A racial bias test with tertiary cancer centre employees: why anti-racist measures are required for First Nations Australians cancer care equity
I. D’Costa A B * , I. Hunt C , L. Russell D and K. Adams E
+ Author Affiliations
- Author Affiliations
A School of Medicine, Nursing and Health Science, Monash University, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia.
B Peter MacCallum Cancer Centre, Melbourne, Vic. 3000, Australia.
C University of Tasmania, Launceston, Australia.
D Monash Indigenous Studies Centre, School of Philosophical, Historical, and International Studies, and Australian Research Council Centre of Excellence in Australian Biodiversity and Heritage, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia.
E Gukwonderuk Indigenous Health Unit, The Faculty of Medicine, Nursing and Health Sciences School, Wellington Road, Clayton, Melbourne, Vic. 3800, Australia.
* Correspondence to: Ieta.DCosta@petermac.org
Australian Health Review 47(1) 5-12 https://doi.org/10.1071/AH21113
Submitted: 31 March 2021 Accepted: 18 January 2022 Published: 28 April 2022
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective To examine implicit bias in employees at a cancer centre using an Australian race (Aboriginal–white) Implicit Association Test (IAT), in an attempt to understand a potential factor for inequitable outcomes of First Nations Australians cancer patients.
Methods All employees at an Australian cancer centre were invited to take part in a web-based, cross-sectional study using an Australian race IAT. The results were analysed using Welch t-tests, linear regression and ANOVA.
Results Overall, 538/2871 participants (19%) completed the IAT between January and June 2020. The mean IAT was 0.147 (s.d. 0.43, P < 0.001, 95% CI 0.11–0.18), and 60% had a preference for white over First Nations Australians. There was no significant mean difference in IAT scores between sub-groups of gender, age or clinical/non-clinical employees. 21% of employees (95% CI 17.65–24.53) had moderate to strong preference for white over First Nations Australians, compared to 7.1% with moderate to strong preference for First Nations over white Australians (95% CI 5.01–9.09).
Conclusions Inequitable cancer survival for First Nations patients has been well established and cancer is now the leading cause of mortality. This paper documents the presence of racial bias in employees at one cancer centre. We argue that this cannot be understood outside the history of colonialism and its effects on First Nations Australians, healthcare workers and our society. Further research is required to evaluate measures of racism, its effect on health care, and how to eliminate it.
Keywords: Aboriginal and Torres Strait Islander, anti-racist measures, cancer care, health equity, implicit bias, racism.
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