Experiences of racism among Aboriginal and Torres Strait Islander adults living in the Australian state of Victoria: a cross-sectional population-based study.

BACKGROUND: Racism is a key determinant of the health of Indigenous Australians that may explain the unremitting gap in health and socioeconomic outcomes between Indigenous and non-Indigenous Australians. We quantified the population-based prevalence of experiences of racism of Indigenous adults in the Australian state of Victoria and investigated whether this was independent of social determinants and lifestyle risk factors. METHODS: We combined data from the 2011, 2012 and 2014 Victorian Population Health Surveys to obtain a sample size of 33,833 Victorian adults, including 387 Indigenous adults. The survey is a cross-sectional, population-based, computer-assisted telephone interview survey conducted annually. Using logistic regression, experiences of racism was the dependent variable and Indigenous status the primary independent variable of interest. Secondary independent variables included age, sex, rurality, socioeconomic status, social capital, and lifestyle risk factors. RESULTS: Indigenous Victorian adults were four times more likely than their non-Indigenous counterparts to have experienced racism in the preceding 12 months; odds ratio (OR) = 4.3 (95% confidence interval (CI): 3.2-5.8). Controlling for social determinants and lifestyle risk factors attenuated, but did not eliminate, the association between experiences of racism and Indigenous status; OR = 3.1 (95% CI: 2.2-4.3). The social determinants of age and social trust made the largest contribution to the attenuation of the association. Education also had a large impact on the association, but in the opposite direction, suggesting that a low level of education may be protective against experiences of racism. When the non-Indigenous comparison group consisted of adults of mainly Anglo-Celtic origin, Indigenous adults were seven times more likely (OR = 7.2; 5.3-9.7) to have experienced racism. CONCLUSIONS: Racism directed against Indigenous Victorians is significant and cannot be ascribed to any specific attributes such as socioeconomic status or lifestyle risk factors. We argue that a human rights-based approach to policy-making for the elimination of systemic and interpersonal racism offers an opportunity and viable alternative to current policy-making, that continues to be dominated by a paternalistic approach that reinforces racism and the resulting inequities. PLEASE NOTE: Throughout this document, the term Indigenous is taken to include people of Aboriginal and Torres Strait Islander descent. While not our preferred term, Indigenous is used in preference to Aboriginal and Koori as not all Indigenous people living in Victoria are Aboriginal or Koori. We recognise that, with the exception of the term 'Koori', these terms are Eurocentric having been imposed upon a people of many nations with distinct languages and cultures. The use of such terms is akin to referring to the peoples of the continent of Europe as 'Europeans'.

Perceived racism may partially explain the gap in health between Aboriginal and non-Aboriginal Victorians: A cross-sectional population based study.

BACKGROUND: There is a persistent gap in the health of Aboriginal Victorians compared with non-Aboriginal Victorians, where Aboriginal Victorians have poorer health. Currently, the most commonly touted explanation for this gap revolves around health behaviours known as 'lifestyle risk factors'. Yet the gap in health is similarly matched by persistent gaps in social and economic outcomes that reflect past and ongoing discrimination of Aboriginal peoples across Australia. Perceived racism has been implicated as a key determinant of the gap in health between Indigenous and non-Indigenous peoples across the world. We sought to determine the contribution of perceived racism to the gap in health and how this compared with the contribution of lifestyle risk factors and other determinants of health such as socioeconomic status. METHODS: We combined data from 2011, 2012 and 2014 Victorian Population Health Surveys (VPHS) to obtain a sample size of 33,833 Victorian adults, including 387 Aboriginal adults. The VPHS is a population-representative, cross-sectional, computer-assisted telephone interview survey conducted annually. Using logistic regression, poor self-reported health status was the dependent variable and Aboriginal status was the primary independent variable of interest. Secondary independent variables included age, sex, perceived racism, socioeconomic status, and lifestyle risk factors. RESULTS: Aboriginal Victorians were almost twice as likely as non-Aboriginal Victorians to report poor health; OR=1.9 (95% confidence interval; 1.3-2.6). Perceived racism explained 34% of the gap in self-reported health status between Aboriginal and non-Aboriginal Victorians, followed by: smoking (32%), unhealthy bodyweight (20%), socioeconomic status (15%), excessive consumption of alcohol (13%), and abstinence from alcohol consumption (13%). In contrast, physical inactivity made no contribution. Together, perceived racism and smoking explained 58% of the gap, while all secondary independent variables explained 82% of the gap. CONCLUSIONS: Perceived racism may be an independent health risk factor that explains more than a third of the health gap between Aboriginal and non-Aboriginal Victorians; equivalent in strength to smoking. The recognised failure of the Australian government's Closing the Gap strategy may be due in part to the failure to consider other determinants of the health gap beyond the lifestyle risk factors, namely racism, which may act to damage health through multiple pathways at multiple points along the causal chain.