Background: Aboriginal Victorians are more likely than non-Aboriginal Victorians to be psychologically distressed, experience discrimination, to smoke, to be obese, and to be of lower socioeconomic status [1] . Given that these factors have been shown to have negative impacts on health, we investigated whether they explained, at least in part, the poorer health status of Aboriginal Victorians compared with non-Aboriginal Victorians.
Methods: We combined data from the 2011, 2012 and 2014 Victorian Population Health Surveys (VPHS) to obtain a sample size of 33,833 Victorian adults, including 387 Aboriginal adults. The VPHS is a population-representative, cross-sectional, computer-assisted telephone interview survey conducted annually. Using logistic regression, self-reported health status, a reliable and well-validated predictor of mortality and morbidity [2], was the outcome or dependent variable and Aboriginal status was the primary independent variable of interest. Secondary explanatory variables included age, sex, experiences of discrimination, socioeconomic status (measured by household income, education, and employment status), lifestyle risk factors (smoking and obesity), and psychological distress (measured using the Kessler 10 Psychological Distress Scale). Any secondary variable that decreased the odds ratio (OR) of the relationship between poor self-reported health and Aboriginal status by 10% or more was deemed to partially explain the inequality in health status between Aboriginal and non-Aboriginal Victorians.
Results: Aboriginal Victorians were almost twice as likely (OR = 1.9, 95% confidence interval; 1.3–2.6) as non-Aboriginal Victorians to report poor health. In declining order of effect, psychological distress reduced the OR of the relationship between poor health and Aboriginal status by 28%, experiences of discrimination by 15%, smoking by 15%, and obesity by 10%.
Conclusions: The higher prevalence of poor health among Aboriginal compared to non-Aboriginal Victorians may be explained by psychological distress, experiences of discrimination, smoking and obesity. Racism directed against Aboriginal Victorians is an independent health risk factor for poor health, equivalent in strength to smoking. Moreover, studies have shown that victims of discrimination are more likely to engage in unhealthy behaviours such as smoking [3]. Therefore, policies and interventions to address racism towards Aboriginal Victorians may help to close the health gap between Aboriginal and non-Aboriginal Victorians.