When I looked at the Minnesota Department of Health (MDH) COVID-19 Dashboard on Feb. 20, Asian Americans in Minnesota made up 5% of the population, yet they represented 6% of all COVID hospitalizations and 8% of COVID ICU cases in Minnesota. I wondered how many COVID cases and deaths were Hmong and how could we know when the Minnesota Department of Health does not provide the information or disaggregate the data by cultural groups?
Our understanding of the data changed on April 15, when the Coalition of Asian American Leaders, the Hmong Public Health Association, and University of Minnesota researchers in partnership with the national Southeast Asian Resource Action Center released a report, “A Race to Close the Disproportionate COVID-19 Death Rates in Minnesota’s Asian Community.” The document is based on my policy research and issue brief as a University of Minnesota executive MPH student; preliminary data details are below.
The need to disaggregate data
The COVID-19 response was slow to pay attention to what the data is telling us since so many are experiencing the disproportionate effects of COVID-19 firsthand, responding on the front lines, or are simply fatigued from the informational overhaul of this pandemic. Yet, it is now more crucial than ever to highlight the issues associated with this problem:
1) The broad education, socio-economic, and language diversity within the Asian community results in marked differences in access to health.
2) Asians are regarded as a monolith and many health interventions ignore disparities within the Asian American community.
3) The increase in Anti-Asian sentiments and racism toward the Asian population has only gotten worse with the spread of COVID-19.
It is not enough to acknowledge and sympathize with the Hmong and broader Asian community. From March to December 2020, more than 223 Asian Americans in Minnesota died as a result of COVID-19 in Minnesota; however, when the mortality data is disaggregated by cultural groups, we see that 110 or 49% of these COVID-19 deaths were from the Hmong cultural group. The current information available does not allow us to understand the burden of COVID-19 in specific cultural communities beyond this preliminary dataset.
However, COVID-19 mortality disparities will persist if surveillance is not more detailed than broad racial groups. If the data doesn’t exist for cultural communities like the Hmong, it’s unlikely current health strategies will target them. The current political climate amplifies anti-Asian sentiments and racism. My own parents are afraid of going out in public alone. I no longer take my nieces out on walks around the park in case we are out of earshot should anything happen. There also exists a general lack of understanding and ability to differentiate between the experiences of a Japanese American versus a Hmong refugee.
During the 2021 legislative session, the House brought to the floor HF 2113, a bill to make COVID-19 vaccination strategies equitable. The bill makes it optional for surveillance data to be collected via race or ethnicity, which still makes disaggregated data by cultural group optional. Having the information to stop preventable deaths should not be optional.
One way to do it
Mandating MDH to collect infectious disease surveillance data to include ethnicity and English proficiency status of patients is one way to make available disaggregated data. MDH has already been given authority by duly elected officials to collect, analyze, and disseminate infectious surveillance data and respond to public health crises. This mandate would add additional detail to the type of health information they are already collecting in order to formulate a disease prevention response, and help close the gap for disparate health outcomes, an initiative shared by federal, state and local public health.
Because this information will be extracted from existing medical records and patient interviews, once the process is designed, long-term sustainability can be achieved. It’s time to stop making excuses for preventable COVID-19 deaths and put into action policy and programs that will allow for targeted responses.
Having disaggregated information will allow community-based organizations, cultural groups and people working in public health to have the evidence and rationale to act. That’s what we need now.
Chao Yang, of Roseville, is a current executive master of public health administration and policy student at the University of Minnesota and a local public health professional. She has over 11 years of experience in public health and human services.
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