Health Determinants

Asian Americans are substantially diverse in terms of socioeconomic status, English proficiency, health needs, and cultural identity. These characteristics, in combination with a variety of other factors—such as knowledge and beliefs regarding causes of disease, modes of treatment, and value of prevention—often delay Asian Americans from seeking out or obtaining quality health care.

Consequently, research indicates considerable barriers to quality health care among Asian Americans. A recent study of the Kaiser Commission on Medicaid and the Uninsured found that Asian Americans are less likely than non-Hispanic whites to receive health insurance from their employers, and of those who do not receive employer-sponsored coverage, only 9% purchase insurance independently.

Compounding the problem, Asian Americans are often burdened by limited-English proficiency and a poor understanding of the intricate American health care system. Members of the community may not know the right questions to ask—or even whom to ask—and may lack a clear understanding of how to assess their problems in their new cultural context.

Social Determinants

The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” As health inequities arise as a result of inequalities within and between societies, social and economic conditions play a critical role in determining a person’s risk of illness and ability to seek out treatment when infirmity occurs. 

In the past several years, the field of public health has moved away from a disparity-specific model to assess “root causes” of disproportionate burdens of illness. Public health experts now embrace a more comprehensive approach that takes into account not only individual factors, but contextual factors as well, including socioeconomic status, home and work environment, access to transportation, and educational attainment.

In response, government agencies and health professionals emphasize addressing the social determinants of health and improving social and physical conditions, such as the “built environment,” to enable healthy minds and healthy bodies.

Income:

  • People in the highest income group can expect to live, on average, at least six and a half years longer than those in the lowest.
  • One-in-ten Asian Americans lives in poverty.

Education:

  • College graduates can expect to live at least five years longer than those who have not finished high school and almost two years longer than those who didn’t finish college.
  • 14.6% of Asian Americans do not have a high school diploma; this number rises substantially when disaggregated by ethnic group, including 27% of Vietnamese and 38% of Cambodians.

Access to Health Care:

  • Nearly one-in-five Asian Americans between the ages of 18-64 reports having no health insurance or being uninsured.
  • There is substantial variation in health coverage among Asian American subgroups. Employer-sponsored coverage ranges from as low as 49% among Koreans to 77% among Asian Indians.

Linguistic and Cultural Determinants

Asian Americans face cultural and linguistic barriers that often discourage or prevent them from accessing available health care services. In most cases, Asian Americans with limited-English proficiency have difficulty understanding the U.S. health care system or communicating with health care providers. 

  • Asian-speaking households in Montgomery County have the highest percentage of linguistic isolation compared to other ethnic minority groups.
  • 36% of Asian Americans report speaking English “less than very well.”
  • Three-quarters of the Asian American population speak a language other than English at home.
  • Asian Americans, along with Hispanics, are less likely than other ethnic groups to report always getting medical care when needed.

A significant problem is that many Asian Americans believe their doctors do not understand their culture or their values. They are less likely to rate their care highly and have confidence in the care provided, when compared to the overall population, while different cultural values and traditional beliefs about disease and treatment prevent individuals from seeking care. Because of these traditional approaches to health care, Asian Americans may not perceive the value or identify the purpose or necessity in obtaining care. This behavior often contributes to the diagnosis of disease in the later stages of development.