her doctor's original responses was that, you know Asian women don't get breast cancer and that was kind of based on this understanding that Asians as a whole are healthier than other communities.

- [Female 2] When people talk about minorities, they frequently mean Black, Latino, Latin X, Native American and then they don't really include Asian Americans into that.

We have internalized this idea that Asian Americans are sort of the model minority and therefore don't suffer from racism, don't suffer from systemic injustice and therefore are no longer counted as a minority in some ways.

And I can tell you from personal experience we certainly do face racism, we certainly do face many of those barriers.

(soft music) - [Narrator] Asian Americans are now the fastest growing demographic in the United States, growing 72% from 2000 to 2015 mostly due to immigration.

Despite this.

- [Iyanrick] A recent review for example, showed that clinical research by the NIH- - [Narrator] That's the National Institute of Health.

- [Iyanrick] Focused on Asian-American and Native Hawaiian Pacific Islander participants accounted for just 0.17% of the NIH budget over the past 25 years.

And so there has not been a prioritization of research dollars focused specifically on the Asian American community.

- [Narrator] So why is research so lacking?

You might've heard the term model minority.

There's a common perception that Asian Americans are doing well compared to other ethnic groups.

- So the model minority myth in the context of healthcare is this idea that when we look at Asians as a whole, they're doing well in the context of overall health.

They're not necessarily impacted by diseases the way that other racial and ethnic communities are.

- [Narrator] To debunk this myth, we need to take a step back and ask what do we mean when we say Asian?

One of the issues with the racial and ethnic categories we use is that they combine very different cultures under one name.

- [Female 2] The Asian-American is actually probably the largest diaspora of people that exist.

If you can imagine Asia is actually the largest continent in the world and it has the most people in the world.

And so it's a bit arbitrary really when you sort of decide like, okay, so this whole continent there's gonna be one group of people.

We don't ever look at health statics and say, "How are North Americans in general doing?"

And in fact, most of us don't identify us North American, many of us identify us American or Mexican or Canadian.

The desegregation of Asian American data is probably one of the most important issues for Asian American health that exists in this country.

- [Iyanrick] This aggregation is basically breaking down a large group into smaller sub groups.

So for example, within the Asian American community, there's Koreans, Japanese, Indians, Pakistanis, and each of them have different social and demographic characteristics that all impact their health status.

- [Female 2] Particularly in this country, Asian Americans have a significant what we call a bi-modal distribution in the sense that we have a lot of folks who are sort of disadvantaged for lower educational status, low health literacy but we also have a high number of Asians who have socioeconomic privilege, educational attainment.

- [Narrator] Historically US immigration policy has created two tracks of immigration, one for the laboring class, which is allowed to enter during times of crisis or when cheap labor is needed, and refugees, many fleeing conflict in Southeast Asian countries like Vietnam, Laos and Cambodia and one for wealthy educated workers for industries that demand highly skilled labor.

- [Female 2] When we look at Seattle, I see the same pattern playing out in two distinctive areas.

Colloquially one could consider sort of the UDaB Asian: these are the graduate students, these are their undergraduate students, both foreign and domestic younger and more affluent Taiwanese/Chinese folks who are going to school and have that trajectory and path.

And then we kind of have our Seattle Asians who are living in Southcenter, Beacon Hill, Renton, things like that, that tend to be older Asian Americans.

There's the older Chinese immigrants who didn't come from necessarily that sort of educational immigration, but through sort of the working class laboring class.

- [Narrator] Because of their backgrounds these groups have very different health outcomes.

- [Iyanrick] As an example, when we look at stomach cancer for Asian-American, the incidents is 14.5 for a hundred thousand compared to white men, which is 8.5.

But when we look at some subgroups, for example Korean men, it's around 38.5.

When we look at liver cancer, Laotian men their incidence is 66.1, more than three times greater than the incidents for Asian overall.

There's actually subgroups that are worse off in their health outcomes than other minority communities, but that data is masked because we're looking at Asians as a whole.

- [Narrator] Averaged out, the have created the perception that Asian Americans are healthy overall, and that we don't need to research health interventions for them.

- [Female 2] So by creating such a large group of diverse people and creating an average and just looking at one number for them it really misleads us in terms of what is actually happening between those individual communities.

- [Narrator] Advocates say that lumping people under Asian American doesn't cut it anymore, at least not when it comes to healthcare and research.

- [Iyanrick] The fact is that it's a large that's a growing population, there's so much diversity in the population that rapid growth is really impacting how our communities are receiving healthcare and how the healthcare system needs to adapt.

- [Announcer] This series is made possible in part by the generous support of Premera Blue Cross.