Dr. Karabi Acharya, Senior Director, Robert Wood Johnson Foundation
A few years ago, I sat down to fill out a routine intake form at a doctor’s office. I got to the race and ethnicity question and did what I have done since I was a child: I paused. Not because I didn’t know who I am, but because the form didn’t know what to do with who I am. Black or White. Asian or Hispanic. Choose one. I am Indian and White, and I have spent my whole life being asked to leave part of myself in the waiting room.
I am not alone. Thirty-four million Americans now identify as Multiracial, making it the fastest-growing racial category the U.S. Census Bureau tracks. The Multiracial population grew 276 percent between 2010 and 2020 alone. And yet if you look at the systems and culture of health philanthropy, you would barely know we exist. We are, as a population, both undeniably present and functionally invisible.
I know first-hand the challenges of family and community gatherings where I don’t quite fit on either side, not Bengali-enough on one side, too “exotic” for the other side. At work, employee resource or affinity groups rarely include spaces for Multiracial people. We are betwixt and between. Our existence raises lots of questions for some people. Our names, physical appearance, and nationality often lack congruence, each one pointing to a different racial heritage. These are not minor social inconveniences. Interactions with us can lead to microaggressions, incessant codeswitching (even among family), and misclassification in health care settings resulting in inaccurate diagnoses. The consequences for social isolation, belonging, and health are increasingly significant.
So why has this population been so persistently overlooked in every field? The honest answer is that our systems were never designed to see it. American race data collection has, for most of its history, been built on an assumption of monoraciality — that everyone fits into one, and only one, of a fixed set of boxes. The Census Bureau didn’t allow people to select more than one race until the year 2000. Most of the forms, surveys, and reporting templates that health philanthropy still relies on were built on that older, narrower logic, and many have simply never been updated. And of course, we know that when data is not disaggregated, we cannot understand the unique experiences and disparities across populations. The assumption that we all belong to only one box shows up in our cultural norms also. We create affinity spaces based on the assumption that people will pick one group. We celebrate Black History or Hispanic Heritage month. We ask people where they are from and expect uncomplicated answers.
As health funders who understand the connections among data, belonging and health, we have an opportunity to lead the way for all organizations to honor the fastest growing racial group in the country. Here are four places to start.
Disaggregate race and ethnicity data to include Multiracial options
Research studies, community needs assessments, and intake surveys routinely ask people to “select one” race or ethnicity or offer an “other” category that flattens an enormous range of identities into a residual bucket that no one analyzes and no program is designed around. A funder or program cannot target resources toward a population it has defined out of existence. The single highest leverage change a funder can make is to encourage grantees to stop collecting race and ethnicity data in ways that erase Multiracial identity and start disaggregating it in a way that reveals it. This means moving from “select one” fields to “mark all that apply” fields, paired with the ability to write in a specific combination rather than defaulting everyone into “two or more races” as an undifferentiated bucket. It also means going a step further than collection to analyzing and reporting on Multiracial respondents as their own subgroup, rather than letting the category disappear into “other” during analysis.
Rewrite grantee reporting language so it stops forcing a false choice
Funders set the terms by which grantees describe the people they serve, and those terms cascade through an entire ecosystem of nonprofits and community organizations. If a funder’s reporting template asks a grantee to report race as a single mutually exclusive category, that grantee will build its own intake systems the same way, and so will the next organization down the chain. The result is that an entire field’s data architecture inherits the same blind spot, multiplied across thousands of organizations and millions of client interactions.
Funders should audit their grant agreements, reporting templates, and evaluation instruments where grantees are asked to characterize the race or ethnicity of the people they serve and rewrite the ones that force a single-category answer. Include plain-language guidance for grantees on why it matters. A short note in the reporting instructions with the rationale can shift behavior across an entire grantee portfolio far faster than a data mandate alone.
Rethink affinity-group and eligibility structures built around one identity
Eligibility criteria and affinity-group structures are the places where philanthropy doesn’t just measure identity but acts on it. Programs designed to serve a specific racial community, initiatives with race-based eligibility thresholds, and staff or grantee affinity groups organized around a single racial identity all assume that everyone fits neatly into one category. A Multiracial staff member or community member is left choosing which affinity group to join, if any, or discovering that a program built to serve “the Black community” or “the Asian American community” was never built with someone like them in mind, even though they belong to that community too. So many Multiracial people report that they are not accepted into any racial affinity group which leaves them alone to manage the many challenges of our racialized society.
The fix is to make sure Multiracial people are welcomed into these spaces by including language that names Multiraciality explicitly. A community health worker program aimed at “the Latino community,” for instance, should say plainly whether a Multiracial Latino applicant qualifies, rather than leaving that person to guess and self-exclude. Revisit eligibility language so that Multiracial identity within a served community is explicitly, not just implicitly, included. Where there is sufficient interest, create dedicated Multiracial affinity spaces and include parents of Multiracial kids, in light of the demographic shifts.
Foster spaces for Multiracial people to share their experiences
Data fixes, reporting language, and structural changes will only go so far. Social connection and belonging cannot be built by measurement alone. Funders can support the more direct work of helping Multiracial people find and hear each other: grantee-led storytelling projects, peer support cohorts, oral history initiatives, or convenings built specifically around the Multiracial experience rather than folded into a broader diversity program. A modest grant to a grantee already doing this work, or a session at an existing convening set aside for Multiracial voices, sends a signal that this experience is recognized on its own terms. Belonging, is built through being heard and authentic connections.
For most of my life, I was waiting for a guidebook that would tell me how to be Multiracial in America, along the lines of What to Expect When You’re Expecting. When none appeared, I wrote it myself. I explore these issues and more at greater length in my forthcoming book, Multitudes: The Multiracial Experience and How to Forge a Culture of Absolute Belonging, which draws on public health research, national data, and dozens of personal interviews to make the case that Multiracial invisibility is not a data footnote but a failure of belonging with real consequences for health.
Health philanthropy did not create the categories that erase Multiracial Americans, but our field has spent decades reinforcing them through forms, templates, and structures. We need to look at our systems and norms to ask a simple question: does this assume everyone fits in one box? For 34 million Americans and counting, the honest answer is still too often yes. It is the result of a cultural default that treats a single racial identity as the norm and everything else as complexity to be managed rather than understood and honored. We all contain multitudes of identities and it’s time for health philanthropy to catch up.
Dr. Karabi Acharya is a senior director at the Robert Wood Johnson Foundation, where she leads the Global Ideas for U.S. Solutions portfolio. She is the author of Multitudes: The Multiracial Experience and How to Forge a Culture of Absolute Belonging. This book and this piece were developed independently. The views, opinions, and conclusions expressed here are my own and do not necessarily represent the views of RWJF. For more information, see https://www.karabiacharya.com/.