Abstract
BackgroundReported experiences of racism in Aotearoa New Zealand are consistently associated with negative measures of health, self-rated health, life satisfaction, and reduced access to high-quality healthcare with subsequent poor health outcomes. In this paper, we report on perceptions and experiences of prejudice and racism by Indigenous Māori with kidney disease and their family members and donors who took part in a wider study about experiences of kidney transplantation.MethodsWe conducted semi-structured interviews with 40 Māori between September and December 2020. Participants included those with kidney disease who had considered, were being worked up for, or who had already received a kidney transplant as well as family members and potential or previous donors. We examined the data for experiences of racism using a theoretical framework for racism on three levels: institutionalised racism, personally mediated racism, and internalised racism.ResultsWe identified subthemes at each level of racism: institutional (excluded and devalued by health system; disease stigmatization; discriminatory body weight criteria, lack of power), personally mediated (experiencing racial profiling; explicit racism), and internalized racism (shame and unworthiness to receive a transplant).ConclusionsThe wide-reaching experiences and perceptions of racism described by participants with kidney disease and their families in this research point to an unfair health system and suggest that racism may be contributing to kidney transplantation inequity in Aotearoa New Zealand. Addressing racism at all levels is imperative if we are to address inequitable outcomes for Māori requiring kidney transplantation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-021-01212-3.
Highlights
Reported experiences of racism in Aotearoa New Zealand are consistently associated with negative measures of health, self-rated health, life satisfaction, and reduced access to high-quality healthcare with subsequent poor health outcomes
Our 2019 systematic review of the experiences and perspectives of indigenous peoples related to kidney transplantation documented prejudice and a lack of cultural competence by health workers, barriers to transplantation in systems that did not support effective and culturally appropriate delivery of information and care, and a subsequent mistrust of clinicians and the health system [7]
Participants included those with kidney disease who had considered, were being worked up for or who had already received a kidney transplant as well as family members and potential or previous donors
Summary
Chronic kidney disease disproportionally impacts the health and the social and economic well-being of indigenous peoples globally [1, 2]. In the last 5 years, 7 Māori patients have been provided with a preemptive kidney transplant compared with 125 nonMāori, non-Pasifika patients [4]. These outcomes breach the nation’s foundational document, the Treaty of Waitangi,. Reported experiences of racism in Aotearoa New Zealand are consistently associated with negative measures of health, self-rated health and life satisfaction, and reduced access to high-quality healthcare with its subsequent poor health outcomes [6]. Our 2019 systematic review of the experiences and perspectives of indigenous peoples related to kidney transplantation documented prejudice and a lack of cultural competence by health workers, barriers to transplantation in systems that did not support effective and culturally appropriate delivery of information and care, and a subsequent mistrust of clinicians and the health system [7]. We report on those findings and discuss them within the context of the link between the experience of racism and inequitable transplant outcomes
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