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. 2018 Sep;103(9):873-879.
doi: 10.1136/archdischild-2017-313866. Epub 2018 Mar 23.

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

Sarah-Jane Paine  1 , Ricci Harris  1 , James Stanley  2 , Donna Cormack  1
Affiliations

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

Sarah-Jane Paine et al. Arch Dis Child. 2018 Sep.

Abstract

Objectives: Children's exposure to racism via caregiver experience (vicarious racism) is associated with poorer health and development. However, the relationship with child healthcare utilisation is unknown. We aimed to investigate (1) the prevalence of vicarious racism by child ethnicity; (2) the association between caregiver experiences of racism and child healthcare utilisation; and (3) the contribution of caregiver socioeconomic position and psychological distress to this association.

Design: Cross-sectional analysis of two instances of the New Zealand Health Survey (2006/2007: n=4535 child-primary caregiver dyads; 2011/2012: n=4420 dyads).

Main outcome measures: Children's unmet need for healthcare, reporting no usual medical centre and caregiver-reported dissatisfaction with their child's medical centre.

Results: The prevalence of reporting 'any' experience of racism was higher among caregivers of indigenous Māori and Asian children (30.0% for both groups in 2006/2007) compared with European/Other children (14.4% in 2006/2007). Vicarious racism was independently associated with unmet need for child's healthcare (OR=2.30, 95% CI 1.65 to 3.20) and dissatisfaction with their child's medical centre (OR=2.00, 95% CI 1.26 to 3.16). Importantly, there was a dose-response relationship between the number of reported experiences of racism and child healthcare utilisation (eg, unmet need: 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). Adjustment for caregiver psychological distress attenuated the association between caregiver experiences of racism and child healthcare utilisation.

Conclusions: Vicarious racism is a serious health problem in New Zealand disproportionately affecting Māori and Asian children and significantly impacting children's healthcare utilisation. Tackling racism may be an important means of improving inequities in child healthcare utilisation.

Keywords: child; health care utilisation; indigenous; inequities; racism.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Forest plots with ORs and 95% CI of the association between caregiver experiences of racism and (panel A) unmet need for healthcare, (panel B) caregiver dissatisfaction with child’s usual medical centre and (panel C) reporting no usual healthcare centre. Models adjusted for caregiver ethnicity, gender, age, socioeconomic position and caregiver dissatisfaction with own care (panel B only). NZHS, New Zealand Health Survey.
See this image and copyright information in PMC

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