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Do people trust the health system? Whose fault might that be?
Lots of research from New Zealand and overseas shows that experiencing racism leads to poorer health. Many researchers and others assume that this is because experiencing racism feels bad, leads to stress and chronic stress directly harms people's health. But it is also possible that experiencing racism might make people less likely to get healthcare, and that this might be another way in which racism leads to poorer health. A study by Ricci Harris and others from the University of Otago Wellington explored this question.
Some of you might take part in the New Zealand Health Survey, which happens every year. It is carried out by the Ministry of Health and about 13,000 adults and the caregivers of about 4000 children are included. They are asked what kind of health problems they have, and about their use of different kinds of healthcare, their experiences of healthcare and their health-related behaviours like diet, exercise, smoking and many other questions. In the survey people are asked about whether they have experienced physical or verbal attacks, or unfair treatment because of their ethnicity. They are asked about unfair treatment in relation to health professionals, at work, and in housing.
The survey includes a lot of questions about people's experiences of healthcare. Interviewers ask women in the target age groups about whether they have had a mammogram in last 3 years, and whether they have had a cervical screening test in the last two years. (The target age group for mammograms is 45-69 years old and for cervical screening it is 20-69). People who have a regular healthcare provider (like a GP) are asked about whether the health care professional listens carefully to what they say; discusses their health care and treatment with them as much as they want, and whether s/he treats them with respect and dignity.
Ricci Harris and her colleagues looked at who reported being on the receiving end of racism. Pakeha were the least likely to report this: 1.2% of adults who had a regular healthcare provider reported that they had experienced racism in healthcare, and 13.8% reported that they had experienced racism in any context. The figures were much higher for other ethnic groups: for Maori: 5 and 30%, for Pacific 5 and 24%, and for Asians 5 and 35%. These figures are worth thinking about: around a quarter of Pacific people, nearly a third of Maori and more than a third of Asians say they have experienced either a verbal or physical attack, or unfair treatment in healthcare, work or in seeking housing. This latter category is racism in formal settings where some people control resources that other people need, and make decisions that seriously impact on their lives. Five percent of the non-European people felt that healthcare providers had been racist.
It is really easy to see how being treated badly by a health professional could make you more suspicious and less trusting of the health system, and therefore less likely engage in screening and other services (most topically, vaccination). It's also possible that people who are treated badly by health professionals might not be offered the same services as others. The results of the study support this. Amongst Maori women, those who experienced racism from a healthcare provider were less likely to have had regular screening (i.e. mammograms and cervical cancer). For all ethnic groups, those who had experienced racism either in healthcare or elsewhere were more likely to report negative experiences with their current healthcare provider.
The participants in the study reported that they experienced racism. This doesn't mean that the healthcare providers, employers, or workmates intended to be racist, although they might have. The study also only captures individual's experiences of how other individuals treat them in specific settings, so it misses out on institutional racism - the effect of policies and the way the health system is designed to suit some people more than others.
The study really reminded me of a book about African-Americans and the health system. In the US, the poor health statistics for African-Americans are often blamed on their lack of trust in the health system, without acknowledging that the US health system has a terrible history of abuses against African-American people. This includes the Tuskagee experiment, where hundreds of poor African-American men with syphilis were observed, but not treated, for decades, only ending in the 1970s. The men were not told they had syphilis. Trust has to be earned. Yet another reason to #give nothing to racism.
Pauline Norris is a research professor at the Centre for Pacific Health, Va'a O Tautai, and CHeST: the Centre for Health Systems and Technology, in the University of Otago Division of Health Sciences.