Background Racism is increasingly recognised as a significant health determinant that contributes to health inequalities. In Australia efforts have been made to bridge the recognised health gap between Aboriginal and Torres Strait Islander people and other Australians. This systematic scoping review aimed to assess, synthesise, and analyse the evidence in Australia about the impacts of racism on the mental and physical health of Aboriginal and Torrens Strait Islander peoples. Methods A systematic search was conducted to locate Australian studies in English published between 2000 and 2020. Five electronic databases were used: PubMed, CINAHL, Embase, Web of Science and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. The search strategy included a combination of key words related with racism, mental health, physical health and Indigenous people. Data were extracted based on review questions and findings were synthesized in a narrative summary. Results Of total 338 searched studies from five databases, 12 studies met the inclusion criteria for narrative synthesis where eight were cross-sectional studies and four prospective cohorts. General mental health and general health perception were the most frequently studied outcomes followed by child behaviour, smoking and substance consumption and specific health conditions. The prevalence of racism varied between 6.9 and 97%. The most common health outcomes associated with racism were general poor mental health and poor general health perception. More specific health outcomes such as anxiety, depression, child behaviour, asthma, increased BMI and smoking were also associated with racism but were analysed by a limited number of studies. Three studies analysed psychological distress, negative mental health, sleeping difficulties and negative perceived mental health according to severity of exposition to racism. Conclusion Racism is associated with negative overall mental and negative general health outcomes among Aboriginal and Torres Strait Islander peoples. Strategies to prevent all forms and sources of racism are necessary to move forward to bridging the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Further research is needed to understand in more detail the impact of racism from an Aboriginal and Torres Strait Islander definition of health and wellbeing.
Background: Although traditional and cultural health practices are widely used in Colombia, physicians are not trained to address intercultural tensions that arise in clinical practice. Cultural safety encourages practitioners to examine how their own culture shapes their clinical practice and to respect their patients’ culture. It requires inviting patients of non-dominant cultures to co-design culturally safe health care. We co-designed a curriculum for cultural safety training of Colombian health professionals. Methods: A sequential-consensual qualitative study defined the learning objectives of the curriculum. Semi-structured questionnaires and focus groups explored the opinions of traditional medicine users, medical students, and intercultural health experts to inform the content of the curriculum. Deliberative dialogue between key intercultural health experts settled the academic content of the curriculum. A member-checking strategy modified and approved the final version. Results: Seven traditional medicine users, six medical students, and four intercultural health experts participated in the study. The stakeholders defined five learning objectives: (a) culturally unsafe practices: acknowledge the intercultural tensions and its consequences; (b) cultural awareness: examine their attitudes, beliefs, and values, and how they shape their professional practice; (c) cultural humility: listen and learn from the patients’ traditional practices; (d) cultural competence: describe current pedagogical approaches to address intercultural tensions; and (e) cultural safety: discuss with patients to reach an agreement on their treatment. Conclusion: This study integrated the perspectives of different stakeholders and proposed new applications of cultural safety that are relevant to other countries. Researchers and educators can use these results to inform future cultural safety initiatives.
Background Racism is increasingly recognised internationally as a key factor contributing to health disparities. A comprehensive body of strong research from international authors has reported negative associations between racism and health outcomes. In Australia, although the literature is more limited, available findings follow global trends. Australia has an identified health gap between Aboriginal and Torres Strait Islander peoples and non-indigenous Australians, and despite efforts to bridge this gap, health inequities continue to exist. This scoping review aims to assess, analyse and synthesise the relationship between racism and discrimination on the physical and mental health of Aboriginal and Torres Strait Islander peoples living in Australia. Method This is the study protocol for a scoping review. A systematic search will be conducted using five electronic databases: PubMed, CINAHL, Embase, Web of Science and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. The database search will include studies published between 2000 and 2020. Reference lists of the included articles will be searched. Outcome measures will include physical and mental health components including chronic conditions, depression and anxiety, psychological distress, social and emotional difficulties, suicide and health-related outcomes such as wellbeing and life satisfaction. Duplications will be removed, and titles and abstracts will be reviewed to select studies. Full-text screening of preselected studies will be performed by four reviewers independently, to select studies according to inclusion criteria. Included studies will be appraised for quality using appropriate tools tailored for each study design. Data will be extracted, and study findings and characteristics synthesised in a narrative summary. Discussion Our scoping review will synthesise the evidence on the impacts of racism and discrimination in relation to the physical and mental health of Aboriginal and Torres Strait Islander peoples living in Australia. These findings could guide future health interventions by addressing the exposure of racism and racial discrimination in order to reduce health disparity. It is anticipated the findings to be of interest to policymakers, researchers, Aboriginal and Torres Strait Islander communities and community health organisations and other stakeholders interested in optimising public health interventions for and in partnership with Aboriginal and Strait Torres Islander communities of Australia. Scoping review registration The protocol for this review has been registered on the international prospective register of systematic reviews (PROSPERO). The registration ID is CRD42020186193.
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