Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, United States.
Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States.
Front Public Health. 2021 Aug 16;9:690014. doi: 10.3389/fpubh.2021.690014. eCollection 2021.
Structural racism manifests as an historical and continued invisibility of Asian Americans, whose experiences of disparities and diverse needs are omitted in research, data, and policy. During the pandemic, this invisibility intersects with rising anti-Asian violence and other persistent structural inequities that contribute to higher COVID-19 mortality in older Asian Americans compared to non-Hispanic whites. This perspective describes how structural inequities in social determinants of health-namely immigration, language and telehealth access, and economic conditions-lead to increased COVID-19 mortality and barriers to care among older Asian Americans. Specifically, we discuss how the historically racialized immigration system has patterned older Asian immigrant subpopulations into working in frontline essential occupations with high COVID-19 exposure. The threat of "public charge" rule has also prevented Asian immigrants from receiving eligible public assistance including COVID-19 testing and vaccination programs. We highlight the language diversity among older Asian Americans and how language access remains unaddressed in clinical and non-clinical services and creates barriers to routine and COVID-19 related care, particularly in geographic regions with small Asian American populations. We discuss the economic insecurity of older Asian immigrants and how co-residence in multigenerational homes has exposed them to greater risk of coronavirus transmission. Using an intersectionality-informed approach to address structural inequities, we recommend the disaggregation of racial/ethnic data, meaningful inclusion of older Asian Americans in research and policy, and equitable investment in community and multi-sectoral partnerships to improve health and wellbeing of older Asian Americans.
结构性种族主义表现为亚裔美国人长期以来被忽视，他们的经历和多样化的需求在研究、数据和政策中被忽略。在疫情期间，这种被忽视的情况与反亚裔暴力的上升和其他持续存在的结构性不平等现象相交织，导致与非西班牙裔白人相比，老年亚裔美国人的 COVID-19 死亡率更高。本文从社会决定因素的结构性不平等角度描述了这一现象，即移民、语言和远程医疗的可及性以及经济状况等方面导致老年亚裔美国人的 COVID-19 死亡率更高，并面临更多的医疗保健障碍。具体来说，我们讨论了历史上种族主义的移民体系如何将老年亚裔移民群体定型为从事高 COVID-19 暴露风险的一线必要职业。“公共负担”规则的威胁也阻止了亚洲移民获得包括 COVID-19 检测和疫苗接种计划在内的合格公共援助。我们强调了老年亚裔美国人的语言多样性，以及语言可及性在临床和非临床服务中仍然没有得到解决，从而给常规和 COVID-19 相关护理带来障碍，特别是在亚洲裔人口较少的地区。我们讨论了老年亚洲移民的经济不安全感，以及他们与多代同堂家庭居住的情况如何使他们面临更大的冠状病毒传播风险。我们建议采用交叉性视角来解决结构性不平等问题，包括对种族/族裔数据进行细分、让老年亚裔美国人有意义地参与研究和政策制定，以及在社区和多部门伙伴关系方面进行公平投资，以改善老年亚裔美国人的健康和福祉。
