Community Attitudes and Indigenous Health Disparities: Evidence from Australia's Voice Referendum

Overview

Journal Lancet Reg Health West Pac

Date 2024 Oct 15

PMID 39403451

Authors

Karinna Saxby

Zoe Aitken

Luke Burchill

Yuting Zhang

Affiliations

Soon will be listed here.

Abstract

Background: Community attitudes influence health outcomes especially for racially diverse and minority groups exposed to the detrimental effects of racism and discrimination. Using the results from Australia's national referendum to establish an Aboriginal and Torres Strait Islander Voice to Parliament ('the Voice') as a proxy for attitudes to Indigenous Australians, this study examined health outcomes for Indigenous and non-Indigenous Australians according to levels of opposition to the Voice.

Methods: The regional share of votes against the Voice was linked to 2021 data from the Household, Income and Labour Dynamics in Australia survey, a large, national probability sample (n∽17,000) of Australian adults. Adjusting for regional-level confounders, we used logistic regression analyses to predict health outcomes, healthcare use, and risk-taking behaviours among Indigenous and non-Indigenous Australians for different levels (quartiles) of opposition to the Voice.

Findings: Greater opposition to the Voice was associated with widening Indigenous disparities in health, healthcare use, and health behaviours. Indigenous Australians living in regions with the highest opposition to the Voice (top quartile: 72% community voting 'No') were more likely to report fair/poor health [OR 2.28 (95% CI 1.45-3.58)] and poor mental health [OR 2.24 (95% CI 1.48-3.39)], were less likely to have visited any healthcare provider [OR 0.52 (95% CI 0.36-0.75)], and were more likely to smoke [OR 4.21 (95% CI 2.78-6.38)] or engage in risky drinking [OR 2.66 (95% CI 1.60-4.43)] relative to non-Indigenous Australians.

Interpretation: Indigenous Australians living in communities with greater opposition to the Voice experience poorer health relative to non-Indigenous Australians. Disparities in health may be partially due to poorer healthcare access and increased risk-taking behaviours, which may be associated with racism. These findings align with discrimination-related stress processes and potentially reduced availability of culturally inclusive healthcare. Health and social policy should consider how broader societal level conditions shape Indigenous health disparities in Australia.

Funding: This work is supported by the Australian Research Council (project ID FT200100630), the University of Melbourne Faculty Research Grant, and the National Health and Medical Research Council of Australia Investigator Grant (project ID 1201937).

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References

Harris R, Tobias M, Jeffreys M, Waldegrave K, Karlsen S, Nazroo J . Effects of self-reported racial discrimination and deprivation on Māori health and inequalities in New Zealand: cross-sectional study. Lancet. 2006; 367(9527):2005-9. DOI: 10.1016/S0140-6736(06)68890-9. View

Watkinson R, Linfield A, Tielemans J, Francetic I, Munford L . Gender-related self-reported mental health inequalities in primary care in England: a cross-sectional analysis using the GP Patient Survey. Lancet Public Health. 2024; 9(2):e100-e108. DOI: 10.1016/S2468-2667(23)00301-8. View

Hatzenbuehler M, Jun H, Corliss H, Austin S . Structural stigma and sexual orientation disparities in adolescent drug use. Addict Behav. 2015; 46:14-8. PMC: 4395540. DOI: 10.1016/j.addbeh.2015.02.017. View

Bailey Z, Krieger N, Agenor M, Graves J, Linos N, Bassett M . Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017; 389(10077):1453-1463. DOI: 10.1016/S0140-6736(17)30569-X. View

Morey B, Chang R, Thomas K, Tulua A, Penaia C, Tran V . No Equity without Data Equity: Data Reporting Gaps for Native Hawaiians and Pacific Islanders as Structural Racism. J Health Polit Policy Law. 2021; 47(2):159-200. PMC: 10959240. DOI: 10.1215/03616878-9517177. View

Anderson I, Paradies Y, Langton M, Lovett R, Calma T . Racism and the 2023 Australian constitutional referendum. Lancet. 2023; 402(10411):1400-1403. DOI: 10.1016/S0140-6736(23)01954-2. View

Hatzenbuehler M, Nolen-Hoeksema S, Erickson S . Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: results from a prospective study of bereaved gay men. Health Psychol. 2008; 27(4):455-62. DOI: 10.1037/0278-6133.27.4.455. View

Nixon S . The coin model of privilege and critical allyship: implications for health. BMC Public Health. 2019; 19(1):1637. PMC: 6896777. DOI: 10.1186/s12889-019-7884-9. View

Saxby K, Byrnes J, de New S, Nghiem S, Petrie D . Does affirmative action reduce disparities in healthcare use by Indigenous peoples? Evidence from Australia's Indigenous Practice Incentives Program. Health Econ. 2023; 32(4):853-872. DOI: 10.1002/hec.4645. View

10.

Thurber K, Brinckley M, Jones R, Evans O, Nichols K, Priest N . Population-level contribution of interpersonal discrimination to psychological distress among Australian Aboriginal and Torres Strait Islander adults, and to Indigenous-non-Indigenous inequities: cross-sectional analysis of a community-controlled.... Lancet. 2022; 400(10368):2084-2094. PMC: 9807286. DOI: 10.1016/S0140-6736(22)01639-7. View

11.

Chae D, Clouston S, Hatzenbuehler M, Kramer M, Cooper H, Wilson S . Association between an Internet-Based Measure of Area Racism and Black Mortality. PLoS One. 2015; 10(4):e0122963. PMC: 4409363. DOI: 10.1371/journal.pone.0122963. View

12.

Perales F, Todd A . Structural stigma and the health and wellbeing of Australian LGB populations: Exploiting geographic variation in the results of the 2017 same-sex marriage plebiscite. Soc Sci Med. 2018; 208:190-199. DOI: 10.1016/j.socscimed.2018.05.015. View

13.

Johnston D, Lordan G . Discrimination makes me sick! An examination of the discrimination-health relationship. J Health Econ. 2012; 31(1):99-111. DOI: 10.1016/j.jhealeco.2011.12.002. View

14.

Kairuz C, Casanelia L, Bennett-Brook K, Coombes J, Yadav U . Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait islander peoples living in Australia: a systematic scoping review. BMC Public Health. 2021; 21(1):1302. PMC: 8254223. DOI: 10.1186/s12889-021-11363-x. View

15.

Hatzenbuehler M, Link B . Introduction to the special issue on structural stigma and health. Soc Sci Med. 2014; 103:1-6. DOI: 10.1016/j.socscimed.2013.12.017. View

16.

Leggat G, Livingston M, Kuntsche S, Callinan S . Alcohol consumption trajectories over the Australian life course. Addiction. 2022; 117(7):1931-1939. PMC: 9311147. DOI: 10.1111/add.15849. View

17.

Rhee T, Marottoli R, Van Ness P, Levy B . Impact of Perceived Racism on Healthcare Access Among Older Minority Adults. Am J Prev Med. 2019; 56(4):580-585. PMC: 6430677. DOI: 10.1016/j.amepre.2018.10.010. View

18.

Berry H, Welsh J . Social capital and health in Australia: An overview from the household, income and labour dynamics in Australia survey. Soc Sci Med. 2009; 70(4):588-96. DOI: 10.1016/j.socscimed.2009.10.012. View

19.

Saxby K, de New S, Petrie D . Structural stigma and sexual orientation disparities in healthcare use: Evidence from Australian Census-linked-administrative data. Soc Sci Med. 2020; 255:113027. DOI: 10.1016/j.socscimed.2020.113027. View

20.

Lukachko A, Hatzenbuehler M, Keyes K . Structural racism and myocardial infarction in the United States. Soc Sci Med. 2014; 103:42-50. PMC: 4133127. DOI: 10.1016/j.socscimed.2013.07.021. View