Introduction
Racism has been identified as a key determinant of health, potentially contributing to health inequalities in distribution and access. Aboriginal and Torres Strait Islander (ATSI) people of Australia experience prejudice and discrimination based on their race. Racism as a determinant of health and well-being reduces access to other critical determinants of health, including education, housing, and employment. It could lead to unhealthy behaviors such as substance abuse.
Case Background
Charlie, a 9-year-old Aboriginal boy living in a crowded household in Port Augusta, visits the local Aboriginal Community Controlled Health Service for a painful middle ear infection that is part of a long history of untreated ear problems due to limited past access to healthcare. The Aboriginal Health Worker teaches him and his mother about hygiene practices, such as hand-washing and nose-blowing, to prevent further infections and encourages follow-up if his symptoms worsen. Although Charlie enjoys sports, Youth Centre activities, and reconnecting with cultural experiences like fishing, he has been struggling at school with behavioral issues caused partly by bullying and longstanding grief over his father’s death. His family is supportive and creative, but irregular income and household overcrowding sometimes make daily life challenging.
Charlie’s health is indirectly and directly influenced by racism and these other determinants of health. There are several policies, laws, and reforms seeking to protect Aboriginal and Torres Strait Islander people from racist Australians, but these are rarely enforced. The problem of racism could be addressed by practicing culturally safe behaviors to improve the health of this group. The problem of racism amongst the Indigenous Australians causes physical and mental illnesses. It can be resolved by recognizing and ending racial barriers.
Social Determinants of Health
Racism exists in three categories, including interpersonal, internalised, and institutional or systematic, which result in varied impacts. Interpersonal racism refers to the practice of discriminatory habits from one person to another (Asika, 2021). This level of racism is common in communities during one-on-one conversations between people of different races.
Internalized racism is the acceptance of stigmatization by people who hold adverse beliefs about individual or group values and capacities. Discriminated people can internalize the oppression, thus stigmatizing people of their racial group. Institutional or systematic racism is often practiced in private and public institutions during the provision of services (Asika, 2021). Institutions often pass practices and policies to reduce the benefits and opportunities of a minority group.
A significant example of how racism affects Charlie’s health and well-being is the lack of access to healthcare. When Charlie and his mother visit the Aboriginal Health Centre for ear problems, he says that although he has had earaches in the past, he could not access healthcare services in the small community they previously lived in. Charlie experienced institutional racism where policies to establish healthcare facilities in the country marginalized their community.
Another example of racism is Charlie’s interaction with his teacher, where the teacher calls him “typical” and allows children to bully him (“Racism, Privilege, and Health,” n.d). Charlie mentions that his hearing problem has led to him being labeled a “troublemaker” in school. When Charlie gets an answer to a teacher’s question wrong, the children laugh and call him names, while the teacher does nothing. Indeed, the teacher expresses prejudice by rolling her eyes at him.
The case of a police officer dismissing a witness to Charlie’s father’s accident is another example of racism. Charlie’s mother narrates that her husband was killed in a road accident where a drunk driver moving on the wrong side of the road hit his car, killing him. The drunk driver did not stop to check on Charlie’s father, and that was known because there was a witness to the crime (“Family History,” n.d.). Upon reporting this to the police, the police officers dismissed the account of the witness because they were drinking. However, the drunk driver was picked up and questioned later, but no charges were pressed.
The police stated that there was insufficient evidence to link him to the road accident. On the same issue, the law officers racially profiled Charlie’s father by asking his wife whether he was drunk driving or a drug abuser, and why he was driving at night. Charlie’s mother was angry but was threatened with being put in police custody if she did not calm down. Charlie’s mother recounts how her mother was arrested during her activist days. The police charged her with being a public nuisance, but when her white husband came to bail her out, he was allowed to take her without money.
The first issue of Charlie’s case study relates to institutional racism, which leads to the unequal distribution of government resources. According to Gupta et al. (2020), Aboriginal and Torres Strait Islander people are the most disadvantaged in Australia in terms of facing high levels of unemployment, low income, incarceration, and a burden of poor health and mortality. Compared to non-indigenous people, Indigenous people are more likely to be admitted to hospitals. Still, they are less likely to receive adequate medical care (Gupta et al., 2020).
The Aboriginal and Torres Strait Islander peoples represent only 2.4% of the Australian population (Falls & Anderson, 2022). Consequently, the community is prone to marginalization during the development process. There are also laws and policies in place to increase healthcare services among the First Peoples of Australia. However, due to ongoing institutional racism, the policies and laws are never enforced. Systematic practices that hinder the enforcement of favorable laws prevent equal access to healthcare.
The second issue from the case study is racial profiling and incarceration. Dr Hannah McGlade, a fighter for Aboriginal rights, says that despite many efforts to reduce racial profiling, the problem is still prevalent in law enforcement systems (National Indigenous Television, 2022). She says, “It’s something that all Aboriginal people report across the country, and I don’t think there has been a concerted effort to deal with racism in Australia and police forces” (National Indigenous Television, 2022). Cases of wrongful incarceration based on racial profiling have been experienced since colonization.
According to Heiss (2019), racial profiling is primarily caused by the oppressive practices towards the Indigenous Australians during colonization. The police still hold prejudicial beliefs against this group of people and use such beliefs to form poor judgment, which leads to wrongful incarceration. Such practices affect human health and well-being by lowering confidence, self-esteem, and depression, which often leads to risky behaviors like suicide (Kairuz et al., 2020). Therefore, racial profiling and incarceration are risk factors for physical and mental health issues.
The last issue in Charlie’s case is interpersonal racism, where Charlie is bullied in school. According to Kairuz et al. (2021), 43% of the ATSI people reported experiencing racial prejudice in the past 6 months compared to only 20% of the non-indigenous people surveyed. Indeed, 3 in 4 people hold negative prejudices against the Indigenous Australians. Racial bullying and prejudices often cause low self-esteem, internalization of oppression, depression, aggression, and violence, which adversely affect the health of ATSI people (Kairuz et al., 2020).
In 2020, 57% of the indigenous and 42% of the non-indigenous populations agreed that Australia was a racist nation (Kairuz et al., 2020). Such statistics only affirm the devastation regarding racial prejudice and discrimination. Interpersonal racism causes differences between two or more people, leading to anguish and the risk of poor mental health.
Cultural Safety
The most suitable cultural safety practice to resolve the case study is to recognize and end racial barriers. The primary reason why racism continues in Australia despite enlightenment is the failure to recognize and discuss it (Australians for Native Title and Reconciliation, 2023). Since colonialism, racism has significantly undermined the efforts of the indigenous people.
Addressing racism as a determinant of health should be a national priority. Australian institutions are designed to ignore the discussion of existing racism, thus making the condition worse (Butler et al., 2019). Discussing racism alongside its impact on mental and physical health would help highlight workable solutions to this health determinant. Institutional racism should be addressed because its end sheds a brighter and positive light on interpersonal and internalized racism.
One of the most critical cultural safety principles related to Charlie’s case is the establishment of mandatory anti-racism training in public institutions, particularly schools, hospitals, and police facilities. Mandatory anti-racism training should be supplemented with cultural competency training for all new and existing staff in these systems (Dudgeon et al., 2023).
Indeed, training programs should include refresher courses for employees to stay updated on relevant anti-racism practices. This training will equip the system employees with cultural competency to understand and effectively associate with the ATSI people. Consequently, the employees will stop racial profiling and interpersonal discrimination, leading to reduced racism-related health problems.
People in power must openly recognize and acknowledge racism as an endemic in Australian institutions and communities. After recognizing the existing need to address racism, a human-rights-based policy approach should be developed (National Aboriginal Sporting Change Academy, 2023). These groups of minorities should have approaches that defend their rights when policies are established. Such approaches will help ensure that the needs and rights of Aboriginal people are considered when developing laws targeting them (National Indigenous Television, 2022).
This will ensure an even distribution of resources amongst the Australian population. For example, a policy formulated to favor the Indigenous Australians will influence the allocation of enough resources to develop healthcare facilities in these communities. Adequate access to health services reduces the spread of diseases and mortality rates among community members.
The government should also develop policies to non-tolerate racial discrimination, along with potential consequences. These policies should make any form of racism illegal and punishable by law. Enforcement of such practices should end the chances of racial prejudice or discrimination, thus minimizing racism-triggered mental health issues (Socha, 2021). When teachers and police know the consequences of prejudice and racial profiling, they will address the ATSI people, respectively. These interventions are only implementable if there is an adequate representation of these people in the legislative system. Therefore, the first step is to ensure that this group is represented in the policy-making process.
Conclusion
Racism severely impacts the mental and physical health of Aboriginal and Torres Strait Islander people in Australia and requires immediate action. The daily struggles of these communities, exemplified by figures like Charlie, reveal a persistent and openly acknowledged national problem. Despite initiatives like “Closing the Gap” and general anti-racism efforts, prejudice and discrimination remain pervasive.
Institutional, interpersonal, and internalized racism continue to create significant health disparities and hinder access to necessary healthcare services. Ultimately, eradicating racism is a complex, long-term national challenge that demands a strategic and collective approach to effectively prevent prejudice and discrimination.
References
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