Racism, racial discrimination and child and youth health: a rapid evidence synthesis

Abstract

Racism and racial discrimination are fundamental causes and determinants of health and health inequalities globally. 1,2 Children and young people are particularly vulnerable to racism’s harms. 3,4 Racism is an organised system of oppression that classifies and ranks social groups into ‘races’ and devalues, disempowers and differentially allocates power and resources to those considered inferior. 5,6 Race has no biological basis and is not a biological reality. Yet the concept of race remains a powerful social category in society today, and existing categorisations and perceptions of race have major social consequences. 7 Race is a powerful predictor of which groups have access to goods and resources in society and which groups encounter barriers. 8 Race and racism need to be explicitly named and addressed,9 with racism the mechanism by which racial categorisations have biological consequences. 5 Racism is an ideology of power that advantages those considered superior and disadvantages those considered inferior. 5,6 Racial discrimination is the behavioural expression of racism by actions at individual or institutional levels. 10 Racism and racial discrimination have profound impacts on the lives of children and young peoples, their families and communities, shaping risks and opportunities and creating unjust, unnecessary and preventable differences in health between social groups throughout the life-course and across generations. 11,12 Racism, as a form of injustice, is, by definition, wrong. 12,13 Studying how racism harms health, and identifying effective ways to address racism and its harmful health effects, is not to prove racism is wrong or unjust. Rather, we do so to further understanding of how racism shapes population health, to build evidence for accountability, to challenge unjust and unfair systems and structures, and to advocate for human rights and health equity. 12 The coronavirus pandemic together with the concurrent resurgence of the Black Lives Matter movement and attention to the public health emergency of racism in Australia and around the world have further reinforced the need to address racism as a form of injustice and as a fundamental cause of health and health inequalities. There is now heightened attention globally and locally to the enduring social and structural injustices that are derived from racism as a system of oppression and the critical need for urgent action to address them. 14 In Australia, Aboriginal and Torres Strait Islander peoples experience profound structural, systemic and institutional racism, which uniquely and actively manifests in ways including dispossession of land, child removal policies and disproportionately high incarceration rates. These are expressions of the deep injustices of ongoing colonisation that persist today. Ethnic minoritised and migrant communities, not to be confused or conflated with Aboriginal and Torres Strait Islander peoples, experience systemic racism related to historical and contemporary migration and settlement experiences and legacies of legislation such as the White Australia policy. “Structural racism involves interconnected institutions, whose linkages are historically rooted and culturally reinforced. It refers to the totality of ways in which societies foster racial discrimination, through mutually reinforcing inequitable systems (in housing, education, employment, earnings, benefits, credit, media, health care, criminal justice, and so on) that in turn reinforce discriminatory beliefs, values and distribution of resources, which together affect the risk of adverse health outcomes.” 15 Racial discrimination is a common stressor in the lives of many children and young peoples, with growing empirical evidence of negative associations between racial discrimination and multiple child and youth health outcomes. 4,16-18 Longitudinal studies have documented effects of racial discrimination on mental health,19,20 substance use,21 and cortisol dysregulation,22 allostatic load 23 epigenetic ageing 24 and inflammation 25 among youth. Evidence also documents that impacts of racial discrimination are not limited to experiences where children and young peoples are direct targets of racism. Vicarious experiences of racial discrimination, including witnessing or hearing about others experiences, including online, are also associated with child and youth health outcomes including negative and positive dimensions of mental health and sleep duration, latency and quality. 26,27 Concern about increasing societal discrimination is also associated with adolescent behavioural outcomes and depression. 28 Notwithstanding the need to address racism and racial discrimination due to their inherent injustice and unfairness, empirical studies reinforce the need for wide-ranging action and population-level interventions to promote societal anti-racism and bystander anti-racism action - and to ensure those who experience racism and racial discrimination and the associated health impacts of such experiences, receive appropriate support and services. In order to optimise wellbeing for all children, young peoples and their adult caregivers, and to achieve health equity for all, eradicating racism and both direct and vicarious racial discrimination from the lives of children and young peoples is an urgent priority. 29 Addressing racism is a priority in national policies including the National Aboriginal and Torres Strait Islander Health Plan 2013-202330 that identifies addressing racism as a social determinant of health and Australia’s multicultural statement31 that identify racism and discrimination as key barriers to social cohesion. At a state level, the Victorian Aboriginal Affairs Framework 2018-202332 identifies addressing racism and promoting cultural safety as key priorities and enablers of self-determination. Elimination of racism is explicitly identified as a goal, with addressing systemic and everyday racism in health, community services, education and learning, justice and other environments explicitly identified as areas for action. The Victorian Aboriginal and Local Government Action Plan33 provides a practical framework to help councils engage with Aboriginal communities and promote reconciliation. Engagement of Aboriginal people in planning, decision-making, employment, programs and services is identified as a foundational practice for councils. This includes working with Aboriginal people to respond to and address racism. Balit Murrup: Aboriginal social and emotional wellbeing framework34 which aims to support Victorian Aboriginal people, families and communities social and emotional wellbeing and mental health also explicitly identified racism as a key social determinant of health requiring attention, including for children and young people. The Productivity Commission’s recently released Indigenous Evaluation Strategy provides a framework agencies to use when selecting, planning, conducting and using evaluations of policies and programs affecting Aboriginal and Torres Strait Islander people. 35 This framework puts Aboriginal and Torres Strait Islander people at its centre and recognises that the perspectives, priorities and knowledges of Aboriginal and Torres Strait Islander people must be central if outcomes are to be improved. This rapid synthesis review comprises 3 main sections. First, an overview of race and racism, pathways and mechanisms by which racism and racial discrimination influence child and youth health, and a narrative review of current empirical findings is provided. Second, an key data collected in the last 5years (2016-2020) on the prevalence of self-reported racial discrimination among 5-25 year olds in Victoria and Australia is presented. Third, evidence for addressing racism and racial discrimination among 5-25 year olds is reviewed.