Elsevier

The Lancet

Volume 367, Issue 9527, 17–23 June 2006, Pages 2005-2009
The Lancet

Articles
Effects of self-reported racial discrimination and deprivation on Māori health and inequalities in New Zealand: cross-sectional study

https://doi.org/10.1016/S0140-6736(06)68890-9Get rights and content

Summary

Background

Inequalities in health between different ethnic groups in New Zealand are most pronounced between Māori and Europeans. Our aim was to assess the effect of self-reported racial discrimination and deprivation on health inequalities in these two ethnic groups.

Methods

We used data from the 2002/03 New Zealand Health Survey to assess prevalence of experiences of self-reported racial discrimination in Māori (n=4108) and Europeans (n=6269) by analysing the responses to five questions about: verbal attacks, physical attacks, and unfair treatment by a health professional, at work, or when buying or renting housing. We did logistic regression analyses to assess the effect of adjustment for experience of racial discrimination and deprivation on ethnic inequalities for various health outcomes.

Findings

Māori were more likely to report experiences of self-reported racial discrimination in all instances assessed, and were almost ten times more likely to experience discrimination in three or more settings than were Europeans (4·5% [95% CI 3·2–5·8] vs 0·5% [0·3–0·7]). After adjustment for discrimination and deprivation, odds ratios (95% CI) comparing Māori and European ethnic groups were reduced from 1·67 (1·35–2·08) to 1·18 (0·92–1·50) for poor or fair self-rated health, 1·70 (1·42–2·02) to 1·21 (1·00–1·47) for low physical functioning, 1·30 (1·11–1·54) to 1·02 (0·85–1·22) for low mental health, and 1·46 (1·12–1·91) to 1·11 (0·82–1·51) for cardiovascular disease.

Interpretation

Racism, both interpersonal and institutional, contributes to Māori health losses and leads to inequalities in health between Māori and Europeans in New Zealand. Interventions and policies to improve Māori health and address these inequalities should take into account the health effects of racism.

Introduction

More and more research suggests that racism has major health consequences. Most of this work, however, has been done in the USA and, more recently, in the UK.1, 2, 3, 4 Little is known about the effect of racism on health and ethnic inequalities in other countries, where the history and nature of ethnic relations might be very different. We think there is a need to assess the effect of perceived racial discrimination and deprivation on inequalities in health between two ethnic groups—Māori and European—in New Zealand.

New Zealand has a population of about 4 million, with the main ethnic groups being European (80%), Māori (15%), Asian (7%), and Pacific peoples (7%).5 As in other countries with similar histories of colonisation, ethnic inequalities in health exist and, in New Zealand, are most pronounced between Māori (the indigenous peoples) and Europeans.6, 7 Māori have an 8–9 year lower life expectancy than non-Māori,8 with differences noted across most morbidity indicators (including most major chronic diseases, infectious diseases, and injuries).9

Great inequalities in socioeconomic position exist between Māori and non-Māori in New Zealand,10, 11, 12 but they might not fully account for the health inequalities noted between the different ethnic groups.10, 13, 14 Indeed, socioeconomic explanations alone are inadequate, since they do not take into account the factors that lead to marginalisation of Māori and unequal distribution of socioeconomic resources by ethnicity in the first place.

Racism refers to an ideology of superiority—a belief that some races are better than others.4, 15 Racial discrimination can vary in form and type, depending on how, by whom, and against whom it is expressed.16 Various forms of racial discrimination have been described, with the two main types being institutional and interpersonal.17 Interpersonal discrimination refers to discriminatory interactions between individuals, which can usually be directly perceived. In this report, interpersonal discrimination includes racist assault, both verbal and physical, and unfair treatment. Institutional discrimination refers to discriminatory policies or practices embedded in organisational structures, and so tends to be relatively invisible compared with interpersonal discrimination.16, 17

Several studies have noted an association between self-reported experience of racial discrimination and poor health outcomes for a range of ethnic groups in various countries.16, 17, 18, 19, 20, 21, 22 Outcomes include measures of mental health, physical health, such as hypertension and self-reported health, and health-risk behaviours, such as smoking and drinking alcohol. There are many theories to explain how racism affects health, including differential exposure to determinants of health—eg, socioeconomic, environmental, and behavioural—differential access to, and quality of, health-care services, and direct effects of racism, such as trauma and stress.1, 2, 4, 17, 23

For the first time, the 2002/03 New Zealand Health Survey included a series of questions on people's experiences of racial discrimination. Analysis of these data showed that self-reported experience of racial discrimination was highest among Māori and that any such experience was strongly associated with negative health effects equally for all ethnic groups.24 Here, we use the data to specifically focus on indigenous health and inequalities by estimating the prevalence of experience of self-reported racial discrimination in specific circumstances and by assessing the potential effect of self-reported racial discrimination and deprivation on ethnic inequalities in health between Māori and European ethnic groups.

Section snippets

Survey design

The New Zealand Health Survey was done between August, 2002, and January, 2004. The target population was the usually resident, non-institutionalised civilian adult population (aged 15 years and older) living in permanent private dwellings. A complex cluster sample design was applied, with an area-based sampling frame. The primary sampling units (meshblocks of about 100 people) were stratified by ethnic population density thresholds (including Māori, Pacific, and Asian strata) and selected with

Results

72% of people overall and 70% of Māori approached responded to the survey.26 The characteristics of respondents, weighted for selection probability, closely resembled those of the target population with respect to age, sex, ethnicity, socioeconomic position, and regional distribution. We excluded 18 people who responded because of missing values for NZDep2001. Our dataset consisted of 10 377 people, of whom 4108 were Māori and 6269 were European.

Table 1 shows unadjusted prevalences of

Discussion

The findings of this study show that both deprivation and experiences of perceived racial discrimination contribute to inequalities in health outcomes between Māori and Europeans. Indeed, the combination of deprivation and discrimination as measured seems to account for much of the disparity in the health outcomes assessed. The main strength of this study is that it is based on a national sample. However, several issues need to be taken into account when interpreting our findings. Karlsen and

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