The Office of Management and Budget is requesting members of the public to provide feedback on a proposal from the Biden Administration to add Middle-Eastern North African (MENA) to the 2030 U.S. Census. If the reforms pass, it would be a major victory for Middle-eastern Americans who have long campaigned for their own checkbox.
For nearly 100 years, South West Asian North African (SWANA) Americans like myself, known as Middle-Eastern, have been told to self-identify as white across administrative data. Despite the growing SWANA community making up at least 4 percent of Americans, SWANA Americans remain mostly invisible in health care data systems.
The COVID-19 pandemic highlighted the lack of racial and ethnic diversity in data and research as drivers of health inequities. While serving as a data analyst for my state’s Department of Health, this issue became particularly more alarming when pre-vaccine outbreaks would occur in SWANA communities. Little was known about the unique barriers to social determinants of health or how to contain COVID-19 best and protect the community.
In Canada, SWANA is identified as “Arab, Middle-Eastern, and West Asian,” and a recently published study indicated this group has higher rates of COVID-19 infections and hospitalizations than their white counterparts. The findings further emphasize the importance of disaggregate and inclusive health data to include underrepresented racial and ethnic minorities systematically.
Public policy and government decisions use insights from large data sets to make pertinent and strategic decisions. How are inclusive and equitable decisions made if SWANA is not classified in secondary health data sources? Despite the aggregation of SWANA with White, there is growing research indicating SWANA have distinct health and social patterns, including higher prevalence of metabolic disorders and cardiovascular disease, lower birth weight, depressive symptoms, food insecurity, barriers to accessing health care, fear of deportation, and increased political discrimination and racism.
In its 2015 National Content Test, the U.S. Census Bureau included a MENA category as a separate category from white and found that a separate category was optimal and more representative for collecting data from this population. Including MENA significantly decreased the overall percentage of individuals reporting as white while significantly increasing the percentage of individuals reporting as Black and Hispanic.
Despite these findings, the Trump Administration failed to adopt MENA on the 2020 U.S. Census, meaning the Census continues to uphold systems of white supremacy and structural racism by discrediting the unique experiences of SWANA Americans. The Trump administration’s decision to overrule recommendations to add the MENA category to the Census resulted in the Office of Management and Budget ignoring over $7 million in research and advocacy.
The U.S. health care system is ignoring the needs of Middle-Eastern Americans while masking the true depth of health disparities experienced by all racial and ethnic minority groups compared to whites. To achieve health equity, the politicization of race and ethnicity categories should be challenged across all levels of government. As health professionals, researchers, policymakers, and community members, we must identify health inequities experienced by all communities in the U.S. Long-term solutions remain complex. Still, the first step is simple: Support the Biden Administration’s proposal to add MENA to the 2030 census by April 27, 2023.
Guleer Shahab is a post-graduate student.