The Loudest Duck Gets Shot: Why Asian Americans are Dying in Silence

A few weeks ago, I had a chance to make a presentation at the Arizona Department of Health Services regarding Asian American health disparities. Thank you to the Arizona Health Disparities Center for inviting me to speak and for coordinating this series of workshops around social and racial/ethnic inequalities in health.

I titled my workshop “The Loudest Duck Gets Shot: Why Asian Americans are Dying in Silence.”  My contention is that a “perfect storm” of factors continues to compromise the political effectiveness of Asian Americans in this country and that the result in at least one case (chronic hepatitis B infection and liver disease, which disproportionately impact Asian Americans) is that Asian Americans are dying unnecessarily.

The “perfect storm” begins with a cultural disinclination to make waves (“the loudest duck get shot” is a Chinese proverb) and a proclivity towards “face-saving” (keeping problems within the family). In my mind, these tendencies continue to allow the “model minority” to also be the “invisible minority”.  Elected officials and government don’t hear from their Asian American constituents, and not surprisingly, little gets done to address a preventable health problem like hepatitis B infection, which is killing Asian Americans on a daily basis.  

Another factor has an historical context. Asian Americans, like other people of color in this country, have a longstanding history of being oppressed and disempowered. For Asian Americans, this marginalization began not long after their entry into this country – beginning with the 1892 Chinese Exclusion Act and culminating in the 1924 Asian Exclusion Act, which for 40 years essentially halted all Asian immigration into the United States. To this day, many American-born Asian Americans are asked, “Where are you really from?” as if we are less than real Americans. Dr. Frank Yu coined the term “perpetual foreigner” to describe this state of marginal Americanism. It’s harder to impact the outcome of a game if you’ve been relegated to the sidelines. 

There are other important factors. Asian Americans are a very diverse group, constituting peoples from the Far East, Southeast Asia and South Asia – many of whom literally don’t speak the same language and some of whom are historically bitter enemies. Building political solidarity among such diverse groups can be challenging at best.

My point is that Asian Americans need to be better organized and more vocal to address their own policy and systems related needs. In this country, “the loudest duck gets fed.” So, again using hepatitis B as an example, in addition to fighting the good fight and trying to scrape together resources to conduct hepatitis B education and screening among Asian Americans (working within the system), we also need to put a spotlight on and work to redress the inequities in overall hepatitis B funding (working the system). HIV/AIDS advocates learned this lesson decades ago, and that is largely why federal HIV/AIDS funding dwarfs viral hepatitis funding (even though far more Americans are infected with hepatitis B and hepatitis C, and far more die from these infections). I would venture to suggest that their advocacy, which resulted in a steep increase in federal investment in terms of HIV/AIDS prevention, screening, treatment and research, has saved hundreds of thousands of lives in the meantime. Asian Americans with hepatitis B infection deserve no less – but we must organize and speak up.

I’ve placed my workshop slides here on our website if you would like to view the full presentation.


- Doug Hirano, MPH, APCA Executive Director