Hear me out: I don't think we should be presenting and stratifying healthcare outcomes and disparities solely by race. Let's be clear, I don't think that race should be nixed as a variable within health. However, race is not a correlate to behavior and by only stratifying healthcare outcomes by race we perpetuate stereotypes and possibly prejudice. Race does not guide behaviors that result in healthcare outcomes; but rather culture, individual and group experiences guide behavior.Grouping outcomes by race does not necessarily allow for assessment of outcomes based on intersectionality or a true understanding of how culture impacts health care decisions within the race. This then can be just as harmful as racism, because there are behavioral assumptions being made about an entire race based on health outcomes without necessarily understanding the culture which establishes those behaviors.
Race does not guide behaviors that result in healthcare outcomes; but rather culture, individual and group experiences guide behavior.
Additionally I myself as an Indian American woman, find that I only need to identify myself to make others comfortable. Many people think I'm Latina, and approach me as such. Instead of having to identify myself I just answer kindly in Spanish and move on with my life, and I even try my best to move on when people have approached me with vile comments against Latinos. In the best of cases when I am approached as a Latina, whether that be in Texas, NYC, Mexico , Central America or Brazil, there is an assumption of my ability (a behavior) usually by a Latino person to navigate a culture or a language based on my skin tone. My skin tone is used as an assumption of behavior, thankfully in most cases of being mistaken as a Latina, it is harmless and I can be helpful. Knowing Spanish and Portuguese and being able to navigate a variety of cultures as others presume I'm Latina, is an assumed behavior that is presumed by my skin tone.
I do not define myself as Asian American Pacific Islander, which was the only option to select within my public school standardized tests for a majority of my schooling. I remember in the 3rd grade I was quite confused taking my first standardized test - which "race" box do I color in with this freshly sharpened #2 pencil? Asian American Pacific Islander.... the Pacific Islands are very far away from India, I'd thought to myself. Why would I be grouped with people who grew up going in a beach on totally different ocean than Indians?? I am a beach lover, even then. I recall various moments in time coming home to my mom and asking, am I this, or this or this? My childhood confusion is a function of the options provided and structured within categories in order for educational/academic systems to understand my academic capabilities. Again, these racial structures were of no benefit to me in the 1990s and early 2000s, it was for the status quo culture (white-American culture) to categorize me within their standards of public school standardized testing results.
I did not know I was brown until someone pointed it out. I did not know I was part of a diaspora until the Asian diasporas were given 'rights' to use the word in an American context. I never had the words to explain model minority experiences until the term model minority myth was coined in 2020. I never thought in a million years as an adult I'd be on the receiving end of racist comments as a Latina, a heritage I have no blood ties with. Yet these personal experiences are purely based on an "understanding" of my skin tone, not of culture, historical migratory experiences, or heritage.
I did know that by going to mandir (Hindu temple and culture school) what my parents were doing was guiding the education of my heritage, but I didn't know that it was sacred. Why would global history be sacred? I didn't know that I'd need to be able to use that education of India's histories in order to express myself for others to be able to "get it" about me. I didn't know until I was an adult that many Americans weren't aware of the partition of India as a result of British politics, leading to one of the largest mass migrations in modern history. I did not know until I was an adult that many Americans didn't know that most of the world was still colonized in the 20th century. Why aren't others aware of the global events that have likely shaped my culture, my experiences and resulting behaviors? The behavior of having to constantly find the words to describe my identity and relationship to it is exhausting. Am I doing it for myself or for others? Having to constantly figure out my "Asian American" identity for the masses to "get it" is exhausting especially when American exceptionalism disregards the impacts of global history among our own citizens.
I didn't know until I was an adult that many Americans weren't aware of the partition of India as a result of British politics, leading to one of the largest mass migrations in modern history.
Back to only categorizing people by race. Race does not correlate to behavior, race can and has been imposed by larger systems and status quo cultures (often colonizer cultures) at no benefit to those who must identify with said race. But experience and culture correlate to behavior, and I identify with a culture, the Indian American diaspora culture. I also identify with a migratory experience, seeing my parents, grandparents, aunts, uncles and cousins navigate a new culture, navigate their children through a new society, assimilate to new societies in different eras or ages (one of my parents arrived in 1964 and the other in 1983). How does being part of the Indian American diaspora culture impact my health outcomes? How does my grandparents' and parents' migratory experiences and my American generational status relate to my health outcomes? Surely this is more important to understand than my skin is brown and that I fit within the Asian American Pacific Islander "box".
Perhaps rather than race based health outcomes we need to create far more intersectional and intergenerational categories like historically colonized, historically suppressed, recent immigrant, recently legalized migrants (ie - Asian Americans). Generational categories by race may lead to much more nuanced understanding of acculturation, assimilation and hence behaviors within cultural categories among people who may or may not have a similar skin tone.
During my masters of public health program, I was witness to punitive suggestions for global health solutions solely based on race and with little to no consideration of the global culture within that race and gender. And honestly, it was terrifying to be part of these conversations (at an Ivy League), especially when I was the only WOC in the room representative of a heritage that was being discussed and where my suggestions were easily dismissed because they wouldn't work for the "multinational organizations". Are there no people of color who represent that heritage and gender within the multinational organizations? It's hard to know because their voices are likely muted in the name of imperialism and colonialism that is masked as health care and humanitarian aid. Did these professors have no interaction with the culture and heritage on the ground in their global travels, was it simply cast as "other"? What are they doing with all this grant money? I digress.
Unfortunately even in the most liberal of schools of thought there are still undertones of imperialism and colonialism as to how healthcare systems and providers should approach POC health issues domestically and abroad. I truly believe these schools of thought are perpetuated because health outcomes are often only stratified by race rather than historically accurate indicators of migration and suppression.
I disagree that we should be stratifying health outcomes purely by race, and disagree that creating solutions based solely on that variable to address health disparities is sound science, especially considering that many multi-racial or multi-ethnic categories are dismissed as “other”; resulting in the surveys themselves perpetuating racism by determining those with a single race or majority-minority race are those whose health care is valuable enough to be evaluated.
In this country of immigrants, the internet is actually allowing Americans of color to relate to their “heritage's-culture” in a variety of ways which may impact healthcare decisions (herbal remedies, cuisine and nutrition etc..), and we don’t currently have the tools to assess how complex relationships with non-American “diverse” cultures and media are going to impact health outcomes, but it needs to be assessed and not only by race. I think that simplifying a correlation solely based on one ethnic factor, like race, perpetuates stereotypes of prejudice, like racism. Race as a variable must be presented with other heritage and ethnic factors.
I believe that more heritage and ethnic factors need to be included into demographic data in order to create more nuanced solutions for minority communities. Health outcomes’ correlations only based on race do not provide enough insight into why those people and communities are making those healthcare decisions specifically, the behaviors resulting in health outcomes are not defined through naming a race. Many solutions based on presumptions of ethnicity and race are likely outdated and again are presuming a behavior of an entire group of people with similar (not the same) racial features rather than specifying which cultures result in behaviors. In addition to race, we should be identifying health outcomes correlations based on heritage (genetics), suppression type (systemic, historically enslaved, historically colonized etc), culture (cuisine, beliefs, lifestyle, literacy...), migration type (humanitarian based, career based, forced migration) and their generational status (acculturation and assimilation of American values/culture/language/literacy). Implementing these cultural variables as part of race demographics to assess health outcomes will further define health disparities and provide insight for more nuanced solutions while addressing impacts of slavery, imperialism, colonialism and migration among people of color races.
Sheila is the Founder and CEO of Tandem Community (beintandem.co) a digital health platform supporting women of color through postpartum depression and anxiety symptoms with culturally curated tools and community.
WRITTEN BY
Sheila Pande