A considerable amount of the research on health in America divides people into only six racial and ethnic categories: Black/African American, American Indian/Alaska Native, Asian, Native Hawaiian/Other Pacific Islander (NHPI), white, and Latino/Hispanic. This system of classification, established by the federal Office of Management and Budget (OMB), is the minimum standard for all federally funded studies, and is used in many private ones. But a new report from the Robert Wood Johnson Foundation argues that these categories are far too broad, erasing the experiences of minority groups and preventing the achievement of health equity.
According to the report, the OMB classification, which hasn’t been updated since 1997, lumps together people with very different cultural backgrounds and experiences. The Asian category, for example, contains everyone from Hmong tribespeople to highly-educated Taiwanese immigrants, and the white category contains many people of Middle Eastern origin. 
The report argues that these broad groupings can conceal important differences. Diabetes, for example, is a major cause of death among American Indian/Alaska Natives, but death rates vary greatly between regions, from 16.3 per 100,000 among Alaskans to 129.7 in the Great Plains area. Without data about these specific subcategories, the problem would remain invisible.
Statistics about large groups also mask great variation in social determinants of health, such as income. On average, Asian-Americans earn over $15,000 per year more than a typical U.S. individual. But this obscures a high level of income inequality within the group, with Indian-Americans averaging $119,000 and Burmese-Americans averaging only $44,000. This difference is correlated with very different health outcomes.
This lack of data creates a vicious cycle that can make researching smaller groups impossible. “Say you want to do research on Asian-Americans and their well-being,” said Dr. Tina Kauh, a co-author of the report. “Funders aren’t interested in Asian-Americans because there’s no [data] showing that they need to invest resources, but there’s no data because no one’s willing to fund that research.”
The OMB guidelines can also cause smaller groups, such as Native Hawaiian/Other Pacific Islanders, to be combined with Asians, or placed into an ambiguous “Other” category. This makes it harder to do research that would address their needs. And sometimes the standards of categorization are ignored. Months into the pandemic, 30 states and the District of Columbia were not reporting COVID-19 data on Native Hawaiian/Other Pacific Islanders, despite it being required. This prevented researchers from studying what turned out to be a real problem: a 2021 study of data from California showed that the NHPI COVID-19 mortality rate was 1.5 times higher than the state average.
In order to combat these issues, the report calls for the collection of significantly more detailed racial and ethnic data, along with data about related factors that can influence health, such as education, income, and country or region of birth. It calls for this data to always be disaggregated—separated into meaningful subgroups.
