Understanding and Advocating in the Laboratory

Hannah Wang, MD, is a pathology resident at Stanford University and the ASCP Resident Council Chair Elect. Here, she shares her thoughts on race in health care, and how the laboratory can be a leader in meeting the healthcare needs of diverse communities.

How does race affect health care?
As we’ve seen from the way COVID-19 has disproportionately affected Black and Latinx communities, racial inequities and racism translate directly into health inequities. In fact, White life expectancy during COVID is still higher than Black life expectancy has ever been in this country. It is past time that we start treating racism and the downstream inequities it causes as the epidemic that it is.  
 
Much of this is due to institutional racism outside of the healthcare system, like housing segregation, racial violence, police violence, generational wealth gap, etc. But much of it also comes from inside the healthcare system, particularly from the deeply ingrained misconception that patients of different races are biologically/genetically different from or inferior to one another, as well as from the exclusion of racial minorities from positions of power and leadership within health care.
 
What are some of the stereotypes or prejudices that Asian Americans and/or Pacific Islanders encounter from healthcare providers?
For Asian Americans, one obvious one is the “model minority” stereotype that we are high achieving, wealthy, and compliant, which can lead to a “positive health bias.” This likely contributes, at least partially, to Asian Americans having lower cervical/breast/colorectal cancer screening rates compared to other races. Asian Americans also have lower rates of HIV diagnosis, and are less likely to receive HIV care, compared to their White counterparts, despite similar risk levels. Lastly, there is the decreased perceived need for and access to mental health care, which may be particularly relevant given the recent uptick in racial violence against Asian Americans.
 
A second prejudice is a perceived “otherness,” which affects Asian Americans more than any racial group in the U.S. As a result, Asian American patients may be less likely to be asked social/behavioral/lifestyle questions, or invited to partake in shared medical decision-making secondary to provider discomfort or unfamiliarity.

Lastly, I want to take a moment to acknowledge that these thoughts stem from my personal experience as a Chinese American. Other Asian Americans, in addition to Pacific Islanders, may face different stereotypes, prejudices, or struggles. I look forward to learning about and centering their voices this month.

How can healthcare providers in the U.S. get a better understanding of cultural needs or differences for Asian Americans/Pacific Islanders in order to better provide earlier screening and prevention, and better healthcare overall? How can the laboratory play a role in this?
Healthcare providers in the US need to understand that Asian Americans and Pacific Islanders are not a monolithic entity, but rather an incredibly diverse group of individuals culturally, linguistically, educationally, and socioeconomically. There are many things laboratories can do to advance the healthcare of both Asian Americans and Pacific Islanders:
 
1. Ensure that our reference ranges accurately reflect the local population(s) we serve.
2. Create and distribute literature regarding laboratory testing in languages spoken by local Asian American and Pacific Islander communities.
3. Partner with community leaders to assess health needs and provide appropriate cancer and infectious disease screening where gaps are identified.
4. Collect data on laboratory test utilization by race, breaking down “Asian American” and “Native Hawaiian or Other Pacific Islander” into more informative groups when possible, and engage with hospital leadership to implement solutions when disparities are identified.
5. Promote qualified Asian American and Pacific Islander staff to leadership roles.
6. Normalize and encourage utilization of mental healthcare resources by laboratory staff, especially when there are acts of racial violence/trauma.
7. Advocate for racial equity and social justice for Black, Latinx, and Indigenous communities as well, both inside and outside the traditional walls of the healthcare system. If COVID-19 has taught us anything, it’s that our lives and our health are in each others’ hands. We must work, STRONGERTOGETHER, to fight for a brighter, healthier, and more equitable tomorrow.