The pervasive effects of racism: Experiences of racial discrimination in New Zealand over time and associations with multiple health domains

Abstract

Self-reported experience of racial discrimination has been linked to a range of health outcomes in various countries and for different ethnic groups. This study builds on previous work in New Zealand to further investigate the prevalence of self-reported experience of racial discrimination by ethnicity, changes over time and associations with multiple health measures.

The study uses data from the 2002/03 (n = 12,500) and 2006/07 (n = 12,488) New Zealand Health Surveys, nationally representative population-based surveys of adults (15+ years). Reported experience of racial discrimination was measured in both surveys and covered 5 items: experience of an ethnically motivated physical or verbal attack; and unfair treatment because of ethnicity by a health professional, in work, or when gaining housing. Ethnicity was classified as Maori, Pacific, Asian or European. Health indicators included measures of: mental health (SF36 mental health scale, psychological distress, doctor diagnosed mental health condition); physical health (self-rated health, SF36 physical functioning scale, cardiovascular disease); and health risk (smoking, hazardous drinking, excess body fat). Logistic regression was used to examine changes in prevalence of reported experience of racial discrimination over time and associations with health.

Reported experience of racial discrimination increased between 2002/03 (28.1% ever) and 2006/07 (35.0% ever) among Asian peoples but remained largely unchanged for other ethnic groupings (Maori 29.5%, Pacific 23.0%, European 13.5%). Experience of racial discrimination was associated with all negative health measures except excess body fat. Where there were significant associations, a dose-response relationship was also evident.

We conclude that racial discrimination experienced across a range of settings has the potential to impact on a wide range of health outcomes and risk factors. While ongoing research is needed to understand the multifarious nature of racism and the pathways by which it leads to poor health, it is feasible to monitor experiences of racial discrimination in national surveys.

Introduction

In recent years, evidence indicating racism as an important determinant of health and driver of ethnic inequalities has grown considerably (Paradies, 2006a; Pascoe & Smart Richman, 2009; Williams & Mohammed, 2009). However, in New Zealand this is still an emerging field.

New Zealand has a population of approximately 4.4 million people (Statistics New Zealand, 2010). Maori are the indigenous peoples and make up 15% of the population. The other major ethnic groupings are European (77% of the population), Pacific (7%) and Asian (10%). There are stark ethnic disparities in health and socioeconomic position (SEP) in New Zealand. Maori and Pacific people experience lower life expectancy and health disadvantage across most mortality and morbidity indicators compared to European, as well as socioeconomic disadvantage in areas such as housing, education, income, and employment (Ministry of Health & Ministry of Pacific Island Affairs, 2004; Robson & Harris, 2007). Overall, Asian people have similar or better health than the total population although there is relatively less information on the health of Asian people in New Zealand (Ministry of Health, 2006).

Racism is a complex system, based on an ideology of inferiority and superiority, that drives the categorization of people by race/ethnicity and structures opportunity according to those categorizations, resulting in the inequitable distribution of power, goods and resources in society (Ahmed, Mohammed, & Williams, 2007; Jones, 2002; Paradies, 2006b). Racism is enacted via discriminatory institutional and individual practices (racial discrimination) and varies in form and type (Krieger, 2000). Its manifestations are embedded in particular social, political and historical contexts. In New Zealand, this context includes colonization, and related processes of dispossession and marginalization for indigenous peoples, which are reflected in entrenched unequal power relations in contemporary New Zealand society (Robson & Harris, 2007).

Racial discrimination can affect health in different ways (Brondolo, Gallo, & Myers, 2009; Jones, 2001; Williams & Mohammed, 2009). It is hypothesized that racial discrimination is causally related to health status and ethnic disparities through physiological responses to chronic psychosocial stress that results in morbidity and mortality (Williams & Mohammed, 2009). Psychosocial stress responses to racial discrimination also appear to impact health through health related behaviors such as smoking and alcohol consumption, and individuals’ interactions with health care systems (Brondolo et al., 2009; Lee, Ayers, & Kronenfeld, 2009; Pascoe & Smart Richman, 2009). Racial discrimination can have direct impacts on health through the experience of racially motivated attacks and violence (Krieger, 2000). In a less direct, but no less profound manner, racial discrimination impacts health through the structuring of societal resources and health determinants such as employment, education and housing by ethnicity, as well as by influencing access to health care and quality of care received (Williams & Mohammed, 2009).

Most studies of the relationship between racial discrimination and health have focused on individual self-reported experience of racial discrimination, generally showing a negative effect on a range of health outcomes, risk factors and health service utilization measures across various racial/ethnic groups, predominantly in the United States of America but increasingly in other countries (Paradies, 2006a; Williams & Mohammed, 2009). In addition, over 30 longitudinal studies suggest that the primary direction of causation is from racial discrimination to ill health (Paradies, 2006a; Pascoe & Smart Richman, 2009; Williams & Mohammed, 2009).

Although relatively less research has been undertaken on racial discrimination and health in New Zealand, evidence suggests that it may operate in much the same way by structuring determinants of health by ethnicity, with ethnic disparities well-documented in areas such as housing, education, welfare, justice and employment (Robson & Harris, 2007). In addition, self-reported experience of racial discrimination (personal attack and unfair treatment on the basis of ethnicity) has been associated with poorer health outcomes (Harris et al., 2006a). Analysis of the 2002/03 New Zealand Health Survey (NZHS) showed Maori reported the highest prevalence of ‘ever’ experiencing racial discrimination (34%), followed by similar levels among Asian (28%) and Pacific groups (25%). Experience of racial discrimination was significantly linked to poorer health outcomes (mental and physical health, cardiovascular disease (CVD), and smoking) for all ethnic groups and, combined with socioeconomic differences, appeared to account for much of the health inequalities between Maori and Europeans (Harris et al., 2006a, 2006b).

This study builds on previous work to update and expand analyses of the 2002/03 New Zealand Health Survey (NZHS) with data from the 2006/07 NZHS. The NZHS is run by the New Zealand Ministry of Health and undertaken at regular intervals (approximately four-yearly) to monitor changes in the health of the population (Ministry of Health, 2008a). Measures of racial discrimination were first introduced in 2002/03 and repeated in 2006/07. Improvements in survey design, along with developments in the literature, prompted analyses of a wider range of health measures than previously examined in New Zealand.

The specific aims of this study are to: examine changes in the prevalence of reported experience of racial discrimination by ethnicity between 2002/03 and 2006/07; identify predictors of self-reported racial discrimination in 2006/07; and, examine the association of experience of racial discrimination in 2006/07 with mental and physical health outcomes, and risk factors.