Racism and discrimination
The link between self-reported perceptions or experiences of racism and poorer physical and mental health is well established (Kelaher et al. 2014; Ferdinand et al. 2013). There are a number of pathways from racism to ill-health, including: reduced access to societal resources such as education, employment, housing and medical care; inequitable exposure to risk factors including stress and cortisol dysregulation affecting mental health (anxiety and depression); immune, endocrine, cardiovascular and other physiological systems; and injury from racially motivated assault (see Figure 17). Longitudinal and cross-sectional studies both nationally and internationally have found a strong association between experiences of racism and ill-health and psychological distress, mental health conditions, and risk behaviours such as substance use (Paradies 2007; Gee et al. 2009; Paradies et al. 2014). Chronic exposure to racism leads to excessive stress, which is an established determinant of obesity, inflammation and chronic disease (Egger et al. 2014). Analysis of the 2012–-13 Health Survey found that Indigenous Australians with high/very high levels of psychological distress were 1.3 times as likely to report having circulatory disease and 1.8 times as likely to report having kidney disease.
In the 2012–13 Health Survey, 16% of Indigenous Australians reported that they were treated badly in the previous 12 months because they are Aboriginal or Torres Strait Islander. Other studies have found self-reported experiences of racism among Aboriginal and Torres Strait Islander peoples range from 16%–97% depending on the aspects of racism researched (Paradies 2011). A study of 755 Aboriginal Victorians reported that nearly all respondents (97%) had experienced at least one incident they perceived as racist in the preceding 12 months, with 35% reporting experiencing an incident within the past month (Ferdinand et al. 2013). A recent survey to gain insight into discriminatory attitudes and beliefs of non‑Indigenous Australians (aged 25–44 years) towards Indigenous Australians (Beyond Blue 2014) found a general lack of awareness of what behaviour is considered discriminatory, along with widespread belief that behaviours such as employment discrimination are considered an 'unconscious act' by the perpetrator. Key findings include:
- Discrimination is commonly witnessed, with 40% seeing others avoid Indigenous Australians on public transport and 38% witnessing verbal abuse of Indigenous Australians.
- Almost a third (31%) witnessed employment discrimination against Indigenous Australians and 9% admit they themselves discriminate in this context.
- One in four (25%) do not agree that discrimination has a negative personal impact for Indigenous Australians.
- More than half (56%) believe that being an Indigenous Australian makes it harder to succeed.
- Many believe it is acceptable to discriminate, with 21% admitting they would move away from an Indigenous Australian if they sat nearby, and 21% would watch an Indigenous Australian's actions when shopping.
Ferdinand et al. (2013) found two-thirds (67%) of Indigenous Australians who participated in their survey reported being spat at or having something thrown at them, and 84% reported being sworn at or verbally abused. The research also found that about a third (29%) of respondents experienced racism in health settings, 35% in housing, 42% in employment and 67% in shops.
Research and survey results indicate a common response to experiencing racism is to subsequently avoid similar situations: 35% of those who reported in the 2012–13 Health Survey that they had been treated badly, said they usually responded to discrimination by avoiding the person or situation. This holds implications across health (Kelaher et al. 2014), education (Priest et al. 2014), and employment sectors (Biddle, Nicholas et al. 2013).
Figure 17 shows pathways between racism and ill health, with cross-reference to measures within the Aboriginal and Torres Strait Islander Health Performance Framework. This figure is adapted from Paradies et al 2014. There are a number of pathways from racism to ill health, including: reduced access to societal resources such as education, employment, housing and medical care; inequitable exposure to risk factors including stress and cortisol dysregulation affecting mental health (anxiety and depression); immune, endocrine, cardiovascular and other physiological systems; and injury from racially motivated assault.
Source: Adapted from Paradies et al. (2013)