Caregiver experiences of racism and child healthcare utilisation: cross-sectional analysis from New Zealand

Objectives Children's exposure to racism via caregiver experience (vicarious racism) is associated with poorer health and development. However, the relationship with child healthcare utilisation is unknown. We aimed to investigate (1) the prevalence of vicarious racism by child ethnicity; (2) the association between caregiver experiences of racism and child healthcare utilisation; and (3) the contribution of caregiver socioeconomic position and psychological distress to this association. Design Cross-sectional analysis of two instances of the New Zealand Health Survey (2006/2007: n=4535 childprimary caregiver dyads; 2011/2012: n=4420 dyads). Main outcome measures Children's unmet need for healthcare, reporting no usual medical centre and caregiver-reported dissatisfaction with their child's medical centre. Results The prevalence of reporting 'any' experience of racism was higher among caregivers of indigenous Maori and Asian children (30.0% for both groups in 2006/2007) compared with European/ Other children (14.4% in 2006/2007). Vicarious racism was independently associated with unmet need for child's healthcare (OR=2.30, 95% CI 1.65 to 3.20) and dissatisfaction with their child's medical centre (OR=2.00, 95% CI 1.26 to 3.16). Importantly, there was a dose-response relationship between the number of reported experiences of racism and child healthcare utilisation (eg, unmet need: 1 report of racism, OR=1.89, 95% CI 1.34 to 2.67; 2+ reports of racism, OR=3.06, 95% CI 1.27 to 7.37). Adjustment for caregiver psychological distress attenuated the association between caregiver experiences of racism and child healthcare utilisation. Conclusions Vicarious racism is a serious health problem in New Zealand disproportionately affecting Maori and Asian children and significantly impacting children's healthcare utilisation. Tackling racism may be an important means of improving inequities in child healthcare utilisation.