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Abstract
Asian Americans face health inequalities due to many barriers that exist in accessing and utilizing services. As one of the fastest growing racial groups, Asian Americans have not been subjected to the same level of inquiry on this topic. Historical trends identifying Asian Americans as a model minority have also served to discount challenges encountered by this group, including access to health care, level of care used, and quality of care. This article will explore impediments to healthcare access and utilization with a focus on cultural and language incongruity that contribute to discrimination and mistreatment encountered by Asian Americans within the healthcare system. With the majority of Asian Americans being immigrants and the older adult group growing at a faster rate than the overall Asian-American population, cultural and linguistic factors are particularly important, especially among more recent immigrants. Using the socio-cultural framework for health service disparities, we argue that there is not one particular factor that contributes to Asian American health inequalities but rather it is the combination of the multiple levels of social structures in the context of cultural and language incongruity and discrimination. The article concludes with implications for social work at the macro, mezzo, and micro levels.
Keywords: access to services, barriers to services, service use, health challenges, marginalization, healthcare access, immigrants, refugees, older adults
Introduction
Alegria and colleagues (1) state that, "race and ethnicity do play a role in health and health care" (p. 363) and argue that inequalities are compounded by the healthcare system, accessibility to the system, suitability of treatments and providers, and the way care is provided. Health inequalities are defined as systematic differences in health access, quality, and/or outcomes due to unequal positions in society based on social categories such as race. Outright expressions of discrimination experienced by members of nondominant racial and ethnic groups may have been reduced in the last few decades as societal attitudes towards overt expressions of discrimination have shifted to become less acceptable. More subtle forms, however, are still the reality for many. The World Health Organization's Commission on Social Determinants of Health (2) concluded that health inequities are influenced by inequities in people's daily circumstances; which are influenced by inequities in social structures that consist of power, money, and...