The Impact of Racism on Health and Wellbeing
Racism is being cited more commonly in the international literature as having serious adverse consequences for health and is widely acknowledged as playing a crucial role in the formation of health disparities. Racism takes many forms and can be expressed at interpersonal, systemic, and internalised levels. Accordingly, the pathways by which racism impacts on health are multifaceted and complex, for all populations. They include the direct impacts of racism on health (e.g. racially motivated physical assault), and the indirect effects that stem from reduced and unequal access to medical, social and economic resources required for good health, increased exposure to risk factors associated with ill health, such as withdrawal from health care and health promoting activities, and the stress of racism and its ill effects. In addition, poor health in childhood has been linked to the experience of vicarious racism—that is, the experiences of others, including parents, carers and family members. Few studies have examined how vicarious racism impacts on child health and wellbeing (Page 2).
We used data on 1239 Indigenous children aged 5–10 years from Waves 1–6 (2008–2013) of Footprints in Time, a longitudinal study of Indigenous children across Australia. We examined associations between three dimensions of carer-reported racial discrimination (measuring the direct experiences of children and vicarious exposure by their primary carer and family) and a range of physical and mental health outcomes.
Six waves of data from the Footprints in Time study (the Longitudinal Study of Indigenous Children; hereafter referred to as LSIC) are drawn upon to examine the associations between racial discrimination and a range of health outcomes. These outcomes include mental health, general health, sleep difficulties and obesity. In addition, we examine injury as an outcome given the direct threats to health posed by racial violence and the indirect pathways from racism-related stress to mental impairment and unintentional injuries, and asthma, to further test the relationship found between psychosocial stress and the risk to poor child respiratory health. In addition, we use population attributable risks (PARs) to further assess the significance of racism as a determinant of Australian Indigenous child health (Page 3).
Two-fifths (40%) of primary carers, 45% of families and 14% of Indigenous children aged 5–10 years were reported to have experienced racial discrimination at some point in time, with 28–40% of these experiencing it persistently (reported at multiple time points). Almost a quarter (23%) of Indigenous children in Wave 6 of the LSIC had a mental health problem (high risk of clinically significant emotional or behavioural difficulties). In addition, 25% had their health assessed as less than excellent or very good, 21% had difficulty sleeping in the last month, 21% were obese, 4% had suffered an injury in their lifetime, and 11% had asthma. Two-fifths (40%) of primary carers, 45% of families and 14% of Indigenous children aged 5–10 years were reported to have experienced racial discrimination at some point in time. The majority (69%) of primary carers that had experienced racial discrimination had a time-limited exposure (reported in one wave only), while 31% experienced persistent racial discrimination (reported in multiple waves). A similar pattern was observed for family members (60% time-limited and 40% persistent) and study children (72% and 28%, respectively) (Page 5).
Children aged 9–10 years were over 4 times more likely to be treated badly or discriminated against because they were Indigenous than children aged 5–6 years (Page 5).
Primary carer and child experiences of racial discrimination were each associated with poor child mental health status (high risk of clinically significant emotional or behavioural difficulties), sleep difficulties, obesity and asthma, but not with child general health or injury. Children exposed to persistent vicarious racial discrimination were more likely to have sleep difficulties and asthma in multivariate models than those with a time-limited exposure (Page 1).
The effect sizes for the associations between primary carer experiences of racial discrimination and child health tended to be considerably larger for those exposed to persistent racial discrimination when compared with those who experienced time-limited racial discrimination, suggesting a dose-response relationship between this form of vicarious racism and mental health, sleep difficulties and asthma. For example, children were 2.6 times more likely to have asthma when their primary carer experienced persistent racial discrimination, compared to when the carer reported racial discrimination in one wave only (Page 5).
The magnitude of elevated risk for mental health found in our study is consistent with existing studies in Australian Indigenous settings and suggests that the direct experience of racial discrimination (assessed using single-item measures) is associated with a doubling of the risk of an Indigenous child or youth developing a mental health problem. This includes a diverse set of mental health outcomes, such as anxiety, depression, suicide risk, low self-esteem, as well as overall mental health status (Page 9).
The results here suggest that eradicating racism is likely to reduce the burden associated with some important health problems in childhood and therefore account for a portion of the health inequality between Indigenous and other Australians (Page 10).
Reference: Shepherd, et al. (2017). The impact of racial discrimination on the health of Australian Indigenous children aged 5–10 years: analysis of national longitudinal data. International Journal for Equity in Health, 16:116. Pages 1 – 10. DOI 10.1186/s12939-017-0612-0