Health of South Asians in the United States: An Evidence-Based Guide for Policy and Program Development

Book Title: Health of South Asians in the United States: An Evidence-Based Guide for Policy and Program Development

Book Editors: Memoona Hasnain, Punam Parikh, and Nitasha Chaudhary Nagaraj

Publication Information: New York, Routledge, 2017, 306 pp., $150, hardcover

This is a relatively rare book in medicine, at least for this reviewer: one not made redundant by electronic/handheld data sources, and in fact adding new information on a topic relatively unexplored in US health care.

For a relatively large minority demographic, there is surprisingly little on South Asian health in US health guidelines, evidence-based recommendations, or even in the general clinical trials literature. Indeed, even the term South Asian is not widely understood outside centers of concentration.

It is not uncommon for South Asian patients to have no specific demographic checkbox on clinic intake forms, instead checking “Asian,” which (a) more customarily refers to those of East Asian descent and (b) in any case is an over-generalizing term which does an injustice to the many ethnicities and cultures of the most populous continent.

The authors thus wisely set the stage for this work with a chapter on demography and census classification of ethnicity. Explaining who exactly South Asians are—those of origin in India, Pakistan, Bangladesh, Nepal, Sri Lanka, the Maldives and Bhutan—goes a long way to framing the concerns particular to this group.

There are relatively few clinical trials exploring the health issues of South Asians in North America. Thus the book goes through the key health topics of interest in this group, including traditionally important ones such as cardiovascular disease and diabetes. The authors of those chapters do a valuable service in collating available research on the topic. They also highlight the dearth of more nuanced interpretations particular to South Asians. Many clinical trials do not separate out South Asians from Asians in general. This limits the utility and generalizability of such studies. When studies on hypertension are published with recommendations for the US population, as clinicians we may occasionally be provided with information on specific interpretations or treatment recommendations for some groups (eg, African-American patients, and increasingly, Latinos and Asian Americans), yet South Asian Americans are usually absent as a group. It begs the question of whether they are actually absent, or just from the investigators’ perception. This provocative question is explored further in the final chapter by Prasad et al, and is one of the most readable and interesting areas of further research in the book. The chapter reviews national-level work on establishing guidelines for studying South Asian health issues, and developing a framework for implementation. There is a helpful overview of key organizations working together on this initiative. Indeed, this chapter should be required reading for any large-scale clinical trial or study in the United States which aims to study or generalize about the US population.

An area of opportunity in the book is chronic kidney disease. It is not well covered in the Diabetes chapter, and thus may need a section of its own. Due to the high prevalence of both cardiovascular disease and diabetes in this population, chronic kidney disease may be an understudied opportunity for detection, prevention, and intervention.

It is equally important to highlight what the book is not. As a guide for policy and programs, it does not aim to be a compendium of clinical recommendations for South Asians. As such, the reader will not find a discussion of the relative utility of ACE inhibitors, beta blockers or calcium channel blockers in the treatment of hypertension in this population. No doubt as the evidence base improves, such guidelines would be forthcoming as they have for other groups.

There are several topics covered in the book which should be singled out for mention. These topics are not only important in any minority community, but have also been historically stigmatized and under-studied among South Asians. Therefore the chapters on mental health (and in a pleasant surprise, maternal mental health), LGBTQ health, HIV, and intimate partner violence deserve particular recognition and are a valuable addition to the review literature.

Overall, this book is a singular accomplishment. It is a credit to the fine editorship, led by a diverse team of professionals from primary care and public health. Drs Hasnain, Parikh, and Nagaraj have led an important effort to aggregate data, present the existing knowledge base, and advocate for expanding it. Perhaps most importantly, they present a credible and forceful argument for critical improvements in recognizing the importance of South Asian health indicators in the vast evidence base of US health care.