CHILDREN, at least for now, seem to be at low risk of becoming infected with or of transmitting coronavirus disease 2019 (COVID-19). Yet their lives have undergone rapid, major upheavals as a result of the pandemic. The footprint this will leave on their mental, social, emotional and physical health and wellbeing is yet to be seen.
What we do know already though is that this footprint is not going to affect all children equally.
When the virus first emerged in Wuhan, China so did a rise in racism targeting Chinese and Asian peoples in Australia and internationally, framing them as the “cause not the casualty”. This included racism directed towards doctors and other health workers at hospitals and ordinary Australians in their own home. Children and adolescents of Asian appearance were told by peers and by adults they were “dirty” or “virus carriers”.
Unfortunately, experiences of racism for children are neither new or rare events.
Racism and racial discrimination are everyday experiences for many Australian children and adolescents. A recent survey of over 4600 Australian school students aged 10–15 years found that around 40% of students from Asian Australian backgrounds reported experiences of racial discrimination from peers, 20% from teachers, and 40% from wider society outside of school. It is not only new migrants who face these discriminatory experiences: many of these children were Australian-born, with Australian-born parents.
Experiences of racial discrimination are not limited to children of Asian backgrounds, neither before or during the current COVID-19 pandemic.
It is well established that Aboriginal and Torres Strait Islander children in particular experience high levels of racism in everyday life. Further, Aboriginal and Torres Strait Islander peoples experience structural and systemic racism, which uniquely and actively manifests in ways including dispossession of land, child removal policies, and disproportionately high incarceration rates. These are expressions of the deep injustices of ongoing colonisation that persists today.
There are documented examples of Aboriginal and Torres Strait Islander peoples experiencing racism in the context of COVID-19, including reported comments in health care settings that “Aboriginal people only get it because they don’t wash their hands” and concerns about overpolicing of and unequal consequences for Aboriginal and Torres Strait Islander peoples in relation to quarantine requirements and closure of remote communities.
Impacts of racism on child health
There are children in our community who are getting sick from racism. The symptoms they present with at clinics, hospitals and community health services may not be explicitly diagnosable as related to racism, but the contribution of racism may be there nonetheless. Across numerous studies, child depression, anxiety, behaviour difficulties, sleep disruption, and suicide risk are all linked to experiences of racial discrimination. There is also growing evidence that racial discrimination is associated with obesity, blood pressure, inflammation, and epigenetic ageing in children and adolescents. Many of these conditions are associated with increased risk of severe illness if COVID-19 is contracted. The role of racism in disease risk and in population health inequities from childhood into adulthood and beyond requires urgent attention now more than ever.
These health effects of racism are not limited to direct experiences where children themselves are the target. Like second-hand smoking, second-hand racism — vicarious racism — also harms child mental and physical health. This includes children witnessing others’ experiences of racism, as well as the flow-on effects of their families and communities experiencing racism. Therefore, there may be broader and ongoing impacts for doctors and health workers being abused during this pandemic, including negative impacts on their children.
Interpersonal racial discrimination is important – but only the tip of the iceberg
The political and public debate, and much of academic and health research and practice, remains focused on overt, deliberate acts of interpersonal discrimination. However, this is only a symptom of a deeper problem in our society; a problem that is difficult for many of us to acknowledge and admit. Ultimately, racism is a system. It is an organised system of oppression and power that advantages those considered superior and disadvantages those considered inferior.
The effects of colonialism and the White Australia policy, for example, are felt to this day. Their legacies have become embedded within our institutions and continue to drive inequities in health care access and treatment; policing and criminal justice; housing, employment and education opportunities; and child protection. The lifelong and intergenerational impacts (frequently referred to as weathering) on child health and wellbeing are further magnified in times of crises. We need to address the fundamental root cause of inequity, rather than using band-aid solutions that only treat the surface.
Beyond socio-economic and “biological vulnerability” explanations
Explanations for many inequities experienced by Aboriginal and Torres Strait Islander children, and by some ethnic minority children, are focused on socio-economic factors such as education, income and employment. However, even if we account for these socio-economic factors, inequities remain (including in adult COVID-19 mortality). Socio-economic advantage does not bring the same benefit for Aboriginal and Torres Strait Islander children, or for some ethnic minority groups, compared with children from white, Anglo-European backgrounds. This is not due to genetic differences or vulnerabilities. This is due to the structural legacies of racism and intergenerational trauma.
Despite widespread acceptance that race and ethnicity are social categories, they are still being treated by some within biomedicine as biological realities. Focusing on (false) biological explanations masks the role of structural factors and social conditions that determine and influence health from pre-conception through to older age and across generations.
What we can do to address the impacts of racism on child health during COVID-19 and beyond:
- Health care professionals working with children and families must be able to discuss the effects of exposure to racism and support children and families. This is particularly important during times of crises when children and families are facing increased stress and exposure to racism.
- Ensuring all children and families know they are welcome in health care settings, that they will be treated with respect and high quality care regardless of their backgrounds, is also critical. This requires us all to examine our own biases and assumptions, as well as to consider how our health care systems and practices need re-orienting. Meaningful and respectful relationships with Aboriginal and Torres Strait Islander health care workers and peak bodies, and with health care workers from ethnic minority backgrounds and community cultural groups, is essential to ensure culturally safe child health care, especially during COVID-19. As a start, make sure you know who are the traditional owners of the land on which you work, live and play, and which communities are accessing your programs and services.
There are a plethora of resources available from professional peak bodies (National Aboriginal Community Controlled Health Organisation, Australian Indigenous Doctors’ Association, Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, and the Australian Medical Association), non-government organisations (eg, Australian Human Rights Commission, Reconciliation Australia) and government agencies (AHPRA’s Health and Cultural Safety Strategy, National Aboriginal and Torres Strait Islander Health Plan) and the COVID-19 Management Plan for Aboriginal and Torres Strait Islander Populations on a range of topics that can help. Developing a Reconciliation Action Plan is also recommended.
- Advocating for community initiatives and collaboration with organisations to address inequities in health, justice and educational systems to help reduce children’s exposure to racism and its impacts is also an important task for health care workers and peak bodies. Addressing racism requires action far beyond the health care system.
- Position statements on racism and child health from peak representative groups, such as the American Academy of Pediatrics’ recent policy statement on racism and child health, draw attention to the importance of addressing racism within the medical and health care community and serve as a call to action and advocacy tool for individuals and organisations. A similar statement for Australia could be an important priority to ensure racism as a core child health issue is highly visible in COVID-19 responses and beyond.
- Address data gaps: collect and report Indigeneity, ethnicity and racism in child health data. Child health research and health care policy and practice must collect and report data on Indigeneity and on ethnicity as a basic requirement during COVID-19 and beyond. This can and must be done in a culturally safe and sensitive way. Measurement and reporting of individual and systemic level racism and discrimination and their impacts on child health must also be prioritised, including analysis of their contributions to child health inequities.
It’s time to move beyond a colour-blind, whitewashed view of the determinants of child health. Racism, at all levels, is an important, common and often overlooked stressor and adverse experience for many children and their families. It requires urgent and targeted attention as a fundamental cause and critical determinant of child health at an individual and population level. We need to build the capacity of the health care and research workforce and system to address racism across systemic and interpersonal levels and its effects on child health and health inequities. Racism must be seen as a core – and priority – issue for child public health and health inequities research, policy, practice and evaluation. This is even more urgent with COVID-19, but will extend long beyond the current pandemic.
Associate Professor Naomi Priest is a National Health and Medical Research Council Career Development Fellow in the Centre for Social Research and Methods at the Australian National University (ANU) and an Honorary Fellow in Population Health, Murdoch Children’s Research Institute, Royal Children’s Hospital.
Dr Katherine Thurber is a National Health and Medical Research Council Early Career Fellow with the Aboriginal and Torres Strait Islander Health Program at the National Centre for Epidemiology and Population Health, Research School of Population Health at ANU.
Dr Raglan Maddox is a Fellow with the National Centre for Epidemiology and Population Health, Research School of Population Health at ANU.
Roxanne Jones is a Research Associate and PhD candidate at the National Centre for Epidemiology and Population Health, Research School of Population Health, ANU.
Dr Mandy Truong is a Research Fellow with the School of Nursing and Midwifery, at Monash University, and a Senior Project Officer at the Menzies School of Health Research.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.