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Caregiver experiences of racism and child healthcare utilisation: cross-sectional analysis from New Zealand

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Authors:
Summary:

Using data from two instances of the New Zealand Health Survey (NZHS; 2006/2007 and 2011/2012), these researchers analysed the prevalence of children’s (0–14 years) exposure to racism via caregiver experience (vicarious racism) and investigated the association between vicarious racism and measures of low child healthcare utilisation. The analysis included 4,535 child–primary caregiver dyads from the 2006/2007 NZHS and 4,420 dyads from the 2011/2012 NZHS. Caregivers of indigenous Māori and Asian children were more likely to report ‘any’ experience of racism (30.0% for both groups in 2006/2007) compared with caregivers of European/Other children (14.4% in 2006/2007). Children of caregivers who reported ‘any’ racism were more likely to have an unmet need for healthcare (OR 2.30; 95% CI, 1.65 to 3.20); those caregivers were more likely to be dissatisfied with their child’s medical centre (OR 2.00; 95% CI, 1.26 to 3.16). A dose–response relationship was observed between the number of reported experiences of racism and child unmet need for healthcare (1 report of racism: OR 1.89; 95% CI, 1.34 to 2.67; ≥2 reports of racism: OR 3.06; 95% CI, 1.27 to 7.37). Vicarious racism was strongly associated with unmet need for healthcare in an unadjusted model for any racial discrimination (OR 2.53; 95% CI, 1.68 to 3.80) and in a model adjusted for ethnicity, gender and age (OR 2.34; 95% CI, 1.65 to 3.32). Adjusting for caregiver socioeconomic position had little impact on the association between caregiver experiences of racism and child healthcare utilisation (OR 2.30; 95% CI, 1.65 to 3.20), whereas the association was markedly attenuated after adjusting for caregiver psychological distress (OR 1.89; 95% CI, 1.14 to 3.12).

Comment:
I personally remember a time I took my daughter to an after-hours centre and felt so humiliated by the way the GP spoke to me, as if we didn’t ‘count’. I made two decisions: 1. I wrote to the manager of the (Australian) clinic about my experience and asked that she send the GP to cultural safety training and 2. I would try not to treat patients, including caregivers, the same way. However, I hold a privileged position and these options are not ‘available’ for all. I completely understand that parents feel that they have no choice but to stay away from healthcare services after such a negative experience.
Reference: Arch Dis Child. 2018;103(9):873-9
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

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