No MENA Category is a Mistake

An estimated 3.7 million Arab Americans live in the United States. Most are US citizens. Our understanding of this group’s health needs is limited. The limited research is partly due to the absence of an ethnic identifier for Arab Americans in official statistics. The research that does exist points to high levels of chronic disease (including hypertension), obesity, and depression in this population.

The US Office of Management and Budget (OMB) released racial and ethnic standards for federal statistics and reporting in 1977 and updated them in 1997. The OMB has not made changes to these race and ethnicity classifications since 1997 despite significant demographic changes over the last 20 years. Some groups have not received their own ethnic and racial identifiers despite having large representation in the United States. This includes those who consider themselves to be Arab Americans or who have ethnic, linguistic, or hereditary origins in 22 Arabic-speaking countries in the Middle East and North Africa.

Despite this guidance, best available evidence suggests that some Arab Americans select “Other” because they do not feel White properly describes them.

The OMB issued a notice on March 1, 2017 soliciting comments from the general public about improving the accuracy of race and ethnicity information by including a Middle East and North African (MENA) reporting category. The category was tested in the 2015 National Content Test for the Census after significant lobbying by the Arab-American community. In January of 2018, the Census Bureau announced that they would not include the MENA category in the 2020 Census. Individuals with origins from the Middle East are therefore encouraged to indicate White/Caucasian on the Census and other health surveys. Despite this guidance, best available evidence suggests that some Arab Americans select “Other” because they do not feel White properly describes them. In epidemiologic terms, either choice is a misclassification that may ultimately impede our understanding of disease risk in this population.

The potential for misclassification is highlighted with a thought experiment: imagine we are studying a hypothetical diverse population similar in racial/ethnic composition to metropolitan Detroit composed of 10% Arab Americans, 45% White Americans, and 45% who identify as Other.  Then imagine that respondents have only two racial classifications to choose from: White and Other. Imagine we know that 25% of Whites and 50% of those identifying as Other are at risk for depression while Arab Americans have an increased risk at 75%. If all those who are Arab American identify as White, we overestimate the relative risk of depression for Whites in the population by 36%. This misclassification will limit our ability to target interventions to the population most in need of appropriate mental health services.

The incorporation of a MENA category on the Census, and medical and public health surveys would improve our understanding of Arab American health and the health of the communities in which they live.

The incorporation of a MENA category on the Census, and medical and public health surveys would improve our understanding of Arab American health and the health of the communities in which they live. When minorities with unique health needs and social experiences in the United States are counted within the majority group, researchers may be unable to properly calculate disease risk for either group and, therefore, unable to develop effective community-level interventions. Arab Americans represent a vulnerable minority population which is difficult to help without proper racial and ethnic classifications in electronic medical records, surveys, and the US Census. The lack of a MENA identifier on the Census inhibits a true understanding of the health of all Americans, not just Arab Americans.

Feature image: AH86/iStock