Jermyn Awad, an Egyptian-American psychologist at the University of Michigan, recalls that before her son was born safely and healthy, a clinician told her that her hormone levels were too high and the pregnancy was unsafe. “They don't know about us,” her mother reassured her.
Ayman Hamad, a Palestinian-American public health graduate student at Wayne State University in Detroit, has to search online to find out which race or ethnicity box to check on his doctor's office or school forms. did not become.
And Ittedar Shalabi, who runs an Arab-American family services center in the Chicago area and is also Palestinian, said misinformation and hesitancy about the coronavirus vaccine is rampant in her community. . Because there was no category for Arab Americans to be considered white, she said, the county delayed funding for assistance to minority communities and likely caused avoidable deaths.
“So many Arab Americans died at that time, especially the elderly,” she said. “By the time we got the funding, there was a lot of work to do to get it back. [minority] The community was capitalizing on this shot. ”
For decades, U.S. residents from the Middle East and North Africa, internationally known as the MENA region, have been classified by the government as white. This grouping masked differences in income, health, housing, and other important indicators. And if public health authorities lack data on COVID-19 deaths and vaccine uptake in the MENA region, for example, it will be difficult to allocate funds and other public resources effectively.
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“The lack of a proprietary identifier makes it difficult to separate data,” said epidemiologist Nadia Abrezam, an associate professor at Boston University's Connell School of Nursing and the daughter of a Palestinian refugee. “Systematically, structurally, we were ignored or our needs were ignored.”
Last month, the Federal Office of Management and Budget approved revised racial and ethnic data collection across federal agencies, including adding a new MENA category to the census. This is the first change to racial and ethnic categories since 1997. The changes include combining race and ethnicity categories with Hispanic or Latino checkboxes, and removing potentially derogatory terms such as “black” or “far eastern.” etc. are included. Federal officials said the changes will result in a more accurate count and use language that is “sensitive to how people refer to themselves.”
The new federal classification of MENA people is geographical and includes people from Arabic-speaking groups such as Lebanese, Algerians, Egyptians, Palestinians, and Syrians, as well as non-Arabic speakers such as Iranians and Israelis. This includes people in the speaking group. It also includes ethnic groups living in multiple countries, such as Assyrians, Kurds, and Chaldeans.
The updates are expected to be reflected in the next census in 2030, but federal agencies must submit detailed plans for how they will incorporate the new requirements by next year.
Systemically, structurally, we were ignored or our needs were ignored.
– Nadia Abrezam, epidemiologist and associate professor at Boston University Connell School of Nursing
Outside of independent studies by academic and nonprofit researchers, little is known about the health of people in the Middle East and North Africa in the United States.Experts and advocates say the census changes will help local and state About health inequalities and needs that we hope will inspire health organizations to update their own data collection methods to shed light on health inequalities and needs.
“There are so many people here, and we know so little about it,” said Hamad, an intern in the data department at Michigan's Oakland County Health Department. “Change is needed.”
fill the gap
Abrezam, who studies maternal and child health outcomes in MENA residents in Massachusetts, is one of a handful of researchers in the United States working to fill gaps in MENA health data.
Her study of mothers in Massachusetts found, for example, that black Arab mothers were more likely to give birth prematurely and have low birth weight than Arab mothers who were classified as white, while Arab mothers were They were found to be more likely to develop gestational diabetes than their mothers.
From the beginning of the pandemic to July 2021, about 17% of Arab Americans in Michigan tested positive for the coronavirus, compared to 11% of Hispanics and Black Americans, according to one study. 9.8% compared to 7.5% for whites.
Similarly, researchers studying aging, Alzheimer's disease, and related dementias found that confusion and memory problems, which can be early symptoms of the disease, were significantly lower than 9.6% of U.S.-born whites. found it to be present in 17% of MENA immigrants.
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Rima Merhoude, director of the Arab American Community National Network, said the category change only applies to federal agencies, not state governments. However, the official forms used by states, health agencies, and school systems typically reflect the categories used in the Census, and this change was made because “we seek interoperability between state-level and federal data. , which provides more specificity, as we are advocating at the state level. she said.
Awad, a psychologist at the University of Michigan, studies mental health and the impact of discrimination in MENA communities. She said this change will help account for social determinants of health, such as housing and environment, income, access to resources, health care and transportation, and traumatic experiences. Awad and other researchers are also interested in investigating the prevalence of health conditions such as asthma and cardiovascular disease in MENA communities.
“Our group has worked for years to advocate for this box,” Awad said. “It’s been a long time coming, but we will finally be able to collect data to truly dig into some of the unanswered questions. We know there are disparities, but systematic data collection We don't really understand the extent of it because it hasn't been done.”
Matt Jaber Stifler, co-founder of the Arab Story Center, part of the Arab Center for Economic and Social Services (ACCESS), said the health data collected by schools is also biased. In Dearborn, Michigan, for example, Arab children make up the majority of K-12 students, but state data shows they are white, Stifler said.
Inclusion “allows us to better understand who these communities are and what their needs are,” Stifler said.
population number
So far, the federal government's population numbers for MENA communities are estimates. For the first time, the 2020 Census offered a write-in option that allowed respondents to mark their race and ethnicity as “white,” while also providing information about their ancestry. Approximately 3.5 million people write in their countries of origin in MENA, with Lebanese, Iranians, and Egyptians accounting for nearly half of them.
California, Michigan and New York have the largest MENA populations, with a combined population of over 300,000. These states were followed by Texas, Florida, Illinois, and New Jersey. Prior to writing in 2020, the American Community Survey, an ongoing survey conducted by the U.S. Census Bureau, provided limited estimates.
According to the Immigration Policy Research Institute, a think tank that analyzes immigration policy, the 1920 census reported that around 50,000 people were from the MENA region. Over the years since then, a steady stream of Palestinians, Egyptians, Iraqis, Syrians and others have immigrated to the United States, some after the 1948 Arab-Israeli War and others as a result of the United States' restrictive immigration policies in 1965. After the restrictions were relaxed, even more immigrants began to flow in. The US MENA population had increased to approximately 224,000 people.
Last August, Illinois became the first state to enact a law requiring all state agencies that collect racial and ethnic data to include MENA categories. Lawmakers in California and Michigan are considering similar bills.
“This should be incorporated at every level, whether it's data in the health care system or the education system, such as at the university level,” says Sara Aboud, an assistant professor at the University of Illinois at Chicago who studies health outcomes for Arab immigrants. .
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Some critics argue that the census should move away from classifying people by race, rather than adding new racial categories. They point to the Human Genome Project, which found that humans share 99.9% of their DNA with each other. Some argue that race is a social construct, a relic of the 18th century.
But public health experts have demonstrated that racism affects people's health, and Abboud said that Arab Americans have worse health outcomes because of racism. Ta. Additionally, migrants displaced by war, such as Palestinian and Syrian refugees and their children, may have unique stressors centered around trauma.
Shalabi, of Chicago's Arab American Family Services, said including MENA in the data was long overdue.
“We're so excited because it's time for our community to be recognized and seen and recognized in a way that really helps improve health and be a part of American society,” she said. Ta.
