ABORIGINAL AND TORRES STRAIT ISLANDER
HEALTH PERFORMANCE FRAMEWORK 2017 REPORT

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, 2012). 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 40)  (Williams, DR & Mohammed, 2013; Paradies et al, 2013).

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 & Walsemann, 2009; Paradies et al, 2014; Williams, CJ & Jacobs, 2009). A residual racial difference has been found in a range of health outcomes after controlling for socio-economic status (Williams, DR & Mohammed, 2009). Chronic exposure to racism leads to excessive stress, which is an established determinant of obesity, inflammation and chronic disease (Egger & Dixon, 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. Recent research has found that young adult Indigenous Australians had impaired secretion of the stress hormone cortisol and that this was linked to the racial discrimination they experienced (Berger et al, 2017). Research in the US has found that supportive family environments in adolescence buffer the impact of racism, controlling for other factors (Brody et al, 2016).

Racism takes many forms:

• Interpersonal racism is the discrimination or promotion of unfair inequalities by people of one ethnic group toward people of another. This includes verbal or behavioural abuse.
• Internalised racism occurs where a member of a stigmatised group believes racial stereotypes and accepts a position of inferiority.
• Systematic or institutionalised racism is apparent in policies and practices that support or create inequalities between ethnic groups.
• Intra-personal racism is discrimination perpetrated by a member of an ethnic group towards a member of the same group.

In the 2014–15 Social Survey, 35% of Indigenous Australians aged 15 years and over reported that they were treated unfairly in the previous 12 months because they are Aboriginal or Torres Strait Islander. Many said they had heard racial comments or jokes (23%), had been called names, teased or sworn at (14%), had been ignored or served last while accessing services or buying something (9%) or not trusted (9%) (ABS, 2016e).

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In 2014, the Australian Reconciliation Barometer survey reported that Aboriginal and Torres Strait Islander people were 3 times as likely to have experienced verbal abuse in the past 6 months (31%) as the general community (13%) (Reconciliation Australia, 2015). The general community were more likely to cite the media (36%) as their main source of information about Indigenous Australians than Indigenous respondents (10%). Indigenous respondents were more likely to disagree strongly (50%) with a statement that ‘non-Indigenous Australians are superior’, than the general community (35%). However, 19% of Indigenous respondents agreed with this sentiment. Indigenous respondents were more likely than the general community to have experienced at least one form of prejudice, on the basis of their race (39%) than the general community (16%). Indigenous respondents were more likely to have experienced racial discrimination from:

• a school teacher and/or principal in the past 12 months (14%), 5 times as many as the general community (3%)
• health staff (11%) and employers (13%) in the past 12 months compared with the general community (4% and 6% respectively)
• police (16%) and real estate agents (11%) in the past year, compared with just 4% of the general community.

Indigenous respondents were also more likely to feel that they cannot be themselves in their interactions with government (53%), or in interactions with law and order officials (54%), than the general public (35% and 32% respectively).

A recent survey on attitudes of non‑Indigenous Australians (aged 25–44 years) towards Indigenous Australians (Beyond Blue, 2014) found that:

• Discrimination is commonly witnessed, with 40% seeing others avoid Indigenous Australians on public transport and 38% witnessing verbal abuse of Indigenous Australians.
• 31% witnessed employment discrimination against Indigenous Australians and 9% admit they themselves discriminate in this context.
• 25% did 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.

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, 2012). Ferdinand et al. (2012) 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. Over half of those who experienced racial discrimination reported feelings of psychological distress and the risk of high or very high levels of psychological distress increased as the volume of racism increased. 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.

Experiences of racism in housing include real estate agents falsely stating that there are no rental properties available or no success in applications in comparison to other non-Indigenous applicants (Andersen et al, 2016; Nelson, J et al, 2015). Racism has also been found to be associated with mental health and aspects of physical health for Aboriginal children (Shepherd et al, 2016). A common response to experiencing racism is to subsequently avoid similar situations (Williams, DR & Mohammed, 2009). In the 2014–15 Social Survey, 14% of Indigenous Australians aged 15 years and over reported that they avoided situations due to past unfair treatment. This holds implications across health (Kelaher et al, 2014), education (Priest et al, 2014), and employment sectors (Biddle, 2013).

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