It's enough to make you sick: the impact of racism on the health of Aboriginal Australians

Widening the aim of health promotion to include the most disadvantaged: vulnerable adolescents and the social determinants of health

Growing numbers of adolescents are marginalized by social factors beyond their control, leading to poor health outcomes for their families and future generations. Although the role of the social determinants of health has been recognized for many years, there is a gap in our knowledge about the strategies needed to address these factors in health promotion. Drawing on a review of literature on health promotion for marginalized and out-of-school adolescents, this paper highlights some urgent areas of focus for researchers and policy makers addressing adolescent health. Social determinants of health affecting marginalized adolescents identified by the review were education, gender, identity, homelessness, poverty, family structure, culture, religion and perceived racism, yet there is little solid evidence as to how to best address these factors. More systematic research, evaluation and global debate about long-term solutions to chronic poverty, lack of education and social marginalization are needed to break the cycle of ill health among vulnerable adolescents.

Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities

This paper provides an overview of racial variations in health and shows that differences in socioeconomic status (SES) across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality and individual and household indicators of SES capture relevant but limited aspects of this phenomenon. Research is needed that will comprehensively characterize the critical pathogenic features of social environments and identify how they combine with each other to affect health over the life course. Migration history and status are also important predictors of health and research is needed that will enhance understanding of the complex ways in which race, SES, and immigrant status combine to affect health. Fully capturing the role of race in health also requires rigorous examination of the conditions under which medical care and genetic factors can contribute to racial and SES differences in health. The paper identifies research priorities in all of these areas.

Improving medication uptake in aboriginal and Torres Strait islander peoples

BACKGROUND

Poor medication adherence is associated with adverse health outcomes. Improving access and adherence to pharmacological therapy is important in achieving optimal health outcomes for Indigenous populations. In spite of the impressive evidence base for cardiovascular pharmacotherapy, strategies for promoting adherence and evidence based practice are less well refined and the challenges for Indigenous populations are more pronounced.

AIM

To identify factors impacting on medication adherence in Aboriginal Australians and identify solutions to improve the quality use of medicines.

METHOD

The World Health Organization adherence model was used to classify barriers to adherence. Key elements of this model are (1) health care team/health system; (2) socio-economic factors; (3) therapy; (4) patient; and (5) condition related.

RESULTS

Entrenched socio-economic differentials aggravate challenges to medication adherence amongst Aboriginal Australians. Initiatives to promote the quality use of medicines, such as the Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander People (QUMAX) Program, are important strategies to promote adherence.

CONCLUSIONS

Medication adherence is a complex issue and addressing modifiable factors is imperative to improve health outcomes. Subsidised access to medications whether living in urban, regional, rural or remote areas is an important strategy in Closing the Gap.

The spectrum of 'new racism' and discrimination in hospital contexts: a reappraisal

In keeping with the United Nations Declaration of Human Rights, all people have the right to the highest attainable standard of health. Despite the universal right to health, people of minority racial and ethnic backgrounds experience commonplace and significant unjust inequalities in their health and health care. A key reason for this rests on what might be described as 'the illusion of non-racism in health care' -- an illusion that rests on the frequently articulated belief that 'racism is not an issue any more'. Although there has been increasing recognition in recent years that race and racism have a particular, consistent and complex independent negative effect on the health and health care of racial and ethnic minority groups, racism per se still tends to be under-recognised and poorly addressed in health and nursing care domains. In this paper, it is suggested that a key reason racism in health care has been Largely ignored is because of its 'changing face', making new and different forms of it difficult to recognise and manage. A key premise on which this paper rests -- and also its ultimate conclusion -- is that the problem of racism (to be distinguished from 'culturally insensitive' and 'culturally incongruent' care) needs to be unmasked and managed so that those most at risk of being discriminated against on racialised grounds can rest assured that when in need, they will receive the equitable, safe and quality care they are entitled to receive.

Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting

OBJECTIVE

To report Aboriginal patients' views about effective communication between Aboriginal people and health service providers in Western Australian hospital settings.

DESIGN, SETTING AND PARTICIPANTS

Qualitative study involving indepth interviews between 1 March 2006 and 30 September 2007 with 30 Aboriginal people affected by cancer from across WA.

MAIN OUTCOME MEASURES

Aboriginal patients' views about the quality of communication within the hospitals, factors impairing communication and suggestions for improvement.

RESULTS

Factors crucial to effective patient-provider communication such as language, shared understanding, knowledge and use of medical terminology require attention. Additionally, communication between Aboriginal people and health care professionals needs to be understood within a broader sociocultural and political context. Fear of the medical system and of being disempowered; mistrust; collective memories of the experience of colonisation and its aftermath; lack of understanding of Aboriginal customs, values, lifestyle and the importance of family and land; and experiences of racism were key issues impairing communication. Health service providers' inability to interpret non-verbal communication and the symbolism of hospital environments also posed problems.

CONCLUSION

Key areas for the attention of health service providers in communicating and caring for Aboriginal people in the hospital setting include culturally sensitive and empathetic personal contact, acknowledgement and respect for Aboriginal family structures, culture and life circumstances, an understanding of the significant role of non-verbal communication, and the importance of history, land and community. Employing more Aboriginal health workers in hospitals, and allowing Aboriginal people to participate at a decision-making level in hospitals is likely to improve Aboriginal people's access to cancer treatment, and would be important symbols of progress in this area.

Who is not coping with colonization? Laying out the map for decolonization

OBJECTIVE

This paper explores reasons for using decolonization as a method for improving Indigenous health status. Decolonization is a method required to shift the current paradigm of Western dominance and colonial amnesia that constructs and maintains Indigenous poor health status.

CONCLUSION

Decolonization requires every Australian to examine the impact colonization has upon their past and present in order to formulate a future that does not reinstate the past. To take these steps requires a balance of histories, informing our current political and social context, critical reflexive practice and open communication with Aboriginal and Torres Strait Islander peoples.

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

The neglect of racism as an ethical issue in health care

Race and racism has been increasingly implicated in known disparities in the health and health care of racial, ethnic and cultural minorities groups. Despite the obvious ethical implications of this observation, racism as an ethical issue per se has been relatively neglected in health care ethics discourse. In this paper consideration is given to addressing the following questions: What is it about racism and racial disparities in health and health care that these command our special moral scrutiny? Why has racism per se tended to be poorly addressed as an ethical issue in health care ethics discourse? And why, if at all, must racism be addressed as an ethical issue in addition to its positioning as a social, political, cultural and legal issue? It is suggested that unless racism is reframed and redressed as a pre-eminent ethical issue by health service providers, its otherwise preventable harmful consequences will remain difficult to identify, anticipate, prevent, manage, and remedy.

Development and validation of the Measure of Indigenous Racism Experiences (MIRE)

BACKGROUND

In recent decades there has been increasing evidence of a relationship between self-reported racism and health. Although a plethora of instruments to measure racism have been developed, very few have been described conceptually or psychometrically Furthermore, this research field has been limited by a dearth of instruments that examine reactions/responses to racism and by a restricted focus on African American populations.

METHODS

In response to these limitations, the 31-item Measure of Indigenous Racism Experiences (MIRE) was developed to assess self-reported racism for Indigenous Australians. This paper describes the development of the MIRE together with an opportunistic examination of its content, construct and convergent validity in a population health study involving 312 Indigenous Australians.

RESULTS

Focus group research supported the content validity of the MIRE, and inter-item/scale correlations suggested good construct validity. A good fit with a priori conceptual dimensions was demonstrated in factor analysis, and convergence with a separate item on discrimination was satisfactory.

CONCLUSION

The MIRE has considerable utility as an instrument that can assess multiple facets of racism together with responses/reactions to racism among indigenous populations and, potentially, among other ethnic/racial groups.