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The healing powers of Netflix’s Heartstopper.
As the leader of an LGBTQ+ youth support group, Gary Kopycinski always tells his students: “Live for the best, prepare for the worst.” Enter Heartstopper, a Netflix show about British teenagers grappling with queer love, identity, friendship, and mental health. “It sends the message that the best is possible,” Gary says.
Though Heartstopper centers high schoolers, people of all ages are reveling in the hopeful LGBTQ+ stories. For Gary, 59, the show is a catharsis for moments in his own life growing up gay, like when someone outed him to his family. Watching Heartstopper gives Gary a way to touch and feel that experience again, some 40 years later. “It’s wonderfully therapeutic and healing,” he says. “I kind of cry a little bit for who I was as that young person. But it always brings me back to where I am now, and I just feel better about myself.” Today, Gary has been teaching theology at a Catholic school in Illinois for over 30 years, and has worked to find and create community for queer people like him.
Heartstopper’s healing powers are working. Since season one launched on April 22, the show has landed in the top spot on Variety’s trending TV chart, earned a 100 percent score on Rotten Tomatoes, and been renewed by Netflix for two more seasons. Its popularity has given a boost to the four graphic novels the series is based on, which are numbers 2, 3, 5 and 6 on the New York Times bestsellers list for graphic books and manga as of June 22. It’s a hit, and it’s one that has a message.
As in Alice Oseman’s Heartstopper books, which started as a webcomic of the same name, the show follows Charlie Spring (Joe Locke) and Nick Nelson (Kit Connor) as their friendship develops into something more. Charlie is dealing with the aftermath of being unintentionally outed to the entire school the previous year, while Nick, the stereotypical popular rugby star, starts to realize that he might be different from what everyone expects him to be.
Oseman explains her goal in this video on the making of the show: “I want Heartstopper to inspire young people — especially LGBTQ+ young people — to be whoever they want to be, and to believe that they can find happiness and find love and find friendship, because it is a joyful story … everyone can get something out of it.”
She succeeded; Heartstopper resonates with audiences of all ages. For some older fans, though, it’s bittersweet to only now see their lives accurately and positively represented on screen. They can’t help but be a little envious at how different things are, but this Pride, with so many fights for human rights seemingly ahead, it’s a reminder that there’s always more acceptance and understanding to push for. “I look at the healthy ways young people can look at themselves today,” Gary says, “whereas for us, we were in the shadows or desperately trying to stay out of the light.” Now? “It’s a wonderful world that’s becoming possible. And nobody is going to send us back.”
For many people in the LGBTQ+ community, watching shows like Heartstopper that tell queer teen love stories comes with a blend of grief and joy for their younger selves. As the Second Adolescence podcast points out, this mix is likely because people didn’t have those experiences or this level of positive representation in the media when they were growing up.
Watching Heartstopper was an “emotional rollercoaster” for Erik Van Dam, 41. Erik, who lives in the Netherlands and is a member of multiple Heartstopper Facebook groups, says that even though his parents were supportive when he came out, the lack of representation left him feeling at a loss at the time. Representation matters because “the fewer things you see around you that you can relate to, the less you’re going to understand what you are and what you feel,” he said.
Between the anxiety-producing-but-sweet journey of young love, the strong dose of hope infused into tough topics like bullying and mental health, and a sprinkling of animated elements taken from the graphic novels, the show expertly depicts the many struggles of trying to figure yourself out as a teenager. At the same time, it encourages people to embrace who they are instead of hiding — and reminds them not to rush the process.
One particularly relatable scene for Erik is when Nick explains to his longtime friend Imogen, who has a crush on him, why he doesn’t want to go on a date. Sitting on a park bench together with Nick’s dog, he shares: “Do you ever feel like you’re only doing things because everyone else is? And you’re scared to change or do something that might confuse or surprise people? Your real personality has been, like, buried inside you for a really long time?”
Erik felt exactly the same way. “I’ve never heard anyone describe my feelings so perfectly,” he said. Erik put his feelings about coming out behind him in order to move on, but that doesn’t mean that he’d processed them. Until he saw his story told on screen in this way, he wasn’t aware that he needed to heal.
Most of the other main characters are queer, and their equally heartwarming stories are woven throughout the show. Tara and Darcy find out the ups and downs of coming out publicly as a lesbian couple, Elle takes change in stride as she switches from an all-boys school to an all-girls one after coming out as trans, and Tao grows a little too overprotective of his best friend Charlie. And then there’s Isaac, who simply wants to “believe in romance” and read books on the sideline of rugby matches.
Steven Wong, 30, recognizes that Heartstopper is the kind of queer representation that’s needed in the media right now — and also believes the positive tone and relatable characters would’ve had an impact in his life when he was a teenager.
“The show would have been such a positive outlet for me and … [it would’ve] shown me the process of discovering who I am, dealing with bullying, and an idea of what coming out might be like. I probably would’ve been more confident, more open … and probably would’ve come out earlier to my family and friends.”
If Heartstopper existed during his middle school and high school years — when Steven experienced bullying, name-calling, and getting outed on someone else’s terms — he says he would have rewatched the show over and over again. Yes, these are fictional characters. But for Steven, who didn’t see any LGBTQ+ representation as a teenager, it would’ve felt like he had friends.
TJ Hocum, 33, says Heartstopper is one of the first TV shows with queer representation that made him feel seen — and really happy. He was shocked by just how much of an emotional reaction he had to it.
But a few days after TJ watched the show, he felt an overwhelming sense of sadness. “You wish that would have been you when you were younger,” he says. “Because when you’re young, you wanted to be that happy. And for a lot of people my age, we didn’t get that.”
While TJ wishes he had a show like this to watch while growing up, he’s glad one exists today. “I know it would’ve helped me a ton to see these experiences portrayed in such a happy manner. And I’m grateful that there are teens now who have a story like this that will give them hope and show that it’s okay to be different.”
That message immediately came across to the younger audience. The day Heartstopper dropped on Netflix, Esme Calder, 18, used a pivotal scene in the show to come out to their parents. On a recent Zoom call, Esme shared their journey falling in love with the Heartstopper world. They first heard about the books on TikTok last year, and then saved up to buy them. Their initial reaction to the show? “So overwhelming, in a good way.” There’s something about seeing the stories of characters they’d grown to love and identify with on the page, they say, and they’ve never seen that on TV or in a film.
The scene when Nick Nelson comes out to his mom has always been one of Esme’s favorites in the books, and when they came across a cast interview that mentioned a moment in the show that some people might use to come out to their parents, they were tempted to do the same. They sent it to a friend, saying “Can you imagine? I should do that …”
When Esme finally saw the scene, they felt like it would be the perfect moment and decided to go for it. Esme sent a clip of the scene to their parents, watched Heartstopper to relax while waiting for a response — which turned out to be a “very nice” one — and then tweeted about it because, they say, they were proud of themselves and wanted their friends to know about it.
just came out as queer to my parents using nicks coming out scene in the show feeling emotional rn … pic.twitter.com/LKwAEyEWEV
— ez bash’s publicist (@loverneIson) April 22, 2022
In the scene, Nick’s mom’s reaction is sweet, kind, and understanding, as she says, “Thank you for telling me … I’m sorry if I ever made you feel like you couldn’t tell me that.” No negativity. No awkwardness. Only love. This reaction is one of the reasons Esme used the scene to come out. If their parents didn’t know how to react or what to say, they’d have a model of how to behave.
“In a lot of media, when there’s a scene of a queer character coming out, a lot of the time it’s shown to go really poorly. And obviously that can happen,” Esme said. “But it’s equally important to show that it can go well and it can be a really beautiful moment.”
Heartstopper’s LGBTQ+ consultant, Jeffrey Ingold, agrees. In an interview, he stresses the importance of seeing your younger self reflected on screen, especially if you were robbed of those experiences when you were younger. Before consulting on TV, Ingold worked as the head of media for LGBTQ+ rights organization Stonewall UK. He was hired to help the actors accurately represent what it’s like to be a queer teenager in school, as well as make sure the crew on set understood the importance of their work for the audience.
“I didn’t get to see two boys in school having a fun, nice time and showing that that was a possibility. If you can’t see that when you’re growing up, you don’t think you can have it. The damage and trauma that can do is a lot, so the hope this show will give to lots of young LGBTQ+ kids is hugely important, and Netflix is going to make sure that that’s seen so widely,” Ingold said.
Older fans love this show because it maps to universal, timeless feelings and transcends them, soothing their inner child. Everyone wishes they could have had the world Oseman creates: a support system while they explore their sexuality, an understanding art teacher to remind them, “Don’t let anyone let you disappear,” a loyal friend group, and a family that loves them for exactly who they are. Watching Heartstopper is a glimpse into what it would be like to have all of that as a teenager.
Just ask Ana Pinto, who felt “very small” in her teenage years. Now 26, she says the stories in Heartstopper relate to her experiences growing up and coming out as bisexual/queer.
“The pressures and expectations to be a specific kind of person, the fear that you might be rejected by loved ones, the relief when someone you didn’t expect holds you and helps you be who you want to be,” she wrote in an email to Vox, “… all of that made me feel a sense of nostalgia and relatability.”
Ana says she can’t stress enough how much she believes Heartstopper will change LGBTQ+ representation for the better. “Alice created something that is helping older queer kids heal and younger queer kids have a safe place where their identities are seen and understood.”
Season one of Heartstopper is streaming on Netflix. You can read the webcomic here and find Oseman’s other work — related to the Heartstopper universe and beyond — here.
Everything feels broken. Who can blame people for wanting NFTs to be a fix?
On a rainy Tuesday in June, I found myself in a packed and buzzing Times Square theater, having skipped a line that wrapped seemingly endlessly around the city block thanks to a very handy press pass. The occasion: an event hosted by Doodles, a collection of 10,000 brightly colored NFTs.
To say I didn’t get the commotion is an understatement — one of Doodles’ most prominent images appears to be one of a cartoon vomiting a rainbow, and among its founders is a guy who goes by “poopie” on Twitter. But attendees assured me this was a very exciting moment. Some were jazzed about what they said would be a highly anticipated new phase of the project, while others speculated about who the promised musical act would be. Ultimately, the audience was treated to video messages from Serena Williams’ husband (a new investor) and Pharrell (new chief brand officer) and a performance by The Chainsmokers. The company also promises more NFTs, music projects, and art, a lot of which is TBD.
“Doodles is here to color our world, it’s here to help us channel our inner child, and ultimately help us understand that anything is possible with the power of our imagination,” said Doodles CEO Julian Holguin in what amounted to a glorified TED talk. He joined the project in May after coming over from Billboard. “The market needs that right now, the world needs right now,” he added. The market line elicited laughs from the crowd. It is, as you may know, a less-than-ideal time to be investing in NFTs, crypto, or, really, most investments lately.
“We’re kind of speculating on the cultural impact that Doodles makes on music, sports, gaming,” David, a Doodle holder who had traveled to New York from Los Angeles for the week, told me. He excitedly explained to me what was going on throughout the evening, after the Pharrell announcement leaning over to whisper the floor price of the NFTs had just crept up. “We hope that the future is something that delivers greater good.”
Much of what’s going on in crypto, perhaps especially in Web3 (the supposed next version of the internet) and NFTs (unique digital bits), is pretty scammy and predatory. A lot of it’s based on some future promise of “utility” that in most current iterations translates to nothing more than hype. That hype is generated by a select few on the backs of the masses, some desperate to be part of contrived communities. It fails at its basic premise of decentralization and taking the power out of the hands of concentrated authorities. NFT NYC, the context in which the Doodles event was held, was a prime example: Thousands of attendees paid hundreds and even thousands of dollars to attend a conference that can only be described as pure chaos. Some attendees criticized it as a cash grab by its handful of organizers.
Still, if you immerse yourself in the arena for a bit, you can start to see why some of this works. Everything has felt so bad for so long, everyone seems so disconnected. People want to feel excited, and if a rainbow drawing that says it’s doing an album with Pharrell does it for you, why not? We feel an inherent desire to be a part of something, to belong, and we often spend money to achieve that.
Amid the current market crash, being in a room full of unconcerned NFT fans feels a bit like the “this is fine” meme in live action. Then again, so does everything else.
For four days in late June, thousands of people descended onto Midtown Manhattan for the fourth installment of NFT NYC, an event that claims to be one of the biggest in non-fungible tokens. Organizers claimed 15,000 people were set to attend, and they had a lineup of 1,500 speakers. If this all seems like a bit much, it’s because it was. It was often easier to navigate the tourist-ridden streets of Times Square than the hallways of the multi-floor, casino-like Marriott Marquis Hotel, where the conference was based. Most speakers were given just a handful of minutes on stage, largely addressing half-empty conference rooms at best.
You might have thought the chaos of the conference itself would have been reason for some doubt, on top of the most recent crypto crash that has seen cryptocurrencies and NFTs alike plummet in value. Instead, the environment was one of almost toxic positivity. The “we are all going to make it” (or WAGMI) attitude was pervasive, even though it’s definitely a situation where most people acknowledge the “we” is a pretty narrow segment they hope they’re a part of.
Well-funded people in the arena say they anticipated the downturn and even welcome it. “There’s so much noise in the NFT space, in the crypto space, right now, and if anything, what this crypto winter represents is the ability to shake some of that out,” said Jason Melo, chief technology officer at VHS, the company behind Zed Run, a digital horse racing game. Phillip Shoemaker, the executive director of Identity.com, an identity verification company focused on Web3, and former head of the Apple App Store, echoed the sentiment. “Everybody that was an OG crypto person saw this coming,” he said.
I believe both when they insist they’re trying to build out real-ish projects in the burgeoning Web3 space. Gambling is fun, so why not on digital horses? Shoemaker really does seem to care about pseudonymity.
However, both can also afford to lose, a privilege that normies and new entrants in the area with much shallower pocketbooks don’t necessarily have. Web3 absolutely needs some shaking out. The ones who are going to be shaken out are those who might be able to least afford it.
Austin Kuechle, one of the founders of Galactic Gaylords, an NFT project aimed at the queer community, spent thousands of dollars for a sponsorship booth (of which there were dozens upon dozens) and for his team to attend NFT NYC. Kuechle, who goes by Austin Please online and describes himself as a “gay dad from Canada,” just quit his job as a mechanical engineer to get more into Web3, though he still has an e-commerce business on the side. His timing isn’t great, but he’s determined to forge ahead. “For a long-term project like us, I’m not too worried about it,” he said. The actual NFTs aren’t available yet.
Galactic Gaylords will be “story driven,” and the team will hire LGBTQIA writers to “tell their queer journey within the constraints of our super gay galaxy,” he explained. The ultimate goal is to get a Netflix show. In the meantime, they plan to send physical playing cards to NFT holders quarterly. I tell him I don’t really get it. He tells me I’m just not there yet. “Until you dive into it, you might not feel it.”
Yet again, I believe him. I also don’t get people who go to Phish concerts or collect Pokémon cards, both of which have thriving communities around them. The culture surrounding many higher-profile NFT projects, whether it be Bored Apes or Doodles or whatever else, is hyper-monetized fandom. Web3 in many circumstances may be a cynical cash grab from those at the top, but at the bottom of a pyramid are a lot of people who are at least, in part, true believers.
“The Web3 community is so small that the people in it are the ultra-passionate ones, so they’re almost willing to jump at anything,” said Lauren Mitchell, one of the forces behind Save Web3, which purports to try to keep the Web3 promise of decentralization and community alive.
We meet alongside one of her business partners, Tyler Stockfield, the day after NFT NYC ended. She is a pretty daring crypto trader (or, as the lexicon goes, a “degen,” short for degenerate), is soon hosting some Bali NFT event, and tells me she’s here for “eliminating poverty” for Web3. He talks about the conspicuous connections between crypto, venture capital, and major companies in a way that can feel a bit like that It’s Always Sunny meme.
But then in the middle of a Herald Square hotel diner, Mitchell hits the nail on the head. “There’s a lot of people benefiting from the desire people have for community coming out of the pandemic,” she says. Stockfield comes in with a different, and likely also correct, angle. “There’s a tight-knit club of people that are pulling the strings.”
I absolutely still do not want a Doodle, and most people in the space agree that approximately 99 percent of this will not exist in five to 10 years. But I am going to say something that I probably should not: I empathize with the hope of what it maybe could be, and with why that hope exists in the first place.
The internet right now is a real bummer — giant tech companies rule everything, privacy is a lie, and Facebook has maybe ruined democracy. It’s so hard to make it as a musician or an artist. It feels like the economy and society are crumbling around us. Crypto and DeFi and Bored Apes and whatever else are absolutely unequal and pyramid-y and unfair and bad for the environment. The same goes for so many aspects of big business and capitalism. The metaverse is maybe not great, and neither is the real world. Crypto might be particularly bad in terms of regulation and consumer protection, but also we let people get screwed over by predatory financial services and investments all the time. It’s all more of the same.
In the midst of the NYC NFT event, I sought out a moment of quiet in one of the side conference rooms, which were generally empty. There, I encountered Stephan Ledain, who works with an NFT project called the Jenny Metaverse DAO. It deals with fractionalized shares — meaning multiple people can have a stake in it — of art.
Ledain, who works at a consulting firm, is enthusiastic about the project and also aware it might not work. He’s also clear-eyed about what’s going on in NFTs. “Every nascent industry has this gold rush, capitalist energy around it,” he said. In his view, the art market as it is today is broken in the first place, so why not see if Web3 can help fix it?
It makes it hard not to root for the underdog, even if the underdog is banking on a future that very well may not pan out.
We live in a world that’s constantly trying to sucker us and trick us, where we’re always surrounded by scams big and small. It can feel impossible to navigate. Every two weeks, join Emily Stewart to look at all the little ways our economic systems control and manipulate the average person. Welcome to The Big Squeeze.
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Have ideas for a future column? Email emily.stewart@vox.com.
Pandemic-related hate crimes against Asian Americans have left many feeling unsafe in public. The consequences of missed health care will have lasting effects.
This story is part of The Aftermath, a Vox series about the collateral health effects of the Covid-19 pandemic in communities around the US. This series is supported in part by the NIHCM Foundation.
Jenny H. loved going out to volunteer in San Francisco, her home city for the past three decades. She even liked getting there and the opportunity to strike up a conversation with strangers while on the bus. But now she no longer feels safe on public transportation. She’s stopped volunteering. She hardly goes out. She struggles even to get to her doctor’s appointments.
Jenny H., who did not want to be identified by her full name for fear of being further targeted, is in her 60s and is Chinese American. She reports having been attacked numerous times, including being shoved so hard near a metro station in 2020 that she lost consciousness and suffered broken bones. Another time, years before, she was hit in the face on the bus, resulting in permanent eye injuries that still require checkups every three months.
With the precipitous rise in hate crimes against Asian Americans over the past two years, she is now “living in a constant state of fear,” she told Vox through an interpreter. “It changes the way I live. … I don’t want to go outside.”
Despite chronic pain and her eye injury, she now waits until a family member can escort her to medical appointments, or relies on the kindness of a 30-year-old civil engineer from the local Chinatown Volunteer Coalition to accompany her.
Jenny H. is one of countless Asian Americans who have struggled with accessing health care in the wake of pandemic-fueled, racially motivated violence.
Discrimination against Asian Americans, which has affected the community since the first major wave of Chinese immigration to the US in the 1800s, has increased across the country in the past two years following President Donald Trump’s 2020 claim that the pandemic was “China’s fault” and his racist branding of Covid-19 as the “China virus” and “kung flu.” (The spread of Covid-19 is most attributable to a worldwide failure to monitor the virus and take active preventive measures early in the pandemic.) Last year, attacks on Asian Americans surged more than 3.3 times higher than pre-pandemic levels, according to a 2022 report from the Center for the Study of Hate and Extremism.
As worry about the virus itself has waned, this metastasis of anti-Asian American racism has accelerated. By late 2021, nearly one in five Asian Americans and Pacific Islanders (who comprise more than 25 million of the US’s population) had experienced a hate incident in the past year, according to estimates from the coalition Stop AAPI Hate. And the percentage of these reported hate incidents that involved physical assaults rose from about 11 percent in 2020 to about 17 percent in 2021.
These numbers parallel a trend in public opinion: In 2021, 11 percent of US adults said that Asian Americans were at least partly responsible for Covid-19 (a belief tied to the “perpetual foreigner” stereotype of Asian Americans). By 2022, that number had risen to 21 percent.
This epidemic of hate crimes has discouraged many Asian Americans from going out even for basic errands for more than two years. As of spring 2022, more than one in three Asian Americans still say they have changed their daily routine because they’re worried about being assaulted or threatened. (Who would want to make themselves a target for physical attacks, racial slurs, verbal threats, or being spat on?)
But the disruption to health care has gone largely undiscussed.
While data is still scarce, experts warn that the pandemic-driven scapegoating could be fueling a public health crisis among Asian Americans.
Internal medicine physician Anthony Tam, who practices in Manhattan and Brooklyn, said he’s recognized a clear drop in visits from his Asian American patients, many of whom need regular care. “They’re too afraid to come out,” he said.
Over the course of two months, Vox reached out to more than 100 Asian American health care providers, advocacy organizations, and researchers to learn more about this underreported problem. Many said they saw their Asian American patients miss doctor’s visits due to the rise in hateful acts. These same patients, they said, were hesitant to talk about their concerns, however. This reluctance was backed up by our reporting: Patient after patient who admitted to these fears declined to speak about the issue for this article (although several, such as Jenny H., eventually did).
Experts and care providers warn that this delay in health care — compounded by its lack of visibility — could cause unforeseen consequences, from unmanaged chronic conditions to undiagnosed diseases, for many in this growing segment of America, and for years to come.
Covid-19’s arrival caused a mass deferral of health care across all demographics due to shutdowns, social distancing, short staffing, and general concern about catching the virus, leading to worse health outcomes for many. But within months, more people began returning to the doctor.
For many Asian Americans, however, the other threat of race-based attacks has remained high, with more than 10,900 reports of hate incidents against Asian Americans and Pacific Islanders reported to Stop AAPI Hate between March 2020 and December 2021 alone (a number experts agree is likely a vast undercount).
Almost half of these incidents happen in public spaces, which makes getting to essential appointments onerous, particularly for the 95 percent of Asian Americans who live in urban areas, many of whom rely on walking or public transportation.
“Families are afraid to leave their homes to get the care they need — and they’re afraid for their loved ones,” said Adam Carbullido, director of policy and advocacy at the Association of Asian Pacific Community Health Organizations.
For many Asian Americans, these fears are such a regular feature of living in America they often feel it’s not worth talking about, or they’re concerned about drawing more attention to themselves. Instead, they would rather put off appointments than risk putting themselves in more immediate danger.
Venkata Jonnalagadda, a psychiatrist in North Carolina, said doctors often have to explicitly ask about anti-Asian sentiment before their patients will talk about it. “One of my male Asian patients said … ‘I’m not going to burden you with that because that’s not why I came to see you,’” she said.
Of course, not every Asian American has delayed health care due to fear of being attacked. But reports from providers suggest that the problem is substantially underestimated. And those who are most likely to become victims of these crimes — which have predominantly targeted older adults and women — also tend to be those more in need of regular health care.
Another point of concern is that population-wide studies assessing health behaviors and outcomes often fail to break out Asian Americans as a separate demographic, further hiding these serious health consequences.
Even many health care providers were reluctant to speak about the issue. “When we got the call to do this interview, none of my colleagues wanted to do it,” Jonnalagadda said. “They said I was crazy for talking.”
In April 2022, Anthony Tam received an urgent call from one of his patients. The 61-year-old man was slurring his words and reported weakness in his arms and legs — hallmark symptoms of a stroke. Tam told the Chinese American man (who did not want to be identified by name) to go to the emergency room immediately, since any delay could lead to more permanent brain damage or even death. The man said he didn’t want to, for fear not only of catching Covid-19, but also of being assaulted. A day or two later, the man finally went, but the wait may have permanently impacted him: Tam says the patient still speaks with a slur.
Tam has been practicing medicine in Manhattan’s Chinatown for seven years. But since the onset of the pandemic — and a concurrent rise in violence and vitriol against Asian Americans — he has seen how fear has driven many to miss or postpone important treatment.
Mainstays in preventive care such as mammograms, colonoscopies, and blood tests are also falling by the wayside because many patients are afraid to travel around the city, Tam said. And he worries these delays are harming their long-term health, in the form of budding cancers, unchecked diabetes, worsening heart disease, and other serious but avoidable problems.
“Over the last two years, there were people who were managing chronic conditions … in the past they’d come to me every three to six months. [Now] it’s not uncommon to see them once a year,” Tam said. Those with previously well-controlled diabetes are skipping appointments, and Tam is noticing that their hemoglobin levels (which doctors use to assess diabetes severity) are now higher than recommended. (Asian Americans are about 37 percent more likely to have diabetes than white Americans.)
“Diabetes is a silent disease, and for the most part the patient may not even know there’s something wrong unless they come into the office,” Tam said. “Especially for my patients who don’t live in the immediate area of the clinic, there’s been a real drop in their health care,” he said. “They say … ‘I have to force myself to get on the train to see you.’”
Follow-ups are another hurdle. “Sometimes I have patients that need a work-up for blood in the urine,” Tam said. But “they’d rather stay home than go on the train,” to get the lab test.
The rise in Asian American discrimination and violence also rattles Tam as a doctor. His Manhattan office is just blocks from the Canal Street subway station, the site of two high-profile attacks on Asian Americans since 2020, including on one woman who died from her injuries. “That could have been one of my patients,” he said. These concerns trouble him.
“I find myself having to weigh the medical risks of not doing a [test or follow-up] with the very real risk of harassment or violence [for patients] getting to the office,” Tam said.
“It saddens me to know there’s something I have to take into account before … telling them to come to the office unless they really have to — because I don’t want to be the reason they’re attacked or suffer,” he said.
Across the country, Vaughn Villaverde, the director of advocacy for Asian Americans for Community Involvement, a nonprofit organization that provides health services in California’s San Jose area, reports a sharp decline in people participating in the organization’s senior wellness program. The majority said they have reduced their outdoor activity due to anti-Asian discrimination.
Jane Jih, an associate professor of medicine and research director of Asian American Research Center on Health at the University of California San Francisco, has watched patients who normally managed chronic diseases through outdoor exercise suddenly lose control of their condition because they were too afraid to go out. Since the rise in pandemic-fueled racist incidents, Jih has noticed, for example, “patients whose blood sugar for diabetes was really well controlled for a while and then it’s not. They would say, ‘I don’t feel safe having my father walk around for exercise,’ or ‘the public park where we normally went to, we stopped going to, because we heard of people receiving verbal assaults,’” she said.
These aren’t idle anxieties but lived experiences, Jih said. “I’ve had patients tell me stories — if I ask them … they’d be assaulted and no one would come to their defense.”
Helen Lu, a pediatrician in San Francisco, said an attack on one of her teenage patients sent him to the emergency room. “My patient was about to go inside his home, and suddenly someone hit him on the back of his head — the person ran away, and the patient could not see who it was,” she said. She saw him for follow-ups and staple removal, but he told her that he tries not to go outside anymore because of this attack.
Despite a general reluctance to speak publicly, several Asian Americans and their family members talked to Vox about their experiences, which paralleled those shared by providers.
Amy Y., who is in her 60s and lives in the Flushing neighborhood of New York City, says that while she still tries to make all her mandatory checkups, she has limited her other health care. For example, she stopped going to her acupuncturist (whom she used to visit regularly for pain management and wellness) and never went to the physical therapist to whom she was referred to manage severe back pain. “I try to minimize my time outside,” she told Vox via an interpreter. “I believe in the law of attraction — if you don’t go outside, then you won’t have as much trouble.”
Chia Thao, a 66-year-old Hmong American living in Butte County, California, has high blood pressure that requires frequent management, including doctor’s office visits two to three times a month. To get there, she waits until her son can take her to the Hmong Cultural Center, where he works, and from there, relies on one of the center’s shuttles to her doctor — a trip that now takes about an hour and a half each way.
Thao is too worried to make the trek on her own: “I know that ever since Covid hit that we are specified as the people who brought the disease to the US,” she said through an interpreter. “We are afraid to go about in public because of that.”
Richard Chen and his wife live with their three young children in Marine Park, in the far southeast reaches of Brooklyn. But they had long made a point for their family to see doctors in Manhattan’s Chinatown or Brooklyn’s Sunset Park (one of the borough’s Chinatowns), even though they were miles away. As a second-generation Taiwanese American, Chen saw this as a way of staying connected to their family’s cultural heritage.
But when the rise of anti-Asian violence began hitting the news, the software engineer and his wife felt increasingly nervous about shuttling around the city. This was especially a concern with young children, whose pediatrician visits added up to several dozen a year. The Chens made the decision to suspend all health care visits for eight months while looking for options closer to home. This put the kids behind on vaccinations that would protect them against other illnesses and delayed care for issues, including vision trouble, unexplained weight loss, and checkups for their infant, whose persistent fussiness worried the Chens.
Today, the children’s pediatrician, ophthalmologist, and nutritionist are all within walking distance. The parents’ primary care physicians are a bit farther, but easy to drive to. Still, when the Chens make an appointment, they ask for one well before closing time to avoid walking in the dark.
Other Asian Americans have taken even more extreme measures to avoid hate crimes. In 2021, Shirley Ha Chock’s 80-year-old father, a retired jewelry store owner, was diagnosed with aortic stenosis, a serious heart condition that required surgery and frequent cardiologist appointments in Manhattan. Rather than face long trips on public transportation — common sites of anti-Asian violence — he reluctantly gave up his beloved home in the Bedford-Stuyvesant neighborhood of Brooklyn, where he had lived for the past 15 years, and moved to Manhattan’s Chinatown.
The January 2022 surgery, however, resulted in a rare complication when his body rejected a new heart valve. “His cardiologist advised him to stay in New York City to finish up his care,” Chock said. Nevertheless, he and his family decided he should travel to Taiwan to continue his treatment in a safer city. “He would rather take the risk of flying overseas — even though he had complications with the heart surgery — and go to a whole team of different doctors who don’t know his medical history because New York City has become so unsafe for older Asians.”
Addressing the disrupted care for so many Asian Americans will require increased attention and a wide range of efforts.
While pandemic-era adaptations, such as telehealth, could help many Asian Americans replace some in-person visits, they need to be revamped.
For example, telehealth platforms have a long way to go in effectively including language translation to make these sorts of appointments accessible to non-English speakers. Older Asian Americans also face the same barriers to adopting new technology as many other American seniors do, so organizations like Asian Americans for Community Involvement are offering more tech literacy programs. And those living in ethnic enclaves disproportionately still need access to high-speed internet.
The rise in acts of hate has served as an unprecedented call to empower and protect members of Asian American communities. Programs have sprouted up around the country that teach Asian Americans and limited English speakers how to report crimes to the police, bystander intervention training, and even self-defense, in an effort to increase confidence in returning to public places. From spring 2020 to summer 2021, OCA-Asian Pacific American Advocates partnered with Lyft to provide free rides for Asian Americans to safely run errands. And organizations such as the Chinatown Volunteer Coalition have also burgeoned across cities to provide one-on-one support, including connecting older Asian Americans, like Jenny H., with younger ones who could escort them to doctor’s appointments.
Jenny H.’s volunteer is Jonathan Sit, who is Chinese American and joined the group in early 2021. Having grown up in the Bay Area’s Chinatown community, he has witnessed firsthand many of its minority residents being violently targeted. He has also been the target of many “go back to your country” slurs and even beatings. When the pandemic inflamed existing anti-Asian discrimination, it sparked memories of these incidents, and he wanted to do something to help.
“There is a sense that if it’s not going to be me looking out for my community, I can’t really expect people outside my community to be looking out for them,” Sit said.
Despite being helpful for some, like Jenny H., these efforts do little to address the underlying, systemic infections behind this public health crisis.
The US government has a long history of anti-Asian American racism — from the 1882 Chinese Exclusion Act to the Japanese internment camps of World War II — to undo. And American policymakers, who have often cast blame on the country’s Asian residents, have fueled racist acts, such as public health officials setting fire to Chinatown buildings occupied by Asian and native Hawaiian residents in an ill-informed attempt to quell an outbreak of the bubonic plague in 1900.
Only recently has nationwide legislation made meaningful steps against anti-Asian American racism, such as with the 2021 Covid-19 Hate Crimes Act. Among other things, this law gives more local resources to facilitate reporting hate crimes. But even in the year since President Joe Biden signed the bill, nearly half of Asian Americans surveyed are still calling for stronger anti-hate crime laws.
In addition, more funding needs to be allocated to data specifically aimed at understanding Asian American health disparities.
To date, Asian Americans are the most understudied major racial or ethnic group in US peer-reviewed literature, and research is severely underresourced. Only 0.18 percent of funding from the National Institutes of Health from 2000 to 2018 has supported Asian American health research. (Seven percent of people living in the US are Asian American.)
“AAPI are often not included as a separate group in studies,” Justin Chen, assistant professor of psychiatry at Harvard Medical School, wrote to Vox in an email. He noted that the “model minority myth,” in which Asian Americans are portrayed as universally successful, means they might be seen as “a group without problems in need of investigation,” he said. “Yet we do have health disparities, especially in mental health, and we need funding agencies to recognize and address these.”
What’s more, lumping “Asian Americans” into a single group — often encompassing those of Chinese, Filipino, Japanese, Korean, and other backgrounds — hides important health risks and disparities among very different populations.
The federal government began to address this problem through a May 2021 executive order, which provides federal funding to improve access to health care, reduce health disparities, and strengthen research for Asian Americans, Pacific Islanders, and Native Hawaiians. Whether this will meaningfully improve health, however, remains to be seen.
In the meantime, these pandemic-era delays in health care for so many Asian Americans remain invisible to the majority of America.
“I just hope that the anti-Asian sentiment subsides and my patients can go about their lives without having to always look over their shoulders,” Tam said. He calls for more people, including those outside of Asian American communities, to speak up about the issue and for policymakers to look for solutions, rather than scapegoats.
“My patients are as much a part of the fabric of our society as anyone else,” Tam said. “They deserve to live peacefully and do very ordinary things, like coming in for an annual physical, without fearing for their safety.”
CREDITS
Editors: Katherine Harmon Courage, Susannah Locke
Visuals editor: Bita Honarvar
Copy editors: Tanya Pai, Tim Williams
Fact-checker: Willa Plank
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Turned out she was a cheetah.
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An old lady is complaining to her motel receptionist that a man in the room across from hers is taking a shower with the blinds up.
‘It’s obscene!’, she yells. The receptionist goes up to her room and says, ‘Well ma’am, you can’t see anything from your window except the man’s head.’
Now she’s really mad. ‘Is that so! IS THAT SO! Get on that table and take a look!’
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With just the tip.
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Because they’ll never accept a foreign ruler.
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The cucumber says, “my life sucks. I get left in the garden until I’m huge. Then cut into pieces and put in a salad.” The pickle says, “That’s nothing! I get to sit in a jar with vinegar till I get swollen. Then I get eaten.” The penis laughs and says, " When I get huge, they throw a bag over my head and shove me into a dark wet place and bang my head against a wall till I throw up and pass out!"
Excuse the formatting, on mobile.
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