Saxby Karinna, Aitken Zoe, Burchill Luke, Zhang Yuting
Melbourne Institute: Applied Economic & Social Research, Faculty of Business and Economics, University of Melbourne, Melbourne, Victoria, Australia.
Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Lancet Reg Health West Pac. 2024 Aug 1;50:101154. doi: 10.1016/j.lanwpc.2024.101154. eCollection 2024 Sep.
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.
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.
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.
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.
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).
社区态度会影响健康结果，尤其是对于遭受种族主义和歧视不利影响的种族多样化群体和少数群体。本研究利用澳大利亚全国公投结果来建立一个向议会发声的原住民及托雷斯海峡岛民之声（“该声音”），以此作为对澳大利亚原住民态度的代理指标，根据对该声音的反对程度，研究了澳大利亚原住民和非原住民的健康结果。
反对该声音的选票在各地区的占比与澳大利亚家庭、收入和劳动力动态调查2021年的数据相关联，该调查是对澳大利亚成年人进行的一个大型全国概率样本（n≈17000）。在对地区层面的混杂因素进行调整后，我们使用逻辑回归分析来预测澳大利亚原住民和非原住民在不同反对程度（四分位数）下的健康结果、医疗保健使用情况和冒险行为。
对该声音的反对程度越高，原住民在健康、医疗保健使用和健康行为方面的差距就越大。生活在对该声音反对程度最高地区的澳大利亚原住民（最高四分位数：72%的社区投票“反对”）更有可能报告健康状况一般/较差[比值比2.28（95%置信区间1.45 - 3.58）]和心理健康状况较差[比值比2.24（95%置信区间1.48 - 3.39）]，去看任何医疗保健提供者的可能性更小[比值比0.52（95%置信区间0.36 - 0.75）]，并且吸烟[比值比4.21（95%置信区间2.78 - 6.38）]或进行危险饮酒的可能性更大[比值比2.66（95%置信区间1.60 - 4.43）]，相比非澳大利亚原住民。
与非澳大利亚原住民相比，生活在对该声音反对程度更高社区的澳大利亚原住民健康状况更差。健康差距可能部分归因于医疗保健可及性较差和冒险行为增加，这可能与种族主义有关。这些发现与与歧视相关的压力过程以及可能减少的具有文化包容性的医疗保健可及性相一致。健康和社会政策应考虑更广泛的社会层面状况如何塑造澳大利亚原住民的健康差距。
本研究得到澳大利亚研究理事会（项目编号FT200100630）、墨尔本大学教师研究基金以及澳大利亚国家卫生与医学研究理事会研究员基金（项目编号1201937）的支持。
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