Examining Racism in Australia: Upstream, Midstream and Downstream Determinants and its Impact on Karen Refugees

Running head: RACISM
Racism
Name of the Student
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1RACISM
Racism in Australia traces back the history as well as contemporary racist attitude of
communities along with governmental negligence and non-compliance to political factors based
on standards in human rights and incidents that takes place in Australia. The contemporary
picture of Australia is the result of multiple waves of process of immigration. As per recent
statistics, one in five people living in Australia experienced racism during the year 2015-2016 in
the form of verbal abuse being the most common form of racism (Jonason, 2015). Australia has a
culture of racism denial that affects the immigrants in the form of cross-cultural tension. Among
the immigrant populations residing in Australia, Karen refugees are indigenous people to the
Thailand-Burma border region in Southeast Asia and one of the ethnic groups in Burma known
as Karen people. They came ten years ago from Myanmar settled in Mount Gambier city in
Australia as a part of a pilot program for their regional settlement. However, the Australian
government is less responsive towards the Karen refugees and they face communication barriers
that results in struggle in accessing healthcare services (Riggs et al., 2012). Therefore, the
following essay focuses on examining racism in context to upstream, midstream and downstream
determinants, steps taken to curb this condition and further recommendations that can be added
to the current efforts.
Upstream, midstream and downstream determinants interact with racism being
categorized as macro, intermediate and micro determinants. The upstream determinants
comprises of global forces including policies and social determinants of health. Racism is
considered as a social determinant of health inequalities. The determinants of health (DOH) like
physical, social, economic and environmental are linked to racism and health. DOH includes
upstream factors like social disadvantage, inequalities and risk exposure that plays a causal role
in health outcomes. Social disadvantage approach greatly links the health and racism that acts as

2RACISM
a causal link for stress related to coping with these disadvantaged conditions (Marmot et al.,
2012). Educational attainment, level of income, occupational grade and literacy level are
associated with health outcomes. The population with greater social disadvantage have poorer
health outcomes as they have less economic resources to improve their health.
Racism greatly affects health through recognized pathways like reduced access to
housing, employment and great exposure to risk factors. The racial or ethnic differences in health
status is greatly linked to minority populations as they have varied experiences in the healthcare
system in terms of quality of care and access to healthcare services. Neighbourhood conditions
also influences health conditions as water and air quality and exposures with availability of
quality services in the neighbourhood like schools, transportation and housing determine health
outcomes (Zainal et al., 2012). Low-socioeconomic status people have poor accessibility to these
facilities due to racism being exposed to multiple health risks. Similarly, poor working
conditions also influence health and constrain the low-socioeconomic disadvantaged people to
get access to occupational health and safety facilities as they are racially discriminated exposing
them to increased risk of sedentariness, chronic disease and musculoskeletal injuries
(Butterworth et al., 2013). Racially discriminated people have low education attainment and as a
result, they have poor health knowledge and health behaviours that are greatly linked to poor
health. Due to low education attainment, there are mere opportunities of employment for the
socially disadvantaged people and less perceived health control.
Economic resources comprises of income and monetary benefits that influence health.
Ethnic or racial differences in income level underestimate the health conditions as low-income
level is linked to poor health with fewer advantages due to racism. Racism greatly affects health
through stress and lead to unhealthy coping mechanisms. Racial disparities perpetuates social

3RACISM
disadvantage in terms of low quality, resource-challenged neighbourhoods with under-resourced,
inadequate and unsafe schooling and housing (Major, Mendes & Dovidio, 2013). Institutional
racism refers to general instances of inequality, racial discrimination, domination and
exploitation in terms of labour market can be influenced by policy formation. If a firm policy
excludes the participants of a particular race then they are considered to be racially discriminated
and as a result, have less access to resources with an overtly racist intention.
Midstream determinants comprises of psychosocial factors that influence health
behaviours. The immigrants or racially discriminate people are at high risk of infectious diseases
that affect their health and give rise to psychosocial distress and unhealthy behaviour due to the
above mentioned upstream determinants. Stress arises due to social exclusion or rejection that is
associated with racism having worse health consequences. Chronic stress condition has several
negative effects on the people who experience them on a daily basis. Individuals who are
discriminated against the mainstream society suffer from negative effects of perceived
discrimination leading to mental health problems like anxiety and depression (Henderson, Evans-
Lacko & Thornicroft, 2013). Moreover, well-being, self-worth and self-esteem, social relations
are greatly hampered because of discrimination. There is an exact relationship between perceived
racism and psychological health as there is varying levels of stress experienced by different
individuals. Research suggested that treatment of cultural minorities struggling with mental
health issues depends on perceived discrimination. Racial discriminated people would receive
less social support as predicted by social support deterioration model with greater risk of
depression and low levels of satisfaction (Arnberg et al., 2012). People who are racially
discriminated often have unhealthy coping mechanism to deal with stress related to perceived