Structural disadvantage, experiences of racism and a culturally unsafe service system can reinforce health inequalities.
First Peoples, multicultural and multifaith communities that face structural disadvantage in other areas of life may face worse health outcomes.
This can include:
- where they live
- their housing conditions
- income
- education levels
- how often they can access and use preventive healthcare services
Low levels of English literacy can also increase healthcare inequalities, particularly when combined with low health literacy or underlying health risks.[51]
People who experience racism are much more likely to have poor mental and physical health. The greater the frequency of racist experiences, the worse the health outcomes.[52]
These issues are made worse when people face racism in healthcare settings and deal with a system that may be culturally unsafe or not responsive to their needs.
Racism is a health and wellbeing issue
Racism has serious effects on people’s mental health and wellbeing.
- Facing racial discrimination regularly is associated with increased psychological distress and risk of mental illness.[53]
- The suicide rate among First Peoples nationally is twice the rate of the non–First Peoples population.[54] This can be due to complex interrelated social, cultural and historical influences including:
- colonisation
- intergenerational trauma
- racism
- disadvantage.[55]
- For young people, racial discrimination is linked to higher rates of anxiety, depression and psychological distress.[56] A national survey of high school students found that racism had mental and physical health impacts including:
- post-traumatic stress disorder
- depression
- headaches
- increased heart rate
- muscle tension
- anxiety.[57]
- Among First Peoples, a national study found that 48.3% of people who faced racism experienced psychological distress. This compares with 25.2% of people who did not face racial discrimination.[58]
During consultations, we heard that a lack of in-language information and interpreter services made accessing health care challenging for Victorians with low levels of English, including older people. Research also tells us that some groups are more likely to need interpreters in health settings. This includes, for example, women from refugee backgrounds compared with women from migrant backgrounds in Victoria.[59]
We also heard that people from multicultural communities find the health system confusing and challenging to navigate.
Research shows that First Peoples are more likely to delay seeking health services, leave hospital early and not seek medical treatment when it is needed. This may be due to past personal, family or community experiences of negative treatment in health services. In the 12 months from 2018 to 2019, 30% of First Peoples across Australia reported not accessing health care when they needed it.[60]
Along with a lack of available time and cost, First Peoples cited the following reasons for not accessing health care:
- feeling that the service was discriminatory, inadequate or not culturally safe
- not trusting the service provider
- feeling embarrassed or afraid.[61]
We also heard that some First Peoples, multicultural and multifaith Victorians have faced direct racism from healthcare staff, including:
- being talked down to
- being ignored
- having assumptions made about their lifestyle and habits.
Women from racialised communities described how their symptoms or pain were ignored or minimised by doctors:
It is common for [people of colour] to not get offered the care or medicines that others do. One nurse told me once that people like me just don’t feel pain like white people do. Surprisingly many medical people think this and it is dangerous.
– Survey respondent
We also heard that people face challenges in finding culturally safe mental health services and providers across metropolitan, rural and regional areas. Consultation participants told us that sometimes healthcare staff do not have enough understanding of their needs or experiences of racism and discrimination. This prevents people from getting the treatment they need.
Addressing racism in health care is critical to ensuring First Peoples, multicultural and multifaith communities have better and fair health and wellbeing outcomes.
There is a lack of mental health providers who can understand cross-cultural issues and the mental health impact of discrimination and racism. I have struggled to find a mental health provider who can empathise with my struggles due to psychologists and counsellors being very white and very upper middle class. As they have never experienced racism and discrimination, they think it doesn’t exist.
– Survey respondent
There needs to be trust in the community in the institutions and systems. In the [COVID-19] pandemic response, people were being asked to trust a system that they had no engagement with. When it was the trusted organisations coming to talk to people about testing and quarantine, then there was traction in the community. What works is support and investment in those institutions with community trust.
– Health consultation participant
Racism in health care
- In a national survey, 25% of respondents reported experiencing racism in healthcare settings.[62]
- An Australian study found that patients with low levels of English had only a 1 in 100 chance of having a professional interpreter available when needed in a primary care setting.[63] Unqualified family members and bilingual staff are often asked to interpret in health appointments, increasing the risk of poor health outcomes.[64]
- Women from refugee backgrounds are 5 times more likely than non-refugee migrants to need an interpreter during maternity care.[65] A study of Afghan families in Melbourne found that very few women who needed an interpreter during labour had access to one.[66]
- People from multicultural backgrounds often find mental health services to be Eurocentric and alienating.[67] Yet people from refugee backgrounds and people seeking asylum experience mental illness and suicidal behaviour at significantly higher rates than the general population.[68]
[51] J Dawe, E McDonald, E Riggs, J Szwarc and J Yelland, ‘Interpreter requirements of women of non-English speaking migrant backgrounds in maternity hospitals in Melbourne, Australia’, International Journal of Migration, Health and Social Care, 2023, doi: 10.1108/IJMHSC-08-2023-0073
[52] Department of Health and Human Services (DHHS), Racism in Victoria and what it means for the health of Victorians, DHHS, Victorian Government, 2017, p 18
[53] AS Ferdinand, Y Paradies and M Kelaher, ‘Mental health impacts of racial discrimination in Australian culturally and linguistically diverse communities: a cross-sectional survey’, BMC Public Health, (2015)15:401, doi:10.1186/s12889-015-1661-1
[54] M Truong and E Moore, Racism and Indigenous wellbeing, mental health and suicide, Australian Institute of Health and Welfare, Australian Government, 2023. https://www.indigenousmhspc.gov.au/publications/racism
[55] Australian Institute of Health and Welfare, Suicide & self-harm monitoring: populations & age groups [data set], 2022. https://aihw.gov.au/suicide-self-harm-monitoring
[56] N Priest, Y Paradies, B Trenerry, M Truong, S Karlsen and Y Kelly, ‘A systematic review of studies examining the relationship between reported racism and health and wellbeing for children and young people’, Social Science & Medicine, 2013, 95:115–127
[57] F Mansouri, L Jenkins, L Morgan and M Taouk, The impact of racism upon the health and wellbeing of young Australians, Foundation for Young Australians, 2009. https://research.monash.edu/files/11597854/Impact_of_Racism_FYA_report…
[58] KA Thurber, M-M Brinckley, R Jones, O Evans, K Nichols, N Priest, et al., ‘Population-level contribution of interpersonal discrimination to psychological distress among Australian Aboriginal and Torres Strait Islander adults, and to Indigenous–non-Indigenous inequities: cross-sectional analysis of a community-controlled First Nations cohort study’, The Lancet, 2022, 400: 2084–2094
[59] Dawe et al., ‘Interpreter requirements of women of non-English speaking migrant backgrounds in maternity hospitals in Melbourne, Australia’
[60] Australian Institute of Health and Welfare (AIHW) and National Indigenous Australians Agency (NIAA), Aboriginal and Torres Strait Islander Health Performance Framework, AIHW and NIAA, Canberra, 2023, accessed 18 October 2023
[61] AIHW and NIAA, Aboriginal and Torres Strait Islander health performance framework
[62] K Blair, K Dunn, A Kamp and O Alam, Challenging Racism Project 2015–16 National Survey Report, Western Sydney University, 2017. https://www.westernsydney.edu.au/__data/assets/pdf_file/0009/1201203/OM…
[63] CB Phillips and J Travaglia, ‘Low levels of uptake of free interpreters by Australian doctors in private practice: secondary analysis of national data’, Australian Health Review, 2011, 35(4):475–479
[64] J White, T Plompen, C Osadnik, L Tao, E Micallef and T Haines ‘The experience of interpreter access and language discordant clinical encounters in Australian health care: a mixed methods exploration’, International Journal for Equity in Health, 2018, 17(1): 151
[65] Dawe et al., ‘Interpreter requirements of women of non-English speaking migrant backgrounds in maternity hospitals in Melbourne, Australia’
[66] J Yelland, MA Biro, W Dawson, E Riggs, D Vanpraag, K Wigg, J Antonopoulos, J Morgans, J Szwarc, C East and SJ Brown. Engaging professional interpreters in labour: a Bridging the Gap quality improvement initiative. Murdoch Children’s Research Institute, Melbourne, 2016
[67] M Plowman and S Izzo, Recommendations for a culturally responsive mental health system, Ethnic Communities’ Council of Victoria and Victorian Transcultural Mental Health, Melbourne, 2021
[68] Royal Commission into Victoria’s Mental Health System (RCVMHC), ‘Chapter 21’, Final report (Volume 3): Promoting inclusion and addressing inequities, Victorian Government, 2021
Updated