Issue 20 / 10 June 2014

HIGH rates of racism in the Australian health care system may be directly contributing to psychological distress among Aboriginal patients, MJA research suggests. (1)

Melbourne researchers found a third of Aboriginal Australians had experienced racism in health settings in the past 12 months, based on their survey of 755 people from four Indigenous communities in rural and metropolitan Victoria.

While racism was less common in health care than other settings such as shopping centres, the study suggested the psychological impacts were worse in health care. For example, 65% of people who experienced racism in health care had high or very high psychological distress, compared with 47% of those who experienced racism in other settings.

“Racism in health settings may contribute to poorer health through stress-mediated pathways as well as through reduced quality of health care and limited access to health services and other resources that protect and promote health”, Associate Professor Margaret Kelaher, director of the Centre for Health Policy at the University of Melbourne, and colleagues wrote.

The most common forms of racism in health care were name-calling, teasing and comments, being treated as unintelligent and being ignored, the study found.

The study did not examine whether the perpetrators of racism were patients or staff, however Dr Tammy Kimpton, president of the Australian Indigenous Doctors’ Association, said she believed both were to blame.

Dr Kimpton said the findings were “very consistent” with patients’ stories and feedback from medical students about incorrect racist attitudes from hospital staff and GP supervisors.

“Health workers often assume that Aboriginal patients are less intelligent or non-compliant”, she said. “For instance, I have patients who I know are doing quite well with medication management who are sent back from hospital on Webster packs because the hospital doesn’t trust that they’ll take their medication.”

Another typical scenario was the denial of certain services to Aboriginal patients because they don’t “look Aboriginal”, she said.

Yet Dr Kimpton said ongoing education of medical students about a patient-centred approach toward Indigenous Australians was starting to dismantle racist attitudes.

“It’s heartening to see that in health care the number of interactions which are racist is decreasing,” she said.

AMA president Associate Professor Brian Owler said while the study was concerning, he would “hate to think that people would draw conclusions that doctors and nurses were racist and that the problem was systemic”.

“I’m sure there are elements of racism and we must do everything we can to reduce that, but in general, there are many doctors and nurses in the health system who are very dedicated to Indigenous health”, he said.

Professor Shane Houston, the head of Indigenous strategy at the University of Sydney and a deputy vice-chancellor, said it was important to draw a distinction between “systemic” and “institutionalised” racism.

“Systemic implies that racism is pervasive … even ubiquitous. I don't think that's the problem in health care”, he said.

“But I do think racism is institutionalised, which means that, because one culture designed a system with its own people in mind, the policies and processes of that organisation unintentionally create a feeling of being discriminated against.”

Professor Houston said the problem was not solved by the common approach of sending the most junior health staff to 1-day cultural awareness workshops.

“The most junior ward clerk is powerless to change the culture in a health system of one million people”, he said.

Senior staff also needed to be engaged in “deep reflection about their own biases and cultural blinkers” as part of an “ongoing, lifelong professional journey toward cultural competence”, he said.

1. MJA 2014; Online 9 June


Have you experienced or witnessed racism in the health care system?
  • No (39%, 36 Votes)
  • Yes - witnessed (35%, 33 Votes)
  • Yes - experienced (13%, 12 Votes)
  • Yes - both (13%, 12 Votes)

Total Voters: 93

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4 thoughts on “Racism means poorer health

  1. Dr Ben Koh says:

    I am not sure that the matter is confined only to the Aboriginal patient community. Non-White patients and staff within the healthcare system often have to experience (in silence) both the explicit and covert racism without any truly independent and impartial avenue for redress in confidence.

  2. Jon Hunt says:

    I’m sure that racism is present in the health industry. I know of a specialist that refused to see patients referred from the Aborginal Health Service because ‘they never turned up’. But I think that sending someone home with a webster pak (many are not good at taking their meds, this is common knowledge) is probably prudent when the person concerned is not well known. This is not to suggest there are not many who manage their meds well.

  3. QUT Library Serials Unit Publisher Pkgs says:

    It goes much further than what Non-White Medico refers to as well.  You don’t have to be non-white.  It permeates every form of minority and marginalised group in society.  Consider the overt and covert forms of hetersoxism that exists within our institutions and the effect that has on the mental and physical health of those affected, transgender people for example.  40% of trans* people are known to self-harm as a direct result of discrimination and there is an inordinate amount of interpersonal heterosexism displayed and tolerated by those who are there to care.  Imagine a nursing handover session and the nurse handing over a trans* patient says “the ‘it’ in bed 4.” That actually happened in an oncology ward of a major metropolitan hospital.  It is about time that culturally safe care was practised by all health professionals regardful of individual diversity (look up Irihapeti Ramsden to see what that is if you don’t know).

  4. Balaji Bikshandi says:

    It is not just patients but even non-white Australian Specialists endure this menial act. It is perpetrated against them through agencies like the Ahpra where the constituent members belong predominantly to a particular race and abuse their position to harass meritorious Specialists not belonging to their race. Racism is real and has to be rooted out if Australia is to be seen as a developed multicultural nation. 

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