In contrast, personally-mediated racism has been defined as, “prejudice and discrimination, where prejudice is differential assumptions about the abilities, motives, and intents of others by ‘race,’ and discrimination is differential actions towards others by ‘race’” (p. Institutionalised racism, for example, has been defined as, “the structures, policies, practices, and norms resulting in differential access to the goods, services, and opportunities of society by race” (p. Racism can be expressed at structural and individual levels, with several taxonomies describing different levels of racism. Historical power relationships underpin systems of racism, which in New Zealand relates specifically to our colonial history and ongoing colonial processes. Racism can be understood as an organised system based on the categorisation and ranking of racial/ethnic groups into social hierarchies whereby ethnic groups are assigned differential value and have differential access to power, opportunities and resources, resulting in disadvantage for some groups and advantage for others. In models of health, racism is recognised as a key social determinant that underpins systemic ethnic health and social inequities, as is evident in New Zealand and elsewhere. In New Zealand, these inequities are largely patterned by ethnicity, particularly for Māori (the indigenous peoples) and Pacific peoples, and intertwined with ethnic distributions of socioeconomic status. This method allows for management of confounding at the sampling stage, while also reducing the need and cost of following up with all NZHS participants.ĭifferential access to the social determinants of health both creates and maintains unjust and avoidable health inequities. The use of the NZHS as a baseline for a prospective study allows for the use of propensity score methods during the sampling phase as a novel approach to recruiting participants from the NZHS. This study will add robust evidence on the causal links between experience of racism and subsequent health. Analysis will compare outcomes between those exposed and unexposed to racism, using regression models and inverse probability of treatment weights (IPTW) to account for the propensity score sampling process. Those invitees not responding following reminders are contacted for computer-assisted telephone interview (CATI).Ī brief questionnaire was developed covering current health status (mental and physical health measures) and recent health-service utilisation (unmet need and experiences with healthcare measures). Respondents receive an initial invitation letter with choice of paper or web-based questionnaire. All exposed participants are invited to participate, with unexposed participants selected using propensity score matching (propensity scores for exposure to racism, based on several major confounders). Target sample size is 1680 participants (half exposed, half unexposed) with follow-up survey timed for 12–24 months after baseline NZHS interview. Participants are adults aged 15+ sampled from 2016/17 New Zealand Health Survey (NZHS) participants, sampled based on exposure to racism (ever exposed or never exposed, using five NZHS questions) and stratified by ethnic group (Māori, Pacific, Asian, European and Other). Most of these studies have used cross-sectional designs: this prospective cohort study (drawing on critical approaches to health research) should provide substantially stronger causal evidence regarding the impact of racism on subsequent health and health care outcomes.
Studies have shown that people exposed to racism have poorer health outcomes (particularly for mental health), alongside both reduced access to health care and poorer patient experiences.
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Racial discrimination is recognised as a key social determinant of health and driver of racial/ethnic health inequities.
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