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.

Being a ‘wog’ in Melbourne – young people's self-fashioning through discourses of racism

The Greek community in Melbourne, Australia, is large and has a long history in the city. It is diverse and associated with a range of cultural, social and political structures. It has strong transnational links and in many ways exemplifies ‘diasporic’ in contradistinction to ‘migrant’. This paper focuses on young people from this community, particularly those who attend schools established to promote Greek language and cultural maintenance. In this paper, we examine such students’ explorations of their cultural identifications, most specifically how they adopt the term ‘wog’. This term is complex and its place in Australian discourse has shifted over time. Tracking these shifts and considering them as a context for these young people's use of the term allows us to consider the processes involved in their self-fashioning. We argue that their uptake of ‘wog’ involves the deployment of irony, given their awareness of its strong association with racism. We are also interested in the potential for women's experience to be silenced through the common association between ‘wog’ and protest masculinities. We argue that these students’ use of the term illustrates self-fashioning that provides insights into the complexities that surround cultural identification at the micro level, including schooling, but also in the broader context of globalisation.

‘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.

School principals and racism: responding to Aveling

This study responds to Nado Aveling's call in ‘Anti-racism in Schools: A question of leadership?’ (Discourse: Studies in the Cultural Politics of Education, 2007, 28(1), 69–85) for further investigation into racism in Australian schools. Aveling's interview study concluded that an overwhelming number of school principals denied the presence of racism in their schools, and that there were no discernible differences in how principals in different schools constructed racism. In contrast, our research found that school principals' constructions of cultural racism are strongly influenced by their school contexts. We elucidate these differences examining the various intersections between race, class and religion deployed by principals in different sites, and argue for the utility of examining and theorising cultural racism using an intersectional approach. By bringing context into our analysis we provide a more nuanced insight into the different ways in which racism is constituted and understood by Australian school principals.

Experiences of racism, racial/ethnic attitudes, motivated fairness and mental health outcomes among primary and secondary school students

While studies investigating the health effects of racial discrimination for children and youth have examined a range of effect modifiers, to date, relationships between experiences of racial discrimination, student attitudes, and health outcomes remain unexplored. This study uniquely demonstrates the moderating effects of vicarious racism and motivated fairness on the association between direct experiences of racism and mental health outcomes, specifically depressive symptoms and loneliness, among primary and secondary school students. Across seven schools, 263 students (54.4% female), ranging from 8 to 17 years old (M = 11.2, SD = 2.2) reported attitudes about other racial/ethnic groups and experiences of racism. Students from minority ethnic groups (determined by country of birth) reported higher levels of loneliness and more racist experiences relative to the majority group students. Students from the majority racial/ethnic group reported higher levels of loneliness and depressive symptoms if they had more friends from different racial/ethnic groups, whereas the number of friends from different groups had no effect on minority students' loneliness or depressive symptoms. Direct experiences of racism were robustly related to higher loneliness and depressive symptoms in multivariate regression models. However, the association with depressive symptoms was reduced to marginal significance when students reported low motivated fairness. Elaborating on the negative health effects of racism in primary and secondary school students provides an impetus for future research and the development of appropriate interventions.

Experience of racism and tooth brushing among pregnant Aboriginal Australians: exploring psychosocial mediators

Despite burgeoning evidence regarding the pathways by which experiences of racism influence health outcomes, little attention has been paid to the relationship between racism and oral health-related behaviours in particular. We hypothesised that self-reported racism was associated with tooth brushing, and that this association was mediated by perceived stress and sense of control and moderated by social support.

Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities

To examine experiences of racism in health settings and their impact on mental health among Aboriginal Australians.