Chapter 20 Racism: Science & Tools for Public Health (PDF)

20 The Global and Historical Nature of Racism and Health Among Asian Americans...

20 The Global and Historical Nature of Racism and Health Among Asian Americans Gilbert C. Gee, PhD, Cindy C. Sangalang, PhD, MSW, Brittany N. Morey, PhD, MPH, and Anna K. Hing, MPH INTRODUCTION Despite their label as a “model minority,” Asian Americans continue to experience racism. We define racism as the totality of the social structures, negative climate, pejorative ste- reotypes, and microlevel insults and assaults that serve to reinforce the power structure that maintains white supremacy. This definition highlights racism as a system of power that is upheld through multiple means throughout all of society.1 It is not simply about slurs and incivilities against individual persons but, rather, it is about creating a status quo in which Whites are systematically privileged against racial minorities. The focus on white supremacy is particularly relevant for persons residing in the United States, although we acknowledge that the manifestation of racism may vary in other countries. In keeping with life course and intersectionality perspectives, how racism manifests across history depends on social contexts that include international relations as well as social categories such as gender, sexual orientation, and social class.2 Copyright © 2019. American Public Health Association. All rights reserved. Asian Americans are considered a racial group in the United States. American racism has forced a political alliance and social identity among people of different nations, many of which have been at war with one another. Such conflict includes the vagaries of genocide, rape, torture, and forced assimilation. One example includes Japan’s use of “comfort women,” whereby Japanese soldiers were permitted and, indeed, encouraged to rape women from countries such as Korea, China, and the Philippines.3 In the United States, however, histories of intragroup conflict are often brushed aside because of the common experience that Asians “all look alike” and are subsequently treated alike by non-Asians.4 The main goal of this chapter is to review how racism manifests among Asian Americans and how experiences of racism are inherently dependent on other social fac- tors. We begin with a brief and selective overview of the history of anti-Asian racism. We next focus on three key issues related to immigrants, refugees, and persons of multiple heritage. We then discuss how racism is related to health and end with some thoughts for future work. Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  394 RACISM: SCIENCE AND TOOLS RACISM IS GLOBAL AND INTERSECTIONAL One cannot understand the experience of racism for Asian Americans without also considering the international context of trade and colonialism.5 The earliest Asian American immigrants arrived primarily as contract laborers in the early and mid-1800s, often working in perilous and low-wage jobs in mines, factories, plantations, and railroads.6 During this time, Asian American workers suffered blatant discrimination, few rights, lynchings, and other forms of murder. An outcry from labor and public health commu- nities asserted that Chinese persons were inherently “inassimilable.” They argued that Chinese immigrants were a direct and primary cause of social woes that would infect the White population, leading to the ultimate disintegration of American society.7 As issued from the New York Times shortly after the Civil War, if there were to be a flood-tide of Chinese population – a population befouled with all the social vices, with no knowledge or appreciation of free institutions or constitutional liberty, with heathenish souls and heathenish propensities... we should be prepared to bid farewell to republicanism.8 To plug this “flood-tide” and protect the American (White) population, the solution was to curb immigration. In effect, this would place an impermeable wall around America that would segregate out persons of Chinese descent. By the late 1800s, Chinese Americans, who made up the largest proportion of the Asian American population, received the dubious distinction of being the first group in US history that was targeted with a restrictive immigration policy. Beginning with the 1875 Page Act, signified with the 1882 Chinese Exclusion Act, and building to Immigration Act of 1924, Congress enacted policies that would restrict the immigration Copyright © 2019. American Public Health Association. All rights reserved. of Chinese persons in at least two major ways. First, it made Chinese persons ineligible for citizenship through naturalization. Second, these laws were gendered to further restrict the immigration of women. The major goal of the latter was to prevent the birth of Chinese-origin children who would become birthright citizens. These policies were quite effective: the Chinese population in the United States was 107,488 in 1890, but dropped to 74,954 by 1930.9 Just as importantly, such laws against the Chinese paved the way toward developing similar restrictions against other groups, including people from Japan, India, and the Philippines (Figure 20-1). Because of some technical issues in the wording of the various immigration acts, persons from India were not clearly excluded by the existing policies because East Indians were classified as “Aryans” by anthropologists. This provided a loophole as Aryans were not clearly distinguished from “Caucasians,” and the latter were not targeted by the immigration acts. However, Congress found a clever way to exclude Asian Indians by redrawing the political map of Asia and thus, allowing the Immigration Act of 1917 to exclude them.6 Similarly, Filipinos were a tricky case because the United Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  CHAPTER 20 395 Source: Mabanag.10 Courtesy of the Seattle Civil Rights & Labor History Project, University of Washington. Figure 20-1. Cartoon From The Filipino Forum, January 15, 1929 States acquired the Philippines after the Treaty of Paris in 1898. As a consequence, Filipinos were considered “wards” of the United States and could be considered “nationals.” However, this loophole was closed with the Tydings–McDuffie Act in 1934, which pro- vided for Philippines independence but also restricted Filipino migration to the United States to a mere 50 persons per year.6 Antimiscegenation laws and policies that forbade interracial marriages provided another way of controlling the Asian population. In the 1878 California Constitutional Copyright © 2019. American Public Health Association. All rights reserved. Convention, a referendum was proposed to oppose marriages between Chinese and Whites. Such a union would produce a “hybrid of the most despicable, a mongrel of the most detestable that has ever afflicted the earth.”11 The theory at the time, supporting and reflecting the eugenics movement, was that multiracial offspring would not only them- selves be undesirable but that such intermarriage would lead to “degeneration” of the entire “superior” Caucasian race. In the 1940s, anti-Asian sentiments intensified with the advent of Japan’s participation in World War II. In reaction to the perceived threat of “yellow peril” and the recent attack by Japan on Pearl Harbor, Japanese Americans were interned by the US government under the guise of national security. Japanese Americans lost their basic rights of citizen- ship without recourse, many losing homes and businesses that were unrecoverable after being released from internment camps. The Internment is typically viewed as mass incarceration triggered by international conflict. However, as astutely noted by Azuma, the Internment was actually “racist policy, disguised as military necessity... as yet one more manifestation of a general U.S. institutionalized racism.”5 Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  396 RACISM: SCIENCE AND TOOLS In the 1980s, Vincent Chin, a Chinese American person, was murdered in Detroit, Michigan, by White men who mistook him for Japanese, and blamed him for the layoffs in the auto industry, which they attributed to imported Japanese cars.6 The global eco- nomic context, with the success of the Japanese auto industry and the stagnating American one, was enough impetus for this hate crime. This case also demonstrates the foreignness projected onto all Asians, many of whom are blamed for the actions of a country from which they may have never set foot. RACISM IS OFTEN SUBTLE Many believe that racism is mainly about racial slurs, stereotyping, and hate crimes. Indeed, a fair number of these problems do occur. A recent example includes Astros first baseman Yuli Gurriel, who made stereotypical slant-eyed gestures toward Dodgers pitcher Yu Darvish during the 2017 World Series. Similarly, anti-Chinese graffiti has been seen recently in some communities in San Francisco, California, and there was racist backlash after Nina Davuluri, an Indian American, won the Miss America pageant in 2014.12 Moreover, racism against Asians continues to be linked with anti-immigrant sentiment, as seen with the 2017 killing of Srinivas Kuchibhotla, an Indian software engineer who was shot in Olathe, Kansas, by a White man screaming, “Get out of my country!”13 (For a photo of Gurriel’s racial gestures, see: http://www.latimes.com/ local/lanow/la-me-ln-darvish-asians-insult-reaction-20171028-story.html, and for one of anti-Chinese graffiti, see: http://www.thesfnews.com/anti-chinese-graffiti-appears-around- san-francisco/22470.) In response to such problems, community organizations have redoubled their efforts to combat racism and advocate for their communities. For example, Asian Americans Copyright © 2019. American Public Health Association. All rights reserved. Advancing Justice has recently launched a website that allows individuals to document their experiences with racial bias (https://www.standagainsthatred.org/stories). This pro- vides an outlet that might be more accessible than a formal complaint to law enforcement. However, racism is far more than what people are able to perceive and are willing to report. A good example of this comes from studies of housing discrimination performed by the Department of Housing and Urban Development (HUD). These studies use the paired-testing method in which two people go to purchase a home in a housing market. These pairs are purposefully made to be identical on all characteristics except race. For example, the pairs have similar incomes and dress, and desire the same types of homes. Discrimination occurs when the minority homebuyer is treated more poorly than the White homebuyer. In the most recent nationwide study, in 2012, HUD found that Asian homebuyers were discriminated against in purchasing a home.14 For example, sales agents showed Asian testers fewer homes than they showed White testers. Interestingly, the rates of such discrimination were nearly identical between Asian and Black testers. Sales agents told Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  CHAPTER 20 397 Asian testers about 16% fewer homes and showed them 19% fewer homes than they showed White testers. Similarly, sales agents told Black testers about 17% fewer homes and showed them 18% fewer homes compared with White testers. A similar study of rental units conducted in Toronto, Ontario, in 2007 provided more fine-grade information.15 The researchers performed an audit study distinguishing five different groups: Caucasian, Black, East/Southeast Asian, Muslim/Arabic, and Jewish. They found the highest degree of discrimination occurring against Muslim/Arabic men, followed by Asian men, Black men and women, and Muslim/Arabic women, compared with Caucasian and Jewish men and women. Such discrimination took of the form of nonresponse to inquiries to see an apartment. Significantly, although this study was con- ducted in Canada, where the history of race relations is similar, but not fully equivalent to that of the United States, the manifestation of housing discrimination is quite similar. What is important here is that such discrimination is quite subtle and those who expe- rience it may be unaware that they are experiencing it. We are not talking about racial slurs or overt differences in behavior, but of slights that are usually not easily perceived, yet are consequential. Being informed about and shown fewer homes results in minori- ties taking longer to buy a home and having fewer options. It is possible that such dis- crimination contributes to current patterns of racial segregation. Indeed, in 2010, Asian Americans experienced a fairly high level of racial residential segregation as indicated by the Index of Dissimilarity.16 During that period, roughly 40% of Asian Americans would have to exchange residences with Whites (or vice versa) to integrate metropolitan areas. Furthermore, segregation varied considerably by group, with the highest levels of segre- gation for Chinese and Korean Americans (dissimilarity values of 70).16 LEGAL STATUS IS AN IMPORTANT BATTLEGROUND Copyright © 2019. American Public Health Association. All rights reserved. Structural racism against Asian Americans goes hand in hand with immigration policies that have evolved throughout history, determining through laws and statutes the level of social acceptance, government services, and economic resources that Asians can access.17 One concrete way in which this manifests is through the determining of who is consid- ered to have legal status in the United States.1 Thus, the historical review at the start of this chapter continues to have relevance today—the question of who is eligible to be in America shifts and evolves, but does not disappear. Although many of the current discussions surrounding undocumented immigrants focus on Latino/Latina populations, Asians currently make up the fastest growing group of undocumented immigrants. According to the Center for Migration Studies, there were an estimated 1.7 million undocumented Asians living in the United States in 2015, mak- ing up 16% of the total undocumented population.18 This number is up by a remarkable 300% since 2000, when the Immigration and Naturalization Service estimated that there were only about 500,000 undocumented Asians in the United States.19 By comparison, Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  398 RACISM: SCIENCE AND TOOLS Mexican undocumented population growth has been gradually slowing, growing only 21% from 4.8 million in 2000 to 5.8 million in 2015.20 To put these current numbers in perspective, one out of every six undocumented persons is Asian, and one out of every seven Asian immigrants is undocumented.21 Undocumented immigrants face the fear and stress of being detained or deported. Mixed-documentation-status families also suffer when a member is detained and/or deported, especially when that person is a head of household or sole income earner in the family.22 Undocumented immigrants are furthermore forced to work illegally and are sub- ject to abuse and exploitation.17 Not having legal status in the United States forces people to live in the shadows, where they have less access to higher education and are prohibited from receiving the vast majority of federal safety net benefits.23 The majority of undocumented Asians are from the countries of India, China, Philippines, South Korea, and Vietnam.18 Many likely entered the United States with valid tourist visas but overstayed these visas once they lapsed. The Deferred Action for Childhood Arrivals (DACA) Program was an immigration policy enacted by President Barack Obama in 2012 to allow certain eligible undocumented youths and young adults who were brought to the United States by their parents as children the right to work and attend school in the United States, deferring the threat of detainment and deportation. At the time of DACA’s enactment, The Migration Policy Institute estimated that 87,000 Asian young people were eligible for the program.24 However, by 2015, only 21% of those eligible Asians applied for DACA compared with 77% of eligible Latinos/Latinas. There are several cited barriers for Asians accessing programs like DACA. These include a sense of stigmatization and shame that surrounds being identified as undocumented.24 Furthermore, declining trust in government institutions, especially in certain countries because of government corruption and rights violations, may prevent Asians from apply- Copyright © 2019. American Public Health Association. All rights reserved. ing to receive DACA. In addition, gaps in knowledge about programs like DACA through lack of culturally and linguistically appropriate outreach contributes to lower application rates. Nevertheless, research has shown that Asians who received DACA benefited in the form of access to jobs, education, and a greater sense of psychological well-being.25 Many Asian immigrants suffer under the US government’s efforts to detain and deport immigrants of color. Immigration raids by Immigration and Customs Enforcement have rounded up hundreds of Asian immigrants, many of whom have lived in the United States for decades, with some of them being refugees from places such as Cambodia and Vietnam.26 These actions by the government have prompted a lawsuit on behalf of Cambodian refugees who have been detained.27 There have been several reports of Asians being held in detention centers without access to legal help. These detention centers, the majority of which are run by private prison companies, are notorious for their poor living conditions, lack of health care, and abuse by prison staff members.28 Detained Asian immigrants are often moved without notice to different detention centers around the country, where they cannot be visited by or communicate with family members, friends, Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  CHAPTER 20 399 or lawyers. To complicate matters, some Asian countries do not repatriate people deported from the United States, or only in limited numbers, leaving many Asian immi- grants in limbo in US detention centers for months and even years.27 In addition to the many challenges faced by Asians who do not have legal status in the United States, even those Asian immigrants who do have legal status face barriers to receiving needed resources.29 Federal welfare reform under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 requires a five-year waiting period for legal immigrants before they can qualify to receive federal benefits.30 This policy is a detriment to recent legal Asian immigrants who are low-income, especially those who are refugees. As with DACA, even after this five-year waiting period, many low-income Asians may not take advantage of government benefits because of stigma, government mistrust, and lack of awareness about their eligibility for benefits. These fears are not without foundation; the US government has recently proposed new legislation on public charge, which would make use of public assistance by immigrants as grounds for deter- mining ineligibility for citizenship or even for deportation.31 Citizenship status is more than a legal document. With it comes social prestige and access to resources. As a recent study shows, noncitizen Asian Americans have higher psychological distress than naturalized and native-born Asian American citizens, and this disparity is in part explained by subjective social status.32 Therefore, the way that the US government structures citizenship, who is considered in the “in group” and “out group,” affects people’s place in society, which then can affect health disparities. To sum, US immigration policies impact societal views of Asian Americans, and soci- etal views also influence US immigration policies. These policies may act as forms of structural racism by stigmatizing Asian Americans as foreigners, regardless of their actual citizenship status or country of birth. In addition, immigration policies can structure real Copyright © 2019. American Public Health Association. All rights reserved. barriers for the many Asian immigrants living in the United States by limiting access to social standing and economic resources that fundamentally shape health disparities. REFUGEES HAVE DIFFERENT ISSUES COMPARED WITH IMMIGRANTS The history and context of migration, or whether one’s descendants came to the United States as immigrants or refugees, provides another dimension of diversity among Asian Americans. Broadly speaking, immigrants leave their countries of origin by choice in search of opportunity—for better job prospects, more rights, access to quality education and health care—while refugees are forced to migrate in search of safety from war or extreme violence. The United Nations defines a refugee as a person who must flee his or her country of origin due to “a well-founded fear of persecution” based on one’s race, religion, nationality, political opinion, or social group membership.33 For these reasons, refugees leave their home countries often without warning or planning and are unable to Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  400 RACISM: SCIENCE AND TOOLS return. Although the motivations to migrate may be rooted in both political and economic factors for immigrants and refugees alike, individuals must apply and obtain legal status as a refugee from the United Nations, after which a select few are eligible for temporary refugee assistance upon resettlement in the United States. The Refugee Act of 1980, which created current standards for refugee admissions and resettlement in the United States, was created in response to the substantial number of refugees fleeing their countries as a result of the Vietnam War.34 Southeast Asian refu- gees, who fled from Cambodia, Laos, and Vietnam as a result of the US war in the region, currently represent 14% of all Asian Americans.35 More recently, a surge of refugees flee- ing political turmoil and human rights abuses from Burma (also known as Myanmar) and Bhutan have constituted a bulk of refugee arrivals in the last decade.36 Compared with Asian American communities with longer histories of settlement in the United States, Southeast Asians have faced greater constraints to social and economic mobility. For example, 19.1% of Cambodian Americans and 28.3% of Hmong Americans live below the poverty line, compared with 12.7% in of Americans overall.35 In addition, more than a third of Cambodian, Hmong, and Laotian students do not complete high school, and the majority do not attend college, compared with 90% of the US adult pop- ulation completing high school and more than a third of all adults obtaining a bachelor’s degree or higher. Early Southeast Asian refugee migration to the United States occurred in two phases. The first wave of refugees who arrived around 1975 was a smaller group of highly edu- cated individuals who spoke English and had ties to Western countries. By contrast, refu- gees who comprised the latter wave and fled during the late 1970s through the 1980s came from rural backgrounds, had less exposure to Western culture, and survived conditions of mass violence, torture, and other atrocities before and during the process of migration.37 Copyright © 2019. American Public Health Association. All rights reserved. Due to pre-migration trauma and other stressors, many Southeast Asian persons were ill-equipped and unprepared for adjustment to life in the United States. Because of this context, Southeast Asians are targets of negative stereotyping and discriminatory treat- ment on the basis of their race and ethnicity as well as refugee status, poverty, and class. For example, Southeast Asians have encountered hostility on the basis of stereotypical perceptions regarding dependence on welfare and government services or competition for jobs.38 In addition, many Southeast Asian families live in economically depressed neighborhoods vulnerable to community violence. Accordingly, research has noted the ways in which Southeast Asian adolescents are stereotyped as gang members and school dropouts and experience discrimination in multiple community contexts, including from the police.39 Accounts of random, unwarranted questioning from the police among Southeast Asian Americans with no criminal records remain common. A public account of racial profiling from a youth, Patrick Duong, describes how both he and his mother experienced police violence in separate instances simply because they were told: “You fit a description.”40 Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  CHAPTER 20 401 In June 2017, Tommy Le, a 20-year-old second-generation Vietnamese American man, was shot three times and killed by police in Seattle, Washington, the day before his high-school graduation. Police initially claimed that Le was wielding a knife, but later conceded that he held a pen. His death has mobilized activists to bring attention to the discrimination experienced by Asian immigrants and refugees in their interactions with police and their experience in America more generally. Community Case Study: Cambodian Americans It is clear that the fates of Asian Americans are contingent not only upon race but also upon national origin. This is the central argument behind the concept of intersectionality, which argues that one’s social experience cannot be decomposed to a single identity (such as race only), but must be understood in the context of one’s multiple identities simultaneously (e.g., race, gender, and class).2 A compelling example of the intersection of discriminatory treatment based on race, migration status, and citizenship is the mass deportation of Cambodian refugees.41,42 During the growth of the prison population in the 1990s, Southeast Asian youths had dramatically high arrest rates and were more than twice as likely to be tried as adults, as compared with White youths who committed similar crimes.43 Within the current political climate, these refugees with criminal records who lack citizenship now face deportation to Cambodia, despite their experience migrating to the United States as young children fleeing violence and persecution. Cambodians are among the more recent Asian American groups in the United States, with migration from Cambodia peaking during the 1980s as part of the exodus of refu- gees fleeing Southeast Asia following the Vietnam War. Political instability following Copyright © 2019. American Public Health Association. All rights reserved. French colonization of the region that is now Vietnam, Cambodia, and Laos (Indochina) led to war in the 1950s between communist-controlled North Vietnam and Western- supported South Vietnam. Though not initially part of the US conflict with Vietnam, Cambodia was drawn into war when the United States conducted an intense bombing campaign in the country between 1969 and 1973 to stem the spread of communist forces. The massive displacement of Cambodians helped to create conditions that led to the takeover of the Khmer Rouge (1975–1979), whose regime was responsible for a genocide in which more than a quarter of Cambodia’s population died from torture, starvation, disease, and execution.37 During and after the Khmer Rouge, many Cambodians escaped to refugee camps in neighboring Thailand and in the Philippines. However, they often faced dangerous con- ditions in search of safety and eventual resettlement (e.g., explosives on land, treacherous conditions by boat, assault and exploitation from soldiers or thieves in refugee camps). As survivors of genocide and other atrocities, many first-generation Cambodian ref- ugees endured extreme traumas and have chronic physical and mental health problems. Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  402 RACISM: SCIENCE AND TOOLS In fact, Cambodian refugees continue to report high rates of mental illness, such as posttraumatic stress disorder, depression, and anxiety, decades after resettlement in the United States.44 These health problems have a number of negative effects on Cambodian American families. Currently, a third of Cambodian Americans are aged younger than 18 years, with many Cambodian American families affected by poverty and unemployment.36 Cambodian American youths have faced challenges in educational attainment and, if one considers their modest population size relative to other racial and ethnic groups, are overrepre- sented in crime and violence statistics.43 Many Cambodian Americans were initially drawn to street gangs as youths to afford a sense of belonging and safety in light of experiences of trauma, poverty, and social marginalization in the United States. Racism and anti-refugee hostility contributed to conflict and tensions between Cambodians and other racial and ethnic groups, leading many Cambodian youths living in inner-city, urban areas to join gangs. As shown in the following quote, some founders of Cambodian American gangs were initially targets of verbal and physical abuse because of their appearance, language, and culture45: Many of the Asian youths was looking for a place of acceptance... I spoke some English but not good enough, so I would get teased at school. Most of us got mocked for being different, taunted for being poor, and battered for being foreign... We saw the gang as a congregation for strength and unity... there was no more intimidation at school.42 Some of the Cambodian refugees who committed crimes as youths are being deported to Cambodia now as adults, despite having already served their sentences and their status as asylum seekers.41 In addition, many Cambodians believed that being a lawful perma- nent resident (green card holder) would protect them from deportation, but this is not the case. Only citizenship can fully protect them. In what scholars and activists deem the Copyright © 2019. American Public Health Association. All rights reserved. migration-to-school-to-prison-to-deportation pipeline, the deportation of Cambodians and other Asian American noncitizens reflects what some would say is a contemporary example of the United States ridding itself of “undesirable” or “unassimilable” Asians.41 THE MULTIPLE HERITAGE COMMUNITY IS GROWING An increasing number of Asian Americans have marital partners from other racial/ethnic groups. After the outlawing of the antimiscegenation laws in 1967, about 3% of all newly- wed marriages were interracial. This grew to 17% by 2015.46 Asian Americans have of the highest rates of outmarriage to a partner of a different race. In 2015, 29% of newlywed Asian Americans had a spouse of a different race or ethnicity, while this was 27% for Latino/Latina, 18% for African American, and 11% for White individuals. Also, consistent with an intersectional perspective, these rates vary by ethnicity and sex.47 For example, 36% of Asian newlywed women had a spouse of a different race/ethnicity in 2015, compared with 21% of newlywed Asian men.46 Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  CHAPTER 20 403 Interracial marriages occur not only because of personal preferences but also because of social conditions, such as the proportion of other Asians in one’s region.48 More broadly, social attitudes toward Asians may also influence some of these relationships. For example, Asian Americans have been branded the “model minority,” and certain Asian ethnic groups are asserted to be White or honorary Whites by some commentators.49 This social “closeness” to Whites might be a contributing factor. Furthermore, pernicious racial stereotypes such as the submissiveness of the Asian female,50 which fetishizes and exoticizes Asian women, may also possibly contribute to the gender differences in inter- marriage among Asians (i.e., “yellow fever”). More structurally, intermarriage rates have been shaped by antimiscegenation laws, imperialism, military involvement, and historic global relations between the United States and specific Asian countries. For example, many immigrants from the Philippines and Korea are the wives of US military personnel.51 Accordingly, the prevalence of White–Asian marriages should be understood within this context of historic US imperi- alism and contemporary military relationships. Children born from these marriages have multiple heritages, while also living in multiple worlds. Many of these individuals report prejudice and may experience discrim- ination differently than monoracial individuals.52 A common question asked of multiple- heritage individuals is, “What are you?” which can “other” that individual and convey a message that they do not belong in the monoracial world. Furthermore, multiracial indi- viduals may experience social exclusion from monoracial groups and their authenticity as a member of a racial group may be questioned. In a study with mixed-race college students, one Chinese–White female reported that friends felt they could say racist things about Asians in her presence because she’s “not actually Asian.”52 She elaborated, “one of my friends was like, ‘If I called you a Copyright © 2019. American Public Health Association. All rights reserved. Chink, you wouldn’t actually get offended because you’re not really Chinese.’”52 Others have reported feeling marginalized by their monoracial friends who share part of their background. A Korean–White male stated, “When I was around White friends, I was the Asian kid. When I was with Asian friends, I was called the White kid... I’m always going to be sort of that odd person. Always.”52 Hence, multiple-heritage individuals may face discrimination from many sources, including discrimination from their own com- munities of identity. RACISM IS RELATED TO ILLNESS The types of interpersonal and structural racism considered in the previous section are related to health problems among many racial/ethnic minorities, including diverse sub- groups of Asian Americans. For example, reports of discrimination are associated with poor physical health among Sikh Asian Indians,53 depressive symptoms among Cambodian Americans,39 heavy drinking among Filipino Americans,54 and lower psychological adjust- ment among multiracial persons.55 The associations are seen throughout the life course at Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  404 RACISM: SCIENCE AND TOOLS different ages.56 For example, discrimination is associated with poor adjustment among Korean American adolescents57 and suicide ideation among Chinese seniors.58 These associations have been confirmed in several reviews and meta-analyses. In 2009, a systematic review by Gee et al. noted 62 articles on discrimination and health among Asian Americans, finding that discrimination was strongly associated with a vari- ety of health and behavioral indicators.7 A meta-analysis by Lee and Ahn of 23 studies with Asian Americans showed a significant correlation between discrimination and poor mental health.59 More recently, Paradies et al. performed a meta-analysis of 293 studies of racism from around the world.60 This meta-analysis confirmed previous reports and further found that the effect sizes of racism on mental health outcomes appeared to be stronger for Asian Americans and Latinos/Latinas compared with African Americans. Hence, a growing body of research has consistently found that discrimination is associ- ated with illness, particularly poor mental health, among Asian Americans. How does racism affect health? There are numerous pathways including hate crimes, stress, reduced socioeconomic resources, and environmental exposures. Hate crimes are the most straightforward connection between racism and health. Racial animus contrib- utes to injury or even death. According to the Federal Bureau of Investigation, there were 113 anti-Asian hate crimes in 2016, although it is well-known that such crimes are under- reported.61 While the severity of the physical wounds should not be discounted, hate crimes are much more than the physical wound to a given person. They are also about intimidation to an entire community and social control.62 Racism can also lead to stress and subsequent illness. Stressors can contribute to allostatic load, conceptualized as the “wear and tear” of chronic stress exposure on the body’s working systems.63 Indeed, several studies show that reports of discrimination are related to stress biomarkers, such as allostatic load scores, C-reactive protein, and short- Copyright © 2019. American Public Health Association. All rights reserved. ened telomere length, among African Americans.64,65 Similar research on these biomarkers has yet to be conducted with Asian Americans, but this represents an important area for future research. Racism can diminish and interact with socioeconomic resources. It is well established that people who are less educated, poorer, and who work in lower-skilled jobs suffer from more illness than people with more education, wealth, and higher-skilled jobs.66 Indeed, audit studies have found that job applicants with Black names have lower chances of receiving a callback for an interview than do applicants with White names.67 Despite Asian Americans’ overall higher average incomes, audit studies have uncovered similar types of discrimination among Asian Americans in industries such as the restaurant business.68 Furthermore, socioeconomic status may affect the relationship between dis- crimination and health. For example, Japanese Brazilians who experienced discrimina- tion had poorer physical health, but this relationship was only present among those with less than a high-school education.69 For those with more education, discrimination was not associated with health. More research remains to understand how the multiple Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  CHAPTER 20 405 dimensions of socioeconomic position are related to discrimination and various health outcomes. Such dimensions include not only the traditional measures of income and occupation but also other indicators such as power, prestige and social standing, control, the sending and receipt of remittances, and microfinance. Racism can also be related to exposures to environmental toxicants among Asian Americans.70 This can happen with regard to residential segregation, whereby segregated communities are more apt to encounter hazardous pollutants.71 For example, Morello- Frosch and Jesdale documented that segregation was associated with higher risk of expo- sure to carcinogenic air pollution among Asian Americans.72 However, one study reported no association between segregation and health among Chinese Americans73 and another study reported a protective relationship.74 The latter likely represents possible resources engendered from ethnic enclaves. Hence, clarifying the relationship between segregation, neighborhoods, and health among Asian Americans remains an important topic for future research. Much work remains to understand how racism is related to health among Asian Americans. First, we need to document more comprehensively how racism manifests in this community. What new stereotypes are emerging, and how much do old stereotypes continue to linger? Second, in which settings are racist practices are most evident and harmful? This chapter has mentioned a few, including treatment by law enforcement, immigration authorities, jobs in restaurants, education, and neighborhoods. But, there many other places that have yet to fully develop in the literature, including contemporary settings such as cyberspace. Third, how are systems of oppression interconnected locally, nationally, and internationally? How can we integrate studies of the Asian diaspora with research on racism and health? Fourth, how do all of these factors unfold across the life course of one person and across multiple generations? The study of acculturation, long a Copyright © 2019. American Public Health Association. All rights reserved. staple of research on Asian American communities, has yet to fully merge with the study of racism. Fifth, how can we move researchers and the lay public beyond a binary view of inequality and instead fully embrace the complexity and fluidity of racial categories and systems of oppression that bind us? Increased theorizing and empirical research with the multiple-heritage community would provide a fruitful beginning to answering this ques- tion. The consideration of such connections and complexities should represent the next wave of public health research and community action. CONCLUSIONS This chapter has emphasized the structural and intersectional nature of racism. For Asian Americans, racism cannot be understood without simultaneously considering immigration and global affairs, alongside other factors such as gender and social class. Although the perceptions of Asians in the United States have evolved from the vile “yellow horde” to a “model minority,” such perceptions will continue to change in the future. Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  406 RACISM: SCIENCE AND TOOLS Indeed, 9/11 demonstrated how quickly popular opinion can pivot. Despite these evolutions, a theme that has continued since the early 1800s is that Asians are considered perpetual foreigners, regardless of whether they are US- or foreign-born. Such a theme almost guarantees that the popular perception of Asians, and corresponding treatment, is subject to change in accord with geopolitics. And thus, while Asians are a racial group based on our current understanding, they are more aptly considered political groups. This is most clearly seen in the recent separation of Pacific Islanders from Asians as a race category in the Census (historically, our communities were grouped as “Asian and Pacific Islander Americans”). It is understood that Asian Americans are a heterogeneous group, comprised not only of persons of from varied ethnic subgroups, but further arising from differences based on their citizenship and refugee status. These statuses are extremely important because of their legal and symbolic implications and the accompanying rights and privileges. As the many chapters in this book demonstrate, racism is not only consequential with regard to its moral and legal implications but has health implications as well. What all of this implies is that many natural experiments are in the making to improve population health each and every time we advocate social justice. REFERENCES 1. Gee GC, Ford CL. Structural racism and health inequities. Du Bois Rev. 2011;8(1):115–132. 2. Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Review. 1991;43(6):1241–1299. 3. Hicks G. The Comfort Women: Japan’s Brutal Regime of Enforced Prostitution in the Second Copyright © 2019. American Public Health Association. All rights reserved. World War. New York, NY: WW Norton & Company; 1997. 4. Sue DW, Bucceri J, Lin AI, Nadal KL, Torino GC. Racial microaggressions and the Asian American experience. Cultur Divers Ethnic Minor Psychol. 2007;13(1):72–81. 5. Azuma E. Internment and World War II history. In: Yoo DK, Azuma E. The Oxford Handbook of Asian American History. New York, NY: Oxford University Press; 2016:138. 6. Chan S. Asian Americans: An Interpretive History. Boston, MA: Twayne Publishers; 1991. 7. Gee GC, Ro A, Shariff-Marco S, Chae D. Racial discrimination and health among Asian Americans: evidence, assessment, and directions for future research. Epidemiol Rev. 2009;31: 130–151. 8. Takaki R. Strangers From a Different Shore: A History of Asian Americans. New York, NY: Penguin Books; 1989. 9. Yung J. Unbound Feet: A Social History of Chinese Women in San Francisco. Berkeley, CA: University of California Press; 1995. Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  CHAPTER 20 407 10. Mabanag M. The Filipino Forum: the founding years, 1928–1930. Available at: http://depts. washington.edu/civilr/news-mabanag.htm. Accessed July 2, 2019. 11. Shah N. Contagious Divides: Epidemics and Race in San Francisco’s Chinatown. Vol 7. Berkeley, CA: University of California Press; 2001. 12. Cisneros JD, Nakayama TK. New media, old racisms: Twitter, Miss America, and cultural logics of race. J Int Intercult Commun. 2015;8(2):108–127. 13. Berman M, Schmidt S. He yelled “Get out of my country,” witnesses say, and then shot 2 men from India, killing one. Washington Post. February 24, 2017. Available at: https://www.washingtonpost. com/news/morning-mix/wp/2017/02/24/get-out-of-my-country-kansan-reportedly-yelled- before-shooting-2-men-from-india-killing-one. Accessed January 9, 2019. 14. Turner MA. Housing discrimination against racial and ethnic minorities 2012: executive summary. Washington, DC: US Department of Housing and Urban Development, Office of Policy Development and Research; 2013. 15. Hogan B, Berry B. Racial and ethnic biases in rental housing: an audit study of online apart- ment listings. City Community. 2011;10(4):351–372. 16. Iceland J, Weinberg D, Hughes L. The residential segregation of detailed Hispanic and Asian groups in the United States: 1980–2010. Demogr Res. 2014;31:593–624. 17. Morey BN. Mechanisms by which anti-immigrant stigma exacerbates racial/ethnic health disparities. Am J Public Health. 2018;108(4):460–463. 18. State-level unauthorized population and eligible-to-naturalize estimates. Center for Migration Studies. 2016. Available at: http://data.cmsny.org. Accessed February 14, 2018. 19. Office of Policy and Planning. Estimates of the unauthorized immigrant population residing in the United States: 1990 to 2000. Washington, DC: US Immigration and Naturalization Copyright © 2019. American Public Health Association. All rights reserved. Service; 2003. 20. Estimates of the unauthorized immigrant population residing in the United States, January 2012. Washington, DC: US Department of Homeland Security; 2013. 21. Ramakrishnan K, Shah S. One out of every 7 Asian immigrants is undocumented. Data Bits. AAPI Data. 2017. Available at: http://aapidata.com/blog/asian-undoc-1in7. Accessed January 9, 2019. 22. Capps R, Koball H, Campetella A, Perreira K, Hooker S, Pedroza JM. Implications of immi- gration enforcement activities for the well-being of children in immigrant families: a review of the literature. Washington, DC: Urban Institute and Migration Policy Institute; 2015. 23. Broder T, Moussavian A, Blazer J. Overview of immigrant eligibility for federal programs. Los Angeles, CA: National Immigration Law Center; 2015. 24. Rusin S. Origin and Community: Asian and Latin American Unauthorized Youth and US Deportation Relief. Washington, DC: Migration Policy Institute; 2015. Ford, Chandra L.. Racism: Science & Tools for the Public Health Professional, American Public Health Association, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/emory/detail.action?docID=5968614. Created from emory on 2025-01-09 22:15:35.  408 RACISM: SCIENCE AND TOOLS 25. Sudhinaraset M, To TM, Ling I, Melo J, Chavarin J. The influence of deferred action for childhood arrivals on undocumented Asian and Pacific Islander young adults: through a social determinants of health lens. J Adolesc Health. 2017;60(6):741–746. 26. Sanchez T. Deportations of Vietnamese, Cambodians leave Bay Area Asian immigrants shaken. The Mercury News. November 9, 2017. Available at: https://www.mercurynews.com/2017/11/09/ deportations-of-vietnamese-cambodians-leave-asian-immigrants-shaken. Accessed January 9, 2019. 27. Constante A. Nonprofits sue over immigration detention of Cambodian nationals who came as refugees. NBC News. November 3, 2017. Available at: https://www.nbcnews.com/news/ asian-america/nonprofits-sue-over-immigration-detention-cambodian-nationals-who-came- refugees-n816861. Accessed January 9, 2019. 28. Amnesty International. Jailed without justice: immigration detention in the USA. New York, NY: Amnesty International; 2011. 29. Derose KP, Escarce JJ, Lurie N. Immigrants and health care: sources of vulnerability. Health Aff (Millwood). 2007;26(5):1258–1268. 30. Personal Responsibility an