Racism as a determinant of health: a protocol for conducting a systematic review and meta-analysis

Background: 

A systematic review of the extent and measurement of healthcare provider racism

Background
Although considered a key driver of racial disparities in healthcare, relatively little is known about the extent of interpersonal racism perpetrated by healthcare providers, nor is there a good understanding of how best to measure such racism.

Objectives
This paper reviews worldwide evidence (from 1995 onwards) for racism among healthcare providers; as well as comparing existing measurement approaches to emerging best practice, it focuses on the assessment of interpersonal racism, rather than internalized or systemic/institutional racism.

Methods
The following databases and electronic journal collections were searched for articles published between 1995 and 2012: Medline, CINAHL, PsycInfo, Sociological Abstracts. Included studies were published empirical studies of any design measuring and/or reporting on healthcare provider racism in the English language. Data on study design and objectives; method of measurement, constructs measured, type of tool; study population and healthcare setting; country and language of study; and study outcomes were extracted from each study.

Results
The 37 studies included in this review were almost solely conducted in the U.S. and with physicians. Statistically significant evidence of racist beliefs, emotions or practices among healthcare providers in relation to minority groups was evident in 26 of these studies. Although a number of measurement approaches were utilized, a limited range of constructs was assessed.

Conclusion
Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

A systematic review of studies examining the relationship between reported racism and health and wellbeing for children and young people

Racial discrimination is increasingly recognised as a determinant of racial and ethnic health inequalities, with growing evidence of strong associations between racial discrimination and adult health outcomes. There is a growing body of literature that considers the effects of racial discrimination on child and youth health. The aim of this paper is to provide a systematic review of studies that examine relationships between reported racial discrimination and child and youth health. We describe the characteristics of 121 studies identified by a comprehensive search strategy, including definitions and measurements of racial discrimination and the nature of reported associations. Most studies were published in the last seven years, used cross-sectional designs and were conducted in the United States with young people aged 12–18 years. African American, Latino/a, and Asian populations were most frequently included in these studies. Of the 461 associations examined in these studies, mental health outcomes (e.g. depression, anxiety) were most commonly reported, with statistically significant associations with racial discrimination found in 76% of outcomes examined. Statistically significant associations were also found for over 50% of associations between racial discrimination and positive mental health (e.g. self esteem, resilience), behaviour problems, wellbeing, and pregnancy/birth outcomes. The field is currently limited by a lack of longitudinal studies, limited psychometrically validated exposure instruments and poor conceptualisation and definition of racial discrimination. There is also a need to investigate the complex and varying pathways by which reported racial discrimination affect child and youth health. Ensuring study quality in this field will allow future research to reveal the complex role that racial discrimination plays as a determinant of child and youth health.

Talking culture? Egalitarianism, color-blindness and racism in Australian elementary schools

This study examines egalitarianism as an ethnic-racial socialization message used by teachers with 8-12 year old children in four socio-demographically diverse elementary schools in Melbourne, Australia. The three main types of egalitarian messages identified are i) procedural-justice color-blindness, ii) distributive-justice color-blindness and iii) colormuteness, and each is explored in relation to how teachers talk to children about racial, ethnic and cultural diversity, and racism. We conclude that teacher confidence and capability, and to a lesser degree, school context, influenced the types of egalitarian messages used about diversity and the extent to which teachers had explicit and critical discussions about racism.

“Never read anything that can at all unsettle your religious faith”: reading and writing in the monthly packet

The Monthly Packet of Evening Readings for Younger Members of the English Church (1851–99) reveals the interest that Charlotte Yonge had in promoting and supporting girls as readers and writers. As the editor and as a major contributor, Yonge provided a variety of material for the magazine as part of a strategy for the development of girls' reading and writing habits in ways that were consistent with their High Anglican beliefs and that would never cause them to question their faith.

Fostering intercultural understanding through secondary school experiences of cultural immersion

In parallel with many nations’ education policies, national education policies in Australia seek to foster students’ intercultural understanding. Due to Australia’s location in the Asia-Pacific region, the Australian government has focused on students becoming “Asia literate” to support Australia’s economic and cultural engagement with Asian countries. Drawing on Allport’s optimal contact principles and key factors supporting intercultural understanding, this study examines two “sister school” cultural immersion trips in Indonesia and East Timor to explore ways in which their different approaches supported positive intergroup contact and helped foster intercultural understanding among students. Focus groups and interviews with school project teams and analysis of both researcher and teacher project field notes and documents suggested that these schools’ programmes could be mapped onto Allport’s contact principles in different ways. The paper concludes with promising approaches that can help to inform sister school programmes.

‘You are not born being racist, are you?’ Discussing racism with primary aged-children

Ethnic-racial socialisation is broadly described as processes by which both minority and majority children and young people learn about and negotiate racial, ethnic and cultural diversity. This paper extends the existing ethnic-racial socialisation literature in three significant ways: it (1) explores ways children make sense of racial and ethnic diversity in relation to their experiences of racial and ethnic diversity and racism; (2) considers ways children identify racism and make distinctions between racism and racialisation; and (3) examines teacher and parent ethnic-racial socialisation messages about race, ethnicity and racism with children. This research is based on classroom observations, semi-structured interviews and focus groups with teachers, parents and students aged 8-12 years attending four Australian metropolitan primary schools. The findings reveal that both teachers and parents tended to discuss racism reactively rather than proactively. The extent to which racism was discussed in classroom settings depended on: teachers’ personal and professional capability; awareness of racism and its perceived relevance based on student and community experiences; and whether they felt supported in the broader school and community context. For parents, key drivers for talking about racism were their children’s experiences and racial issues reported in the media. For both parents and teachers, a key issue in these discussions was determining whether something constituted either racism or racialisation. Strategies on how ethnic-racial socialisation within the school system can be improved are discussed.