Prevalence of Everyday Discrimination and Relation with Wellbeing among Aboriginal and Torres Strait Islander Adults in Australia

Abstract

Discrimination is a fundamental determinant of health and health inequities. However, despite the high prevalence of discrimination exposure, there is limited evidence specific to Indigenous populations on the link between discrimination and health. This study employs a validated measure to quantify experiences of everyday discrimination in a national sample of Aboriginal and Torres Strait Islander (Australia’s Indigenous peoples) adults surveyed from 2018 to 2020 (≥16 years, n = 8108). It quantifies Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) for wellbeing outcomes by level of discrimination exposure, and tests if associations vary by attribution of discrimination to Indigeneity. Of the participants, 41.5% reported no discrimination, 47.5% low, and 11.0% moderate-high. Discrimination was more commonly reported by younger versus older participants, females versus males, and those living in remote versus urban or regional areas. Discrimination was significantly associated in a dose-response manner, with measures of social and emotional wellbeing, culture and identity, health behaviour, and health outcomes. The strength of the association varied across outcomes, from a 10–20% increased prevalence for some outcomes (e.g., disconnection from culture (PR = 1.08; 95% CI: 1.03, 1.14), and high blood pressure (1.20; 1.09, 1.32)), to a five-fold prevalence of alcohol dependence (4.96; 3.64, 6.76), for those with moderate-high versus no discrimination exposure. The association was of consistent strength and direction whether attributed to Indigeneity or not—with three exceptions. Discrimination is associated with a broad range of poor wellbeing outcomes in this large-scale, national, diverse cohort of Aboriginal and Torres Strait Islander adults. These findings support the vast potential to improve Aboriginal and Torres Strait Islander peoples’ wellbeing, and to reduce Indigenous-non-Indigenous inequities, by reducing exposure to discrimination.

Potential Determinants of Cardio-Metabolic Risk among Aboriginal and Torres Strait Islander Children and Adolescents: A Systematic Review

“…These areas deserve further investigation, using consistent and validated exposure measures. A recent study with a national sample of Indigenous adults, using a validated discrimination measure, found that those who had experienced moderate–high racial discrimination had increased prevalence of high blood pressure (24% higher), high cholesterol (17% higher), diabetes (57% higher) and heart disease (52% higher), than those with no discrimination [ 95 ]. Evidence about other potential social determinants during childhood and adolescence is largely lacking and a comprehensive investigation of these factors is required so that the underlying drivers of inequities in cardio-metabolic disease for Indigenous people can be addressed.…”

Modelling prevalent cardiovascular disease in an urban Indigenous population

“…This was based on a plausible biological pathway (discrimination leading to stress and other CVD-related outcomes), the large point estimate of the effect size in a bivariate analysis and ambiguity in the literature. Furthermore, discrimination is associated with a broad range of poor health outcomes among Indigenous peoples, including commercial tobacco use, blood pressure, heart disease and diabetes, and is a fundamental determinant of health and health inequities (Thurber et al, 2021). This finding has important implications for healthcare delivery.…”

A new path to address health disparities: How older Aboriginal & Torres Strait Islander women use social media to enhance community health (Protocol)

“…The myriad of social/political factors that impact the health and well-being of Aboriginal and Torres Strait Islander people is well-documented and essential to keep in mind as we evolve digital health technology. Some of the social/political factors impacting Aboriginal and Torres Strait Islander health include racism and marginalisation 5 – 7 ; entrenched inter-generational trauma 8 ; discrimination 9 ; inequalities in society 10 ; disconnection from community and country 5 the historic and ongoing effects of colonisation 5 , 6 , 8 which contributes to distrust and subsequent reluctance to access services. 11 In addition, factors specific to the health system include lack of access to health care services 12 ; inadequate access to culturally competent health carers 6 , 13 which contributes to low trust and a reluctance to ask questions or even seek health services 11 creating additional barriers to self-management.…”