Racism and the Health

of Indigenous Australians

Dr Yin Paradies

Menzies School of Health Research, Charles Darwin University

&

Centre for Health and Society, University of Melbourne

Background

� It is well established that Indigenous Australians have

higher levels of ill health and mortality than non-

Indigenous people

� It should also be clear that this disadvantage is

associated with both historical and contemporary

racism, colonisation and oppression

� Both an ‘adequate state of health’ and ‘freedom from

racism’ are rights enshrined in legislation in Australia

http://www.crcah.org.au/publications/downloads/Racism-Report.pdf

What is racism?

� Racism is the inequitable distribution of opportunity (benefit) across racial/ethnic groups

�� It occurs through avoidable and unfair actions It occurs through avoidable and unfair actions

that further disadvantage the disadvantaged OR that further disadvantage the disadvantaged OR

that further advantage the advantagedthat further advantage the advantaged

� It is expressed through attitudes, beliefs, behaviours, norms and practices and may be either intentional or unintentional

Racism as oppression/privilege

� Racism is one manifestation of the broader phenomenon of oppression which include, for example, sexism, ageism and classism

� Oppression is intrinsically linked to the concept of privilege such that, in addition to disadvantaging Indigenous people, racism also results in white Australians being privileged and accruing unfair opportunities.

The three levels of racism

� Internalised racism

� Inter-personal racism

� Systemic racism

Internalised racism

� The incorporation of attitudes, beliefs or ideologies into one’s worldview about the

inferiority of one’s own group

� For example, believing that Indigenous people

have a low intelligence

Inter-personal racism

� Interactions between people that maintain and reproduce avoidable and unfair inequalities

across ethnic/racial groups

� For example, experiencing racial abuse

Systemic racism

� Requirements, conditions, practices, policies or processes that maintain and reproduce

avoidable and unfair inequalities across ethnic/racial groups

� For example, inferior treatment of Indigenous patients in hospitals

Racism Against Indigenous

people

Interpersonal Racism Against

Indigenous people

� 5000 respondents in the 2001 NSW/Qld Racism Survey and 4000 respondents in the 2006 Victorian Racism Survey were asked:

� Would you be concerned if a close relative were to marry an Indigenous person?

� 28% in NSW/Qld and 25% in Vic expressed concern at such an occurrence

Systemic racism against

Indigenous people

� Although information on systemic racism is patchy at present, there is strong quantitative evidence of its existence in a number of settings including health, welfare, justice, housing and media

� I will present brief findings from the health and welfare sectors

The Health Sector

� Five studies have shown disparities in medical care

experienced by Indigenous patients.

� These studies found that Indigenous patients with the same

characteristics as non-Indigenous patients were about a

third less likely to receive appropriate medical care across all

conditions (Cunningham 2002) as well as for lung cancer

(Hall et al. 2004) and coronary procedures (Coory & Walsh

2005) in particular.

� Indigenous patients were only one-third as likely to receive

kidney transplants (Cass et al. 2003).

The Welfare Sector

� In order to get unemployment benefits in Australia, an

individual must be actively seeking work. Failing to do so is

referred to as ‘breaching’ and can result in various penalties.

� Research by Sanders (1999) shows that national breach

rates are 1.5-2 times higher for Indigenous people. This

finding is consistent across age, gender, income, family

types and payment durations and occurs despite the fact

that Indigenous people are more likely to be exempt from

job searching and filling out jobseeker diaries.

Pathways from racism to ill-health

� Inequitable and reduced access to societal resources required for health (e.g. employment, education, housing, medical care)

� Inequitable exposure to risk factors associated with ill health (e.g. junk food, toxic substances, dangerous goods)

� Stress and negative emotional/cognitive reactions which have negative impacts on mental health as well as affecting the immune, endocrine, cardiovascular and other physiological systems

� Negative responses to racism (e.g. smoking, alcohol and drug use)

� Physical injury via racially motivated assault

What is self-reported racism?

� Racism as reported in interviews or surveys

� Racism is frequently not perceptible to individuals or, if perceived, may not be reported. Hence, self-reported racism really captures only the tip of the iceberg of the health effects of racism

� The self-reporting of racism is not accounted for by psychological factors such as neuroticism, hostility, cynicism, social desirability or impression management.

Self-reported racism & health

� A worldwide review of population-based quantitative studies located 138 studies of self-reported racism and health up until the end of 2004

� Self-reported racism was strongly associated with poor mental health outcomes and weakly associated with poor physical health outcomes

� These associations remained after adjusting for a range of confounders and were shown in longitudinal as well as cross-sectional studies

Worldwide studies of self-reported racism & health

(n=256)

1

96

5 7

42

105

0

20

40

60

80

100

120

1980-4 1985-9 1990-4 1995-9 2000-4 2005-9

No. of studies

Racism and Indigenous health

� Information is available from the WAACHS, NATSIHS, the Darwin Region Urban Indigenous Diabetes (DRUID) study , the Indigenous Urban Location and Health Project and from Larson et al.(2007).

WAACHS & NATSIHS

� After adjusting for age and sex, racism was associated with increased smoking, marijuana use and alcohol consumption among the 1,960 respondents in the WAACHS.

� Racism was significantly associated with self-assessed health status, psychological distress and substance use among the 5,757 respondents in the NATSIHS.

The NATSIHS

2.1 (1.7-2.7)2.3 (1.8-2.8)Substance useSubstance use

1.9 (1.4-2.4)2.2 (1.8-2.6)Psychological Psychological

distressdistress

1.3 (1.2-1.7)1.5 (1.2-1.7)SelfSelf--assessed assessed

health statushealth status

OR adjusted for OR adjusted for

confoundersconfoundersOR adjusted OR adjusted

for age & sexfor age & sexOutcomeOutcome

N=5,757N=5,757

The DRUID Study

� The Darwin Region Urban Indigenous Diabetes (DRUID) study focused on diabetes and related conditions in people aged 15 years and over who lived in the Darwin area and were Indigenous

� 312 DRUID participants completed the survey questions which asked about racism. Inter-personal racism was strongly and consistently associated with depression, poor/fair self-assessed health status and poor mental health

Indigenous Urban Location

and Health Project

� This study focused on Indigenous people living in urban locations across Adelaide. Questions on racism based on the DRUID study were asked of 153 Indigenous participants (Gallaher et al. 2007).

� Preliminary findings show unadjusted correlations between experiences of racism in service provision, from neighbours, and health staff, and poor general health status (SF-12)

‘It’s enough to make you sick’

� A study by Larson et al. (2007) among 183 Indigenous

people in a rural town in Western Australia in 2003.

� Two questions were included on emotional and physical

upset (respectively) due to ‘how you were treated because

of your race’ in the past four weeks.

� Analyses show a significant association between racism and

reduced physical and mental health (SF-12) after adjusting

for age, sex, employment and education.

Combating Racism

�� Individual levelIndividual level

�� InterInter--personal levelpersonal level

�� Systemic levelSystemic level

Individual anti-racism

�� Dispelling false beliefs/stereotypesDispelling false beliefs/stereotypes

�� Highlighting discrepancies between egalitarian Highlighting discrepancies between egalitarian

principles and racist attitudesprinciples and racist attitudes

�� Promoting empathyPromoting empathy

Interpersonal anti-racism

�� Equal group statusEqual group status

�� Common goalsCommon goals

�� InterInter--group cooperationgroup cooperation

�� Support of authorities, law or customSupport of authorities, law or custom

�� Friendship potentialFriendship potential

Systemic anti-racism

�� Public awareness campaignsPublic awareness campaigns

Systemic anti-racism

�� Positive dutiesPositive duties

�� LegislationLegislation

Future Directions

�� There is a need to invest in further research:There is a need to invest in further research:

�� to find effective ways to address systemic racism in to find effective ways to address systemic racism in

public institutionspublic institutions

�� to combat interto combat inter--personal racism against Indigenous personal racism against Indigenous

peoplepeople

�� to better understand the nature and impact of racism to better understand the nature and impact of racism

on Indigenous healthon Indigenous health

Racism research

� The instrument I developed to measure Indigenous experiences of racism has now been used in studies in Darwin, Adelaide, Melbourne and Sydney

� Further analysis of the association between racism and health in national/state surveys in underway

� A detailed assessment of racism in the 2008 NATSISS should reveal the true prevalence of racism against Indigenous Australians

Anti-racism research

� ARC linkage grant to formulate anti-racism responses in selected localities across the country, involving anti-discrimination commissions and the Department of Immigration and Citizenship

� A framework for addressing racism in Victoria

� Evaluation of the VicHealth ‘Building Bridges’ program aimed at reducing prejudice among CALD youth