The pandemic has prompted us all to adjust to major daily life changes, including mass fatalities, putting a heavy burden on our mental health.

Increased mental health strain under covid calls for proper support for grief and coping. However, cultural differences about mental health may make it difficult for some to seek proper support.

Filipino-Americans are one group that faces these difficulties. The Filipino-American community has seen more fatalities under the COVID-19 pandemic than demographics would predict, putting community members more in need of grieving and coping resources.  

In the context of the pandemic, it’s more important than ever to address mental health stigma in the Filipino-American community. We need to normalize seeking help and support, but while confronting this issue, we also must explore why Filipino-Americans have died disproportionately from COVID to begin with.   

A personal experience

Since March 2020, I had become accustomed to news that a distant relative or family friend had passed from COVID-19. It was never a surprise to me that they were nurses or caregivers.

Then in December 2020 I received news that my aunt and her partner tested positive for COVID-19. It started off mild like the cold or flu. Then a month later, my aunt’s partner went to the emergency room and was hospitalized for respiratory complications.  Soon after, my aunt was admitted as well. They were both expected to be released, but my aunt’s partner was suddenly moved to the intensive care unit. 

That January I received a call from the hospital notifying my family that he had passed away. We could not notify my aunt because she had also been moved to the intensive care unit. She was in a coma. Her partner was an undocumented immigrant with family only in the Philippines. I managed to contact them and had to be the person to notify them of their father’s death.

A month later my aunt finally tested negative for COVID-19, but too much damage occurred to her lungs. I sat in her hospital room in full PPE gear to say my goodbyes and be with her as she passed that night. Then I went home and took a midterm for school the next day.

I juggled full-time university, a part-time job, and grieving and coping with the pain and loss. I never seeked any professional help nor support from family or friends. It was difficult to discuss my feelings and state of mental health with my family.

COVID-19 has caused disproportionate Filipino-American fatalities

The US population comprises 2.9 million Filipino-Americans, representing only 1% of the total population. However 1 in 4 working Filipino-Americans work in healthcare.  This means that more Filipino-Americans are at risk of exposure to COVID-19 at work or through a family member or relative.

According to National Nurses United, Filipino-Americans make up 4% of the total registered nurse population in the United States. However, Filipino-Americans make up the second highest percentage of the total US registered nurses fatalities at 31.5%.

This data only accounts for registered nurses, however Filipino-Americans are prevalent in other healthcare workforces such as licensed vocational nurses, certified nurse assistants, and nursing home caregivers. So we also have to ask why Filipino-American HCWs are dying at disproportionate rates.

Disproportionate care access

Other social and economic determinants put Filipino-Americans at risk of serious illness from COVID-19.  

For instance, Americans struggling financially may hesitate to seek healthcare out of concern for costs. According to a study by the UC Davis Bulosan Center, Filipino-Americans make up 24% of Asian Pacific Islander groups that are working, but still struggle with poverty. 

The same study also revealed that there may be an estimated 64,130 undocumented Filipinos in the United States. Undocumented individuals may lack the proper resources and access to services that could save their lives from the virus.  

Health comorbidities

Studies have also shown that Filipino-Americans are at high risk of certain diseases such as diabetes for those over the age of 50 (even if not obese) and hypertension. These and other serious comorbidities that disproportionately impact Filipino-Americans can increase the risk of severe illness from COVID-19.

But why do these disparities exist?

It all comes back to colonialism 

Filipino-American families today may not even know about the history of why so many Filipinos in America are nurses. This pattern stems from a long history of colonialism.

The United States has relied on Filipinos for their work on the healthcare frontlines ever since their colonization of the Philippines in 1898, when migrant Filipino nurses were heavily relied on to relieve nurse shortages in the US. A study has shown that registered nurses trained in the Philippines make up one out of 20 registered nurses in the US. This makes them the largest group of nurses trained in a foreign country.

How did this proportion of Filipino representation in the nursing industry come to be? During the United States’ occupation in the Philippines, nurses were presented with the opportunity to travel to the US for training and work. Visas were limited during this time, therefore pursuing nursing became an elite and desired career in the Philippines.  

Nursing shortages in the US during the second World War resulted from complaints of low wages and poor working conditions. Therefore, programs to bring Filipino nurses in exchange for the ability to permanently petition to stay in the US were utilized.

Filipino nurses were most desired due to the prominence of Western-style schools and training that resulted from the US occupation. By 1967, the Philippines exported the most nurses to the United States out of every nation in the world

Exploitation of Filipino healthcare workers during health crises

The history of the United States’ colonialism progresses into exploitation of Filipinos working in the country.

For example, the U.S. 1980s HIV/AIDS epidemic left the country’s healthcare workforce fearful of treating patients with HIV or AIDS. Resulting shortages led to an influx of Filipino migrant nurses after false proclamations of higher pay. However, Filipino migrant nurses instead faced long hours, poor and dangerous working conditions, and other exploitations. During this decade, the Filipino-American population increased from 774,652 to 1,406,77.  

The pattern of exploiting Filipino healthcare workers, stemming from U.S. colonialism, extends to the pandemic’s impact on the Filipino-American healthcare workforce today. Filipino frontline workers have faced PPE shortages and other dangerous conditions during this health crisis. This plight has dealt a blow to the mental health of the entire community.

Given a long history of exploitation and strain to the mental health of Filipino-Americans, the COVID-19 pandemic has compounded emotional burdens exponentially. So why is mental health still a taboo topic in the Filipino-American diaspora? Why is it so hard to seek help when we are experiencing disproportionate grief and fear, en masse?

Colonialism’s impact on identity and mental health in general

Studies have shown that colonial mentality is related to negative mental health help-seeking attitudes among Filipino-Americans. Findings reflected a lack of identity development and support as a result of higher levels of colonial mentality.

Colonial mentality refers to the lasting attitudes that are a result of a long history of colonialism.  Western colonialism in the Philippines has heavily affected the way Filipinos perceive themselves and led to identity struggles.

Mental health and the colonial mentality scale

The colonial mentality scale (CMS), revealed that Filipino-Americans experience feelings of inferiority, shame and embarrassment of their heritage, self-hatred of bodily features, degradation towards indegenous peoples in the Philippines, and toleration of oppression from Western colonization.

Such feelings stem from deeply rooted colonial attitudes forced onto Filipino people regarding their skin color, nose shapes, “uncivilized” lifestyles, and the manipulation of their perception towards being a “poor” country. 

Seeking help for depression and anxiety often coincided with such identity crises is often frowned upon due to the severity of colonial mentality on older generations. Generations of manipulation and brainwashing has resulted in toleration of such oppression, deeming help unnecessary. 

Why this grief must be confronted and coped with

The lack of knowledge Filipino-Americans may have on the history of migrant healthcare workers and colonialism can contribute to the lack of help-seeking in the Filipino-American community.

The long history of colonial mentality and oppression has been continually straining the mental health of Filipino-Americans. With the COVID-19 pandemic, Filipino-Americans now face an added dual challenge. Mass fatalities and loss resulting from disparities in the community have increased the need for grieving and coping resources, however mental health stigma remains prevalent.

Moving forward

With COVID-19 changing the day to day lives of all Americans, mental health was strongly impacted. Filipino-Americans were hit even harder under occupational health disparity, mass fatalities and loss, and negative mental health stigma, making seeking help more difficult. Many of these issues and obstacles stem from colonialism.

Understanding the causes of COVID-19 disproportionate deaths among Filipino-Americans and the effects of colonialism is the first step towards normalizing help-seeking.

What comes next? Talking to other people about these issues, without fear of judgement. Whether in your community or online, if you share how you’re feeling, you might be surprised by how much others can relate.

This article is part of Supportiv’s Amplify article collection.