Investigating the Relationship between Socially-Assigned Ethnicity, Racial Discrimination and Health Advantage in New Zealand

Abstract

BackgroundWhile evidence of the contribution of racial discrimination to ethnic health disparities has increased significantly, there has been less research examining relationships between ascribed racial/ethnic categories and health. It has been hypothesized that in racially-stratified societies being assigned as belonging to the dominant racial/ethnic group may be associated with health advantage. This study aimed to investigate associations between socially-assigned ethnicity, self-identified ethnicity, and health, and to consider the role of self-reported experience of racial discrimination in any relationships between socially-assigned ethnicity and health.MethodsThe study used data from the 2006/07 New Zealand Health Survey (n = 12,488), a nationally representative cross-sectional survey of adults 15 years and over. Racial discrimination was measured as reported individual-level experiences across five domains. Health outcome measures examined were self-reported general health and psychological distress.ResultsThe study identified varying levels of agreement between participants' self-identified and socially-assigned ethnicities. Individuals who reported both self-identifying and being socially-assigned as always belonging to the dominant European grouping tended to have more socioeconomic advantage and experience less racial discrimination. This group also had the highest odds of reporting optimal self-rated health and lower mean levels of psychological distress. These differences were attenuated in models adjusting for socioeconomic measures and individual-level racial discrimination.ConclusionsThe results suggest health advantage accrues to individuals who self-identify and are socially-assigned as belonging to the dominant European ethnic grouping in New Zealand, operating in part through socioeconomic advantage and lower exposure to individual-level racial discrimination. This is consistent with the broader evidence of the negative impacts of racism on health and ethnic inequalities that result from the inequitable distribution of health determinants, the harm and chronic stress linked to experiences of racial discrimination, and via the processes and consequences of racialization at a societal level.

Socially-assigned race and health: a scoping review with global implications for population health equity

“…In this context, concordance between self-identified and socially assigned race was greatest among individuals who self-identified as European (97.6%, which is considered the dominant ethnic group) and Asians (92.7%). Discordance was highest among individuals who self-identified as Māori, Pacific, and those who identified as multi-ethnic [25]. In a study conducted across several Latin American countries, interviewers reported their assessment of respondent's race/ethnicity according to the following 5 categories: white (blanca/branca); mixed-white (mestizo/parda), mixed-black (mulato), indigenous (indigena), and black (negra/preta) or other [31].…”

“…Socially-assigned race studies conducted in New Zealand, included Māori, Pacific peoples, Asian and European ethnic groups [25]. In this context, concordance between self-identified and socially assigned race was greatest among individuals who self-identified as European (97.6%, which is considered the dominant ethnic group) and Asians (92.7%).…”

“…For example, being socially assigned as black or Latinx may expose individuals to unique psychosocial stressors, such as racial discrimination, that are associated with poorer health outcomes [4,20]. Moreover, there is a growing body of research that uses socially-assigned race to examine the health, social, and economic implications of being perceived as white (or as a member of a dominant social group) in comparison to those who are socially-assigned as non-white or a non-dominant group [20,[22][23][24][25]. This review represents to our knowledge, the first systematic and comprehensive assessment of the research on socially assigned race and its relationship with health and health-related outcomes.…”

The significance of relational continuity of care for Māori patient engagement with predominantly non‐Māori doctors: findings from a qualitative study

“…26 In this paper, socially ascribed ethnicity refers to participants' perceptions of how they are categorised by others (primarily as either Māori or NZ European) that emerged during face-to-face interviews. Further, thematic analysis accords with the epistemological approach employed in this Kaupapa Māori study as it foregrounds a Māori world-view that explicitly recognises the validity and legitimacy of cultural aspirations of being Māori, and the fundamental right to exercise autonomy over health and wellbeing.…”

“…Within the broad overlapping and intersecting themes of age, spatial location at birth, timing of entry into the health system and self-reported perceptions of social ascription as Māori (discussed in more detail elsewhere), 26,28 analysis of participant narratives identified the inability to develop and maintain relational continuity of care with freely chosen and often trusted GPs as a principal barrier to accessing quality and non-discriminatory primary healthcare. Rapid access to any doctor was, however, considered appropriate when consulting with minor or acute problems, for example, by young males with sports injuries.…”