Racism and health in New Zealand: Prevalence over time and associations between recent experience of racism and health and wellbeing measures using national survey data
Racism and health in New Zealand: Prevalence over time and associations between recent experience of racism and health and wellbeing measures using national survey data
Ricci B. Harris 0 1
James Stanley 1
Donna M. Cormack 0 1
0 Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago , Wellington , New Zealand , 2 Dean's Department, University of Otago , Wellington , New Zealand
1 Editor: Baltica Cabieses, Universidad del Desarrollo , CHILE
Racism is an important health determinant that contributes to ethnic health inequities. This study sought to describe New Zealand adults' reported recent experiences of racism over a 10 year period. It also sought to examine the association between recent experience of racism and a range of negative health and wellbeing measures.
Data Availability Statement: This study
undertakes analysis of secondary data from
multiple New Zealand Health Surveys (2002/03,
2006/07, 2011/12) and New Zealand General
Social Surveys (2008, 2010, 2012). These are third
party data. Data are available from Statistics New
Zealand as confidentialised unit record files
(CURFs) or unit record data (microdata) via the
Statistic New Zealand data lab. Researchers must
meet the assessment eligibility criteria for access
to this data. The authors did not have any special
The study utilised previously collected data from multiple cross-sectional national surveys
(New Zealand Health Surveys 2002/03, 2006/07, 2011/12; and General Social Surveys
2008, 2010, 2012) to provide prevalence estimates of reported experience of racism (in the
last 12 months) by major ethnic groupings in New Zealand. Meta-analytical techniques
were used to provide improved estimates of the association between recent experience of
racism and negative health from multivariable models, for the total cohorts and stratified by
Reported recent experience of racism was highest among Asian participants followed by
Māori and Pacific peoples, with Europeans reporting the lowest experience of racism.
Among Asian participants, reported experience of racism was higher for those born
overseas compared to those born in New Zealand. Recent experience of racism appeared to be
declining for most groups over the time period examined. Experience of racism in the last 12
months was consistently associated with negative measures of health and wellbeing (SF-12
physical and mental health component scores, self-rated health, overall life satisfaction).
While exposure to racism was more common in the non-European ethnic groups, the impact
access privileges that others in New Zealand would
not have, however, data cannot be taken or used
off-shore. Information on data access, including
guidelines, policies and contact information, can be
found at (http://archive.stats.govt.nz/about_us/
aspx). Data access is determined and administered
by Statistics New Zealand (the lead government
agency for government-held data).
Funding: This research was supported by a
research grant from the Health Research Council of
New Zealand (14/262) to RBH (as first named
investigator). The funder's website is: www.hrc.
govt.nz. The funder had no role in the study design,
data collection and analysis, decision to publish, or
preparation of the manuscript.
Competing interests: The authors have declared
that no competing interests exist.
of recent exposure to racism on health was similar across ethnic groups, with the exception
of SF-12 physical health.
The higher experience of racism among non-European groups remains an issue in New
Zealand and its potential effects on health may contribute to ethnic health inequities.
Ongoing focus and monitoring of racism as a determinant of health is required to inform and
Racism has been established as an important determinant of health and a root cause of racial/
ethnic health inequities [
]. Racism can be understood as an organised system with historical
contexts and contemporary manifestations [
]. It involves categorising and ranking racial/
ethnic groups into social hierarchies, whereby racial/ethnic groups are assigned differential
value and have differential access to power, opportunities and resources . There are many
expressions of racism at structural and individual levels that can affect health through a
number of pathways [
There has been considerable growth over the last two decades in research on the negative
impacts of racism on health, particularly with regards to the impact of experience of
interpersonal racism [
]. There is now a strong, consistent evidence base linking experience of racial
discrimination to various markers of negative physical and mental health (both self-reported
and objectively measured), health risk and health care utilisation. The magnitude of
association appears to be highest with mental health outcomes [
]. Research has been predominantly
carried out among adult population samples [1, 3±5], although there is increasing research
interest in examining experiences of racism and links to health for children [
among adults also extends into evidence for associations between experience of racism and
broader measures of wellbeing such as life satisfaction, quality of life and self-esteem [5, 7±11].
While most studies are cross-sectional, associations between experience of racism and negative
health measures are also evident in longitudinal studies [
In New Zealand (NZ), there are long-standing and systematic ethnic inequities in health
outcomes, risk factors (including broader social determinants) and health care, particularly
between Māori (the indigenous peoples) and European ethnic groups [12±14]. Population
level studies have demonstrated higher prevalence of reported experience of racism by
nonEuropean ethnic groups, particularly Asian and Māori [15±20]. A growing body of local
research shows a consistent link between experience of racism and a range of negative health
measures that may significantly impact on ethnic health inequities [15±19, 21±26]. This
includes studies investigating a range of mental and physical health measures, individual level
risk factors and health service experience and use. Analysis of data from the adult New Zealand
Health Surveys (NZHS 2002/03 and 2006/07) showed that reported experience of racial
discrimination `ever' was significantly associated with a range of negative health measures for all
ethnic groups, including self-rated general health, self-rated physical functioning and mental
health, psychological distress, diagnosed cardiovascular disesase, diagnosed mental health
disorder, smoking and sleep disturbance [
16, 17, 26
]. Both the experience of interpersonal racism
and socioeconomic position (as a marker of systemic racism) have been shown to contribute
to health inequities between Māori and European ethnic groups [
]. Analysis from the 2006/
2 / 22
07 NZHS also showed that experience of racial discrimination was associated with less positive
patient experiences with their usual primary care provider and, for Māori women, lower breast
and cervical cancer screening coverage [
Longitudinal evidence for these links is also available from New Zealand. The NZ Attitudes
and Values study has shown that experience of racism was negatively linked to subsequent
wellbeing among Māori [
]. The Growing Up in New Zealand study demonstrated that
experience of racism (as reported during pregnancy) was linked to higher likelihood of postnatal
depression among Māori, Pacific and Asian women [
]. Experiences of racism have also been
more broadly documented in other New Zealand studies, both quantitative and qualitative
[27±33], including studies finding negative attitudes and stereotypes towards Māori by health
These studies provide an important local evidence base to build upon in order to better
understand and address racism as a determinant of health in New Zealand. To date, local
studies have tended to focus on a relatively small pool of exposed individuals (giving a small
effective sample size) or limited study time periods. These studies can consequently be limited in
their power to examine relationships between recent experience of racism (last 12 months)
and health, particularly for specific ethnic groups. In addition, there is limited international
evidence of the relationship between racism and health for individual ethnic groups, although
existing research suggests that the strength of association may differ by race/ethnicity and by
time from exposure to outcome [
The routine monitoring of experience of racism as a determinant of health and wellbeing
has now been implemented in multiple time periods for two of our national surveys, the New
Zealand Health Survey (2002/03, 2006/07, 2011/12) and the General Social Survey (GSS 2008,
GSS 2010, GSS 2012). This monitoring allows us greater scope to examine recent experiences
of racism by ethnicity over time, alongside links between racism and health, with improved
precision for specific ethnic groupings. Specifically this study aimed to: examine the prevalence
of reported experience of racial discrimination (in the last 12 months), including changes over
time, using multiple data sources (from the New Zealand General Social Surveys (GSS) and
New Zealand Health Surveys (NZHS)); and examine the relationship between self-reported
experience of racial discrimination (in the last 12 months) and measures of health and
wellbeing, for both the overall adult population and stratified by major ethnic groupings.
This study undertakes a comprehensive analysis of secondary data from multiple national
surveys of New Zealand adults, including the New Zealand Health Survey (2002/03, 2006/07,
2011/12) and the General Social Survey (2008, 2010, 2012). Both survey types allow for the
calculation of nationally representative data through appropriate analysis incorporating the
complex survey design (see details below). The surveys are repeated cross-sectional surveys.
The study followed Statistics New Zealand processes for accessing microdata [
were provided as confidentialised unit record files (CURFs) for all surveys. More detailed data
on racism in particular settings were analysed in the Statistics New Zealand Data Lab for the
]. The study was approved by University of Otago Human Ethics Committee (D14/
The New Zealand Health Survey. The New Zealand Health Survey (NZHS) provides
information on self-reported health status and chronic conditions, health risk and protective
3 / 22
factors, experience and utilisation of health care and sociodemographic factors [
NZHS has moved from a periodic survey (up until 2007) to a continuous survey (from 2011/
12) with additional survey content rotated annually [
]. The three surveys selected for
analysis (2002/03; 2006/07; 2011/12) are those that include questions on participant experiences of
racial discrimination and were available at the beginning of data analysis.
The NZHS used multistage, probability-proportional-to-size (PPS) sampling methods to
select participants from people who usually reside in New Zealand (usually resident) and were
aged 15+ years (for the adult survey) [
]. In 2002/03 and 2006/07 this was restricted to
residents in permanent, private dwellings and excluded those in institutions [
]. In 2011/12
this was expanded to include people in non-private accommodation, such as aged-care
facilities and student accommodation . An area-based sampling frame used meshblocks (small
areas of approximately 90 people) as primary sampling units, followed by random selection of
households and individuals [
]. All instances of the NZHS employed methods to increase
sampling of Māori, Pacific and Asian participants [40±42]. Computer assisted personal
interviews (CAPI) were undertaken with participants by trained interviewers [
]. All results are
weighted to account for survey design (including over-sampling) and non-response to provide
representative results for the New Zealand adult population [
Table 1 summarises the NZHS instances used in this study with details on data collection
period, participant numbers and response rates. Full details on each survey's methods can be
found elsewhere [40±42].
The General Social Survey. The GSS collects data biennially on adults aged 15 years and
over who usually reside in New Zealand in private dwellings and do not reside in insitutions
. It provides nationally representative data on a range of social and economic indicators
including life satisfaction, health, knowledge and skills, work, living standards, housing,
physical environment, safety and security, support, social connectedness, leisure and recreation,
culture and identity, and human rights .
The GSS has a three-stage sampling process. Primary sampling units (PSU) are selected
from the Statistics New Zealand Household Survey Frame (HSF) based on NZ Census
data. Individual dwellings are selected randomly within these PSUs, followed by random
selection of eligible individuals within these dwellings . The GSS is designed to produce
nationally representative results. Data collection is via CAPI interviews . Unlike
the NZHS, the GSS does not employ methods to increase sampling of particular ethnic
The first GSS was conducted in 2008. Table 1 summarises the three GSS instances used in
this study with details on data collection period, participant numbers and response rates. The
three surveys selected for this project were those available at the beginning of data analysis.
Full details on the methods for each survey can be found elsewhere [43±45].
Data collection period
Aug 2002±Jan 2004
Oct 2006±Nov 2007
Jul 2011±June 2012
Apr 2008±Mar 2009
Apr 2010±Mar 2011
Apr 2012±Mar 2013
Number of adult participants
4 / 22
To enable comparisons across time periods and combination of results across survey instances,
we prioritised selection of consistent variables (and categorisation of variables) across all
Racial discrimination. Both surveys (NZHS, GSS) provide data on participant
experiences of racial discrimination, asked in either a one-step or two-step questioning process .
The NZHS uses a one-step process and asks directly about experience of racial/ethnic
discrimination in New Zealand in five situations: physical and verbal attack, and unfair treatment
because of ethnicity in health, housing and work situations. For example, ªHave you ever been
treated unfairly at work or been refused a job because of your ethnicity in New Zealand?º, with
response options: Yes, within the past 12 months; Yes, more than 12 months ago; No; Don't
know; Refused . Items were grouped for analysis into any experience of racial
discrimination in the last 12 months if participants responded yes to any of the five items compared with
no experience of racial discrimination in the last 12 months. Participant responses coded as
ªDon't knowº or ªRefusedº were excluded from analyses.
The GSS uses a two-step process whereby participants are initially asked about any
experience of discrimination in the last 12 months (response options: Yes, No, Don't know, Refused),
with a follow-up question on the attribution of discrimination e.g. due to skin colour,
nationality, age, gender etc. Experience of racial discrimination for this study was categorised based on
discrimination reported as being due to `skin colour', and/or `nationality, race or ethnic group'
in any setting. This is in line with NZ legislative and policy definitions of racism and racial
discrimination whereby `colour', `race' and `ethnic or national origins' are prohibited grounds for
discrimination (Human Rights Act 1993). For analysis over time, and in examining
associations between racism and health, any experience of racism in the last 12 months was used in
analyses compared with no experience of racism in the last 12 months. The number of times
participants experienced discrimination overall was also asked but could not be analysed for
racial discrimination specifically .
The GSS also asks about the settings where discrimination occurred. In this study, settings
where people experienced racial discrimination were examined. Some settings options were
grouped where they were examining similar areas. These groups were `in public' (grouping the
response options: on the street or in a public place of any kind; using transport of any kind;
getting service where buying something), in work (at work or while working; applying for or
keeping a job or position), in justice (dealing with the police; dealing with the courts). Other
settings were: at home (single response option); school (getting into a school or other place
of learning, or being treated fairly there); joining an association or club of any kind (single
response option); housing (applying for or keeping a flat or housing of any kind); dealing with
other government officials (single response option); health (dealing with people involved in
health care); and Other (with no further detail available in the source data).
The two approaches for how the discrimination questions were asked across the NZHS and
GSS can be found in S1 Table.
Ethnicity. The NZHS and GSS use the standard NZ Population Census ethnicity question
that allows people to self-identify their ethnic group or groups. The question provides a
number of ethnic group response options, along with an ªOtherº category accompanied by a
freetext field where people can write in their ethnicity if it is not captured by the response options.
NZ uses a hierarchical classification system to classify responses to the ethnicity question from
Level 1 (broad aggregate groupings) to Level 4 (detailed ethnic groups). For prevalences of
experience of racial discrimination, ethnicity was categorised as total Māori, total Pacific, total
Asian compared to a mutually exclusive European/Other group (see  for information on
5 / 22
the specific ethnic groups included within these categories). Total response ethnicity refers to
the way in which people who report more than one ethnicity are categorised for analysis, by
which they are counted in each of the major ethnic groupings with which they identify .
For multiple regression analyses, ethnicity was grouped into four mutually exclusive categories
using prioritisation  in the following order: Māori, Pacific, Asian and European/Other.
Several of the CURF datasets (NZHS 2011/12, and GSS 2008) did not allow for disaggregation
of people who identified as European or `Other'. To maintain consistency we used the
European/Other grouping for all datasets and analyses. Based on datasets where disaggregation of
European and Other ethnic groups could be undertaken (NZHS 2002/03, 2006/07, GSS 2010,
2012) it appears that this group is predominantly European (`Other' ethnic groups made up
1±4% of the European/Other group).
Health and wellbeing. Health variables common to both survey types were included to
examine associations between racial discrimination and health. These included, self-rated
general health (poor/fair vs. good/very good/excellent), and SF-12 mental and physical health
component summary scores (analysed as continuous variables) . Analysis of SF-12 data
excludes the 2002/03 NZHS as this used version 1 of the SF-12. To include a broader measure
of wellbeing, life satisfaction was also analysed for the GSS data only (responses grouped into
dissatisfied/very dissatisfied vs. no feeling either way/satisfied/very satisfied).
Other covariates. Other variables considered in multivariable models include: age (15±
24, 25±34, 35±44, 45±64, 65±74, 75+ years); gender (male, female); and nativity (born in NZ
vs. born overseas). Socioeconomic variables included an area-based measure (New Zealand
Index of Deprivation (NZDep): quintiles from 1 (least deprived) to 5 (most deprived) ,
and an individual measure (education qualification: no secondary qualification, secondary
qualification or higher).
All analyses accounted for the complex survey nature of the dataset, and adjusted for both
inverse sample weighting, stratification of the sampling frame, and clustering by PSU (see
survey sampling method above.) Analyses of the individual survey instances were conducted in
SAS 9.4 (SAS Institute, Cary, NC) using the SURVEYFREQ, SURVEYLOGISTIC, and
SURVEYREG procedures. Random effects meta-analysis to combine regression estimates across
the six NZHS/GSS survey instances were conducted in R 3.2 (R Institute, Vienna, Austria)
using the meta package .
Reported experience of any racial discrimination (in the last 12 months) by major ethnic
grouping was analysed for each survey. Prevalences of racial discrimination by setting were
analysed for the GSS 2008, 2010, and 2012 in the Statistics New Zealand data lab and are
subject to data lab confidentiality rules related to outputs [
]. Trends over time by ethnic
grouping were visualised using a trend line weighted to the inverse variance of the prevalence
estimates (see e.g. )
Multiple regression analysis was undertaken in each individual survey instance to examine
the sociodemographic patterning of reported experience of racial discrimination in the last 12
months (compared with no reported experience of racial discrimination in the last 12 months),
across all surveys. Standard random-effects meta-analysis methods [54, 56, 57] were used to
combine estimated effect sizes across the six unique survey instances. Sociodemographic
variables included: age, gender, education qualification, NZDep quintiles, ethnicity and nativity.
Nativity had an effect on experience of racial discrimination for some ethnic groups, and
therefore the levels of the ethnic/nativity group variables were combined and analysed with
NZ-born European/Other as the reference group.
6 / 22
Multiple regression analyses were used to examine associations between experience of racial
discrimination in the last 12 months (compared with no reported experience of racial
discrimination in the last 12 months) and health and wellbeing measures for each survey. These
analyses were conducted for the total adult samples, and also stratified by ethnicity (to determine
the impact of racism within each ethnic grouping). Logistic regression was used for binary
health variables (life satisfaction, self-rated health) and linear regression for contiuous
measures (SF-12 mental and physical scores). Logistic regression analyses present the odds ratios
(ORs) for poor health outcomes comparing those reporting experience of racism in the last 12
months to those not i.e. a positive OR indicates a relationship between experience of racism
and poor health or dissatisfaction. Linear regression models present the mean difference in
SF-12 scores for those reporting experience of racism in the last 12 months and those not i.e. a
negative results indicates an association between experience of racism and negative health.
Meta-analysis techniques using random effects models were used to combine effect sizes.
Models presented in the main text of this manuscript were adjusted for age, gender, ethnicity,
nativity, NZDep and education qualification; and adjusted for age, gender, nativity, NZDep
and education qualification in ethnicity-stratified models. Estimates from the unadjusted
models are presented in S2 Fig and S5 Table respectively. Formal hypothesis tests are reported
for whether the impact of recent racism on each health outcome differs between ethnic
groupings (formally considered as a sub-group comparison of the pooled effect sizes from the
ethnicity-stratified estimates, using Cochran's Q test) [56, 57].
Table 2 shows the total number of participants and their sociodemographic characteristics for
each survey analysed. The majority of participants in the Asian (90±94%) and Pacific (57±
67%) ethnic groups were born overseas, while nearly all participants who identified as Māori
were born in New Zealand (97±99%).
Fig 1 shows reported experience of racial discrimination in the last 12 months organised by
major ethnic grouping over the study period (from the 2002/03 NZHS to the GSS 2012). There
was some variation in the prevalence estimates over time and between survey instances,
particularly for the non-European ethnic groups. Asian participants reported the highest experience
of racism (around 13±15% prevalence over the three most recent surveys), followed by Māori
and Pacific (8±10% in three most recent surveys). Europeans (European/Other) reported
significantly lower experience of racism than the other groupings (around 4% over last three
surveys). With the exception of Pacific peoples, reporting of recent racial discrimination appears
to be declining over the time period examined. Prevalence estimates and confidence intervals
are presented in S2 Table.
Table 3 shows the pooled estimates from meta-analysis for patterning of reported
experience of racial discrimination in the last 12 months by sociodemographic variables, pooled
across all six survey instances. Recent experience of racial discrimination was higher among
men compared to women, and among younger age groups. Reported recent experience of
racism decreased with age, with lower rates reported among the oldest two age categories
compared to the youngest. Reporting recent experience of racism also increased with higher levels
of area deprivation. Māori, Asian and Pacific participants all reported significantly higher
experience of recent racial discrimination than participants in the NZ-born European/Other
group, independent of whether they were born in New Zealand or not. Nativity was also
important among Asian and European/Other ethnic groups, with those born overseas
reporting higher rates of racism compared to their NZ-born counterparts in the same ethnic
grouping. Overseas-born Asian participants in particular reported odds of 5.53 that of NZ-born
7 / 22
Unweighted frequencies and weighted percentages.
Nativity is presented as proportion born in New Zealand (NZ) or overseas within each prioritised ethnicity group.
European/Other participants, which was about twice as high as for NZ-born Asian
respondents. Results by individual survey are available in S3 Table.
The GSS enabled examination of the settings in which participants reported experiencing
racism. The two most common such settings were public settings (including on the street,
using transport and service when buying something) and work settings (including at work or
when working, and applying for or keeping a job or position) (Fig 2, showing reporting of
8 / 22
Fig 1. Prevalence of experience of racism in the last 12 months over time by ethnicity and survey, NZHS 2002/03, 2006/07, 2011/12, GSS 2008,
racism by setting for the GSS 2012). For these settings, prevalences were highest for Asian
participants in all survey instances, followed by Māori and Pacific groups, with lowest rates
among the European/Other group. More detailed prevalence data and confidence intervals are
appended for GSS 2008, 2010, and 2012 (S4 Table and S1 Fig).
Fig 3 shows forest plots demonstrating the relationship between any experience of racism
in the last 12 months and each health and wellbeing outcome, adjusted for age, gender,
ethnicity, nativity, NZDep and education. These are reported for each survey (squares and horizontal
lines giving the point estimate and 95% CI for each survey instance) and the pooled effect size
from meta-analysis (diamond at bottom of each health outcome figure). All surveys showed an
association between recent experience of racism and each of the negative health and wellbeing
measures examined. The pooled results from the meta-analysis showed that racism is strongly
and significantly linked to negative measures of self-rated health, mental health (SF-12),
physical health (SF-12) and general wellbeing (life satisfaction). Corresponding results from
unadjusted models can be found in S2 Fig.
The final analyses further examined the relationship between racism and health/wellbeing
measures stratified by respondent ethnicity. Table 4 presents pooled effect sizes for each ethnic
grouping from the meta-analyses, adjusted for age, gender, nativity, NZDep and education.
Effect sizes for the individual survey analyses are in S3, S4, S5 and S6 Figs. where it can be seen
that confidence intervals were wide for any single survey instance, particularly for the smaller
ethnic groupings (Pacific and Asian). Experience of racism in the last 12 months was generally
9 / 22
Odds ratios are from random effects meta-analysis of all six surveys: NZHS 2002/03, 2006/07, 2011/12, GSS 2008, 2010, 2012.
Ethnicity is prioritised in the following order: Māori, Pacific, Asian, European/Other.
Māori overseas born are included in the model but data is not shown because of small numbers.
Recent experience of racism
Odds Ratio (95% CI)
2.16 (1.70, 2.74)
3.08 (2.45, 3.86)
1.96 (1.44, 2.65)
2.23 (1.62, 3.07)
2.63 (1.54, 4.49)
5.53 (4.52, 6.78)
0.81 (0.67, 0.97)
0.86 (0.70, 1.07)
0.83 (0.60, 1.14)
0.60 (0.45, 0.78)
0.28 (0.19, 0.43)
0.13 (0.09, 0.19)
1.19 (1.09, 1.31)
1.01 (0.90, 1.14)
1.19 (0.96, 1.48)
1.43 (1.21, 1.69)
1.55 (1.28, 1.87)
1.64 (1.26, 2.15)
associated with negative health and wellbeing measures for all ethnic groups, with a few
variations seen between ethnic groupings. Recent experience of racism was associated with negative
self-rated health for each ethnic grouping, with no major differences in the estimated impact,
as can be seen by comparing point estimates and confidence intervals across stratified ethnic
groupings (test for sub-group differences: Cochran's Q (3df) = 2.71, p = 0.438). Analysis of the
life satisfaction outcome could only be undertaken using GSS data and was most affected by
small numbers in ethnically stratified results. Therefore, confidence intervals from the
metaanalysis were wide and were not significant for Māori and Pacific groups. However, point
estimates for all ethnic groups demonstrated an association between racism and lower life
satisfaction, with no apparent differences in the strength of association by ethnicity (test for
subgroup differences: Q (3df) = 3.76, p = 0.288). Similarly, for the SF-12 mental health scores,
experience of racism remained associated with subsequently poorer mental health for all
ethnic groupings, with no obvious differences by ethnicity grouping (test for sub-group
differences: Q (3df) = 5.40, p = 0.145). The impact of racism on SF-12 physical health scores
appeared to differ by ethnicity, with no evidence for a strong association with poorer physical
health for Asian participants (mean difference close to 0) but a more substantial difference for
10 / 22
Fig 2. Prevalence (%) of experience of racism by setting and ethnicity, GSS 2012. Figure note: Data is from the Statistics New Zealand data lab.
other ethnic groups (test for sub-group differences: Q (3df) = 28.20, p < 0.001). Unadjusted
findings by individual survey are available in S5 Table.
This study focuses on New Zealand adults' reporting of recent experience of racism (in the last
12 months) utilising data from multiple repeated cross-sectional national surveys over a
tenyear period (NZHS 2002/03 to GSS 2012). Recent experience of racism was most commonly
reported by Asian participants followed by Māori and Pacific peoples, with the largely
European group (European/Other) reporting the lowest experience of racism. Among Asian
participants, reported experience of racism was higher for those born overseas compared to those
born in New Zealand. Encouragingly, reported recent experience of racism appears to be
declining for most of these groups over the time period examined.
The results also demonstrated a consistent association of recent experience of racism with
negative measures of health and wellbeing, including indicators of mental health (SF-12
mental health summary score), physical health (SF-12 physical health summary score and
selfrated general health) and overall life satisfaction. While the impact of experience of racism
appeared similar when analyses were stratified by ethnicity (with the exception of the SF-12
physical health), it is important to note that the burden of higher prevalence of racism for
Māori, Pacific, and Asian groups means that the population-level impact of racism
disproportionately affects these groups.
11 / 22
Fig 3. Association between experience of racial discrimination and health and wellbeing measures, by survey and combined in meta-analysis.
Adjusted for age, gender, ethnicity, nativity, education qualification, NZDep.
As expected the prevalence of reported racism in the last 12 months was lower than
experience `ever', as can be seen by comparing data from the NZHS in this study with previously
published data from 2002/03 and 2006/07 [
]. The finding of associations between recent
experience of racism and negative health and wellbeing measures is consistent with other New
12 / 22
Zealand evidence. Reported experience of racism `ever' in the NZHS has been significantly
associated with poorer self-rated health, and measures of physical and mental health [
Reported experience of racism has also been associated with lower life satisfaction in
longitudinal NZ research [
]. The findings from our study are also consistent with the body of
international evidence demonstrating associations between experience of racism and negative mental
health, physical health and general health [
] and replicate the finding that there is a stronger
association with negative mental health than with physical health . Evidence also suggests
that recent experience of racism may be more strongly associated to mental health and more
weakly related to life satisfaction measures [
]. However, our study is limited in assessing this,
in part as the GSS surveys only ask about recent experience of racism. Differences in study
design and study variables (both mental health and racial discrimination) mean findings are
not directly comparable with studies that have examined associations with longer-term
experiences of racism [
16, 17, 24
A major strength of this study is the documentation of recent experience of racism from
multiple national studies at six time points to examine trends in self-reported experience of
racism over time. Previous analyses of NZHS and GSS data have documented prevalence
estimates of experience of racism and relationships with health for individual studies [
13, 16, 17,
20, 58, 59
]. However, for NZHS data, this is usually focussed on lifetime experience of racism
(16, 22) and for GSS data, focuses on discrimination more broadly [20, 60] and has not
examined trends over time [
]. The apparent reduction in reporting of racial discrimination over
13 / 22
the time period for Māori, Asian and European/Other is encouraging, although the specific
reasons for this cannot be determined. It is important when examining reported experiences
of racial discrimination over time to consider the potential for changes in the way that racism
may be expressed, understood, recognised and reported. In our study, we see a decreasing
prevalence of reporting racism with increasing age. This may reflect differences in exposure to
racism, with earlier research showing that for the NZHS this relationship is driven by higher
prevalences of the personal attack variables in younger age groups [
]. However, this age
relationship is still seen in `ever' reporting of racism, suggesting we may also need to consider
birth cohort influences.
Another strength of this study is the examination of how nativity influences experience of
racial discrimination in New Zealand. The majority of participants in the Asian and Pacific
ethnic groupings were born outside of New Zealand. Our findings showed that experience of
racial discrimination for Asian and European/Other people born outside of New Zealand was
higher than those born in New Zealand. In the US, where the majority of literature on racism
and health is situated, most studies that examine the effect of nativity have found that reporting
of racism among people from minoritised racial/ethnic groups born outside of the US is lower
than their US-born counterparts (e.g. for Black, Latino/a and Asian groups) . However,
this is not always the case, with the reverse sometimes seen and variation in the consistency of
findings by racial/ethnic group . We cannot determine (based on our study) why these
differences might exist between our NZ population and the majority of US studies. It is important
to note that ethnic groupings used in this study (with the exception of Māori) are composite
categories, and include multiple ethnic groups that may not be directly comparable to similar
US racial/ethnic categories with regards to their underlying composition and time since
immigration into the respective country. Contextual factors with regards to the country of study
may also influence differences in exposure, recognition and reporting of racism, as well as
differences in methods to elicit experiences of racism. The inability to disaggregate the European/
other ethnic grouping in this study is also a limitation with regard to understanding the role of
nativity in exposure to racism for particular ethnic groups within this category as we cannot
determine if the higher rate of racism by overseas-born people in this category is more likely to
be non-European participants (though such participants are likely to make up a small
proportion of this group, as noted in the methods).
This study was also able to present the most common settings that people experience racism
from the GSS data. These were at work and in public, which is in line with the settings for
experiences of discrimination more broadly [
]. It is important to understand where people
experience racism as this has direct implications for interventions, particularly in terms of
agency and responsibility for preventing such discrimination . For example, in terms of
workplace safety, employers in New Zealand are responsible for providing safe working
environments, including non-discriminatory environments, under the Employment Relations Act
Another study strength is the use of meta-analysis to combine data over multiple survey
instances for improved precision of estimates. We used meta-analysis methods [63, 64] to pool
estimates across the six survey instances. This allows for direct visualisation of how effect sizes
differ across individual surveys (e.g. see Fig 3) while also providing improved precision for the
pooled estimate compared to considering results from the single survey instances
independently. This assumes that the association between experience of racism and the health
outcomes is reasonably consistent over time, following adjustment for confounders (so changes to
confounder profiles by exposed/unexposed groups over time are accounted for as well). We
considered this to be a reasonable assumption given the same target population for all survey
instances (general NZ population) and the short overall period of the included surveys (over
14 / 22
ten years). As can be seen in the forest plots, estimates for the impact of racism on health were
generally consistent across survey instances.
As per any meta-analysis, there is no particular requirement that outcomes and exposures
be measured in the exact same manner across studies : an additional strength of this study
is that the study outcomes were chosen to be identical across all survey instances, and the
target population for the surveys is identical between the GSS and the NZHS (the adult NZ
population). While the exact wording of the racism questions differed in the two main surveys, as
described above, the underlying construct and timing of experience of racism are consistent
enough that this represents a consistent definition of exposure that is suitable for
meta-analysis. The use of random-effects models also allows potential variation in effect size (due to exact
exposure definition) to be reflected in wider confidence intervals for the pooled estimates.
The relationship between reported racism and health has previously been examined using
data from the NZHS for 2002/03 and 2006/07 data separately, although again this has largely
used experience of racism `ever' in a person's life-time [16±18, 22], with these papers noting
that the smaller numbers reporting racism in the last 12 months limited analytical power
for individual surveys [
]. The use of meta-analysis was particularly useful in providing
improved estimation of this association, with greater statistical precision. It has also allowed
for improved estimates between recent experience of racism and health/wellbeing by ethnic
grouping, another limitation noted in previous research [
] and has allowed for the
quantification of the extent to which racism affects health differently in particular ethnic groups .
In our study, we found that recent experience of racism was similarly associated with negative
mental health, self-rated health and life satisfaction. However, no association with physical
health was found among the Asian ethnic grouping. The relationship between experience of
racism and physical health outcomes is less consistent than for mental health measures [
While there is a long history of Asian immigration to New Zealand [
], this finding may be
influenced by the large proportion of people in the Asian category born outside of New
Zealand and the potential influence of the "healthy immigrantº effect [
]. It should be noted
that this advantage has been shown to fade over time, and the relationship between racism and
negative health has been reported to strengthen over time for Asian immigrants to the US [
Future studies focusing on the role of nativity in this question would be advised to consider
time spent in New Zealand in analyses.
A number of limitations should be considered in the interpretation of findings. Our study
is cross-sectional and therefore limited in terms of attributing causality. However, experience
of racism has been linked to negative health and well-being outcomes in prospective studies,
both in New Zealand [
] and internationally .
In addition, our prevalence estimates for experience of racism may be underestimates,
particularly for non-European groups. Firstly, questions asked about a limited number of settings
and forms of racism (e.g. personal attack in the NZHS). Previous research has shown that
Māori, Asian and Pacific groups are more likely to experience multiple forms of racial
]. Widening the range of settings and forms, and capturing frequency of
exposure may improve measurement in future studies. We also note that under-reporting of racial
discrimination may be higher for marginalised groups with reporting influenced by several
factors including, difficulty recognising racism towards oneself (compared to one's group),
social desirability bias and reluctance to report experiences, explicit versus implicit cognition
of racism, and the impact of internalised racism on recognition and reporting of racism [
67, 68, 69
]. Under-reporting of exposure may in turn lead to underestimation of associations
between racism and health or wellbeing. The measurement of experience of racial
discrimination in the last 12 months also underestimates people's longer-term experiences of racism and
may contribute to an underestimation of the effect size of the relationship between racism and
15 / 22
health, as people in the comparison group (i.e. did not experience racism in the last 12 months)
may have experienced racism more than 12 months ago. Finally, our study focuses on racial
discrimination and does not consider other forms of discrimination (e.g. on the basis of age,
gender, class etc.) that may operate concurrently and cumulatively to negatively affect health
and wellbeing .
While the racism questions are consistent within repeats of each of the two surveys (i.e.
NZHS and GSS), the questions are not identical in these two data sources. The major
distinction is that they ask about experience of racism in two commonly used but distinct approaches
4, 48, 69
]: a one-step question (the NZHS, where respondents are asked about racial
discrimination in each of five domains) and a two-step question (the GSS, where respondents are asked
about any discrimination over the last year, and if answering yes are asked about the type of
discrimination and where it happened). Research has shown that where questions are directly
comparable with regards to the form or setting of discrimination, the two-step question tends
to produce lower estimates of racism than the one-step question [
4, 48, 69
]. However, the two
surveys used in our study (NZHS and GSS) have limited comparability at the individual
discrimination setting or item level because of differences in question wording and in the number
of settings or forms of racial discrimination asked about. However, at the broader level of
overall racial discrimination, outputs for each survey type appear to be consistent for analyses of
the surveys examined in this study. In addition, both question types show associations between
reported experience of racism and health measures in the wider literature [
1, 4, 69
Our study focuses on experience of racism measured at the interpersonal level. As such it
does not capture racism at the institutional or structural level well. Associations between
individual experience of racism and our outcomes were adjusted for a number of covariates,
including socioeconomic measures. Socioeconomic position (SEP) is highly patterned by
ethnicity in New Zealand with large inequities between European and non-European ethnic
13, 70, 71
]. It is important to note that this ethnic patterning of SEP can be
conceptualised as a marker of institutionalised racism and that experience of racism at the individual
level and institutional levels are inter-related [
1, 16, 72, 73
]. Adjustment for SEP in the analyses
demonstrates the independent effect of individual experience of racism on health/wellbeing.
Examining how SEP operates as both a mediator and a risk factor for increased exposure to
experience of racism warrants further study in longitudinal research, which is better able to
tease out the time sequence of events and hence allow conduct of more formally robust
mediation analyses [
While the use of meta-analysis techniques allowed for improved precision of effect sizes for
the impact of racism when stratified by ethnicity, compared to considering a single survey
analysis in isolation, these stratified estimates were still limited by smaller numbers and hence
poorer precision of estimates. This also limited our ability to undertake more in-depth analysis
of the patterning of racism within ethnic groups by other variables. This has implications for
survey design, where it is important to sample populations with higher needs adequately. In
New Zealand, this means adequately sampling smaller ethnic groups in order to provide robust
evidence by ethnicity.
This study provides a comprehensive overview of the experience of racism using nationally
collected survey data from the NZHS and GSS over a ten-year period. It extends previous
analyses of these studies to focus on recent experience of racism and its link to several distinct
negative health and wellbeing measures. It also utilises meta-analysis techniques to improve
precision for estimates, which is of particular use for analytical questions that were previously
limited by small respondent numbers. Racism is a broad system and requires multiple methods
to measure and intervene to not only improve health and reduce ethnic health inequities but
also to improve social wellbeing and reduce inequities more broadly. While further research
16 / 22
and different study designs are necessary to understand specific mechanisms, causal health
effects, and the effectiveness of specific interventions, the on-going monitoring of racism as a
determinant of health at a population level remains a key component of understanding,
prioritising and addressing racism as not only a health, but also a human rights issue.
S1 Fig. Prevalence of experience of racism (last 12 months) by setting and ethnicity, GSS
2008, 2010, 2012. Figure note: Data is from the Statistics New Zealand data lab.
S2 Fig. Association between experience of racial discrimination and health and wellbeing
measures by survey and combined in meta-analysis (unadjusted).
S3 Fig. Association between experience of racial discrimination (last 12 months) and
poor/fair self-rated by survey, stratified by ethnicity and adjusted for age, gender, nativity,
NZDep, education qualification.
S4 Fig. Association between experience of racial discrimination (last 12 months) and life
satisfaction (dissatisfied/very dissatisfied life satisfaction) by survey, stratified by ethnicity
and adjusted for age, gender, nativity, NZDep, education qualification.
S5 Fig. Association between experience of racial discrimination (last 12 months) and SF12
mental health summary score by survey, stratified by ethnicity and adjusted for age,
gender, nativity, NZDep, education qualification.
S6 Fig. Association between experience of racial discrimination (last 12 months) and SF12
physical health summary score by survey, stratified by ethnicity and adjusted for age,
gender, nativity, NZDep, education qualification.
S1 Table. Survey questions used to examine racial discrimination.
S2 Table. Prevalence of reported experience of any racism in the last 12 months by
ethnicity according to survey type and survey year (data for Fig 1). Table notes: A. Unweighted
frequency gives total number of respondents answering yes to recent experience of racism. B.
Unweighted frequency gives total number of respondents for total Māori, Pacific, Asian ethnic
groups and residual European/Other group. C. Weighted prevalence gives estimated
prevalence of recent experience of racism for NZ adult population (95% CI further accounts for
stratification and clustering of responses).
S3 Table. Patterning of experience of racial discrimination (last 12 months) by
sociodemographic factors. Results of multivariable logistic regression analysis by survey year.
Table note: Ethnicity is prioritised in the following order: Māori, Pacific, Asian, European/
Other. aMāori overseas born are included in the model but data is not shown because of small
17 / 22
S4 Table. Prevalence of experience of racism (last 12 months) by setting and ethnicity, GSS
2008, 2010, 2012. Table note: Percentages are weighted to give population prevalences. Total
ethnicity is used for Māori, Pacific and Asian groups, with a mutually exclusive European/
Other comparator group. Data is from the Statistics New Zealand data lab and conforms to
Statistics New Zealand data lab rules with rounding to 3 of raw freqencies and suppression of
cells with small numbers (Statistics New Zealand (2015). Microdata output guide (Third
edition). Wellington, Statistics New Zealand).
S5 Table. Unadjusted association between experience of racial discrimination (last 12
months) and health and wellbeing measures, ethnically stratified models by survey and
random effects outputs from meta-analysis (NZHS 2002/03, 2006/07, 20011/12, GSS
2008, 2010, 2012). Notes: OR = Odds ratio; MD = mean difference; adata only available for
GSSs; bNZHS 2002/03 not analysed because used an earlier version of SF-12; prioritised
We would like to acknowledge the participants in all surveys used in this paper, and Statistics
New Zealand and the Ministry of Health for assisting with data access. Thanks also to Ruruhira
Rameka for assistance with literature review, administrative support and data checking, and
our external advisors for their advice on the wider project. Access to the data used in this study
was provided by Statistics New Zealand under conditions designed to give effect to the security
and confidentiality provisions of the Statistics Act 1975. Specifically, settings for racial
discrimination data from the GSS were sourced from the Statistics New Zealand data lab. The results
presented in this study are the work of the authors, not Statistics NZ.
Conceptualization: Ricci B. Harris, Donna M. Cormack.
Data curation: James Stanley.
Formal analysis: James Stanley.
Funding acquisition: Ricci B. Harris, James Stanley, Donna M. Cormack.
Investigation: Ricci B. Harris, James Stanley, Donna M. Cormack.
Methodology: Ricci B. Harris, James Stanley, Donna M. Cormack.
Project administration: Ricci B. Harris.
Resources: Ricci B. Harris, James Stanley.
Software: James Stanley.
Supervision: Ricci B. Harris.
Validation: James Stanley.
Visualization: Ricci B. Harris, James Stanley.
Writing ± original draft: Ricci B. Harris.
Writing ± review & editing: Ricci B. Harris, James Stanley, Donna M. Cormack.
18 / 22
19 / 22
20 / 22
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