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Racism and racial discrimination are fundamental causes and determinants of health and health inequalities globally. \n1,2 \nChildren and young people are particularly vulnerable to racism’s harms. \n3,4 Racism is an organised system of oppression \nthat classifies and ranks social groups into ‘races’ and devalues, disempowers and differentially allocates power and \nresources to those considered inferior. \n5,6 Race has no biological basis and is not a biological reality. Yet the concept of \nrace remains a powerful social category in society today, and existing categorisations and perceptions of race have \nmajor social consequences. \n7 \n Race is a powerful predictor of which groups have access to goods and resources in society \nand which groups encounter barriers. \n8 \n Race and racism need to be explicitly named and addressed,9 \n with racism the \nmechanism by which racial categorisations have biological consequences. \n5 \nRacism is an ideology of power that advantages those considered superior and disadvantages those considered \ninferior. \n5,6 Racial discrimination is the behavioural expression of racism by actions at individual or institutional \nlevels. \n10 Racism and racial discrimination have profound impacts on the lives of children and young peoples, their \nfamilies and communities, shaping risks and opportunities and creating unjust, unnecessary and preventable \ndifferences in health between social groups throughout the life-course and across generations. \n11,12 \nRacism, as a form of injustice, is, by definition, wrong. \n12,13 Studying how racism harms health, and identifying effective \nways to address racism and its harmful health effects, is not to prove racism is wrong or unjust. Rather, we do so to \nfurther understanding of how racism shapes population health, to build evidence for accountability, to challenge \nunjust and unfair systems and structures, and to advocate for human rights and health equity. \n12 \nThe coronavirus pandemic together with the concurrent resurgence of the Black Lives Matter movement and \nattention to the public health emergency of racism in Australia and around the world have further reinforced the \nneed to address racism as a form of injustice and as a fundamental cause of health and health inequalities. There is \nnow heightened attention globally and locally to the enduring social and structural injustices that are derived from \nracism as a system of oppression and the critical need for urgent action to address them. \n14 \nIn Australia, Aboriginal and Torres Strait Islander peoples experience profound structural, systemic and institutional \nracism, which uniquely and actively manifests in ways including dispossession of land, child removal policies and \ndisproportionately high incarceration rates. These are expressions of the deep injustices of ongoing colonisation \nthat persist today. \nEthnic minoritised and migrant communities, not to be confused or conflated with Aboriginal and Torres Strait \nIslander peoples, experience systemic racism related to historical and contemporary migration and settlement \nexperiences and legacies of legislation such as the White Australia policy. \n“Structural racism involves interconnected institutions, whose linkages are historically rooted and culturally \nreinforced. It refers to the totality of ways in which societies foster racial discrimination, through mutually reinforcing \ninequitable systems (in housing, education, employment, earnings, benefits, credit, media, health care, criminal \njustice, and so on) that in turn reinforce discriminatory beliefs, values and distribution of resources, which together \naffect the risk of adverse health outcomes.” 15 \nRacial discrimination is a common stressor in the lives of many children and young peoples, with growing empirical \nevidence of negative associations between racial discrimination and multiple child and youth health outcomes. \n4,16-18 \nLongitudinal studies have documented effects of racial discrimination on mental health,19,20 substance use,21 and \ncortisol dysregulation,22 allostatic load 23 epigenetic ageing 24 and inflammation 25 among youth. Evidence also \ndocuments that impacts of racial discrimination are not limited to experiences where children and young peoples \nare direct targets of racism. Vicarious experiences of racial discrimination, including witnessing or hearing about \nothers experiences, including online, are also associated with child and youth health outcomes including negative \nand positive dimensions of mental health and sleep duration, latency and quality. \n26,27 Concern about increasing \nsocietal discrimination is also associated with adolescent behavioural outcomes and depression. \n28 \nNotwithstanding the need to address racism and racial discrimination due to their inherent injustice and unfairness, \nempirical studies reinforce the need for wide-ranging action and population-level interventions to promote societal \nanti-racism and bystander anti-racism action - and to ensure those who experience racism and racial discrimination \nand the associated health impacts of such experiences, receive appropriate support and services. In order to \noptimise wellbeing for all children, young peoples and their adult caregivers, and to achieve health equity for all, \neradicating racism and both direct and vicarious racial discrimination from the lives of children and young peoples \nis an urgent priority. \n29 \nAddressing racism is a priority in national policies including the National Aboriginal and Torres Strait Islander \nHealth Plan 2013-202330 that identifies addressing racism as a social determinant of health and Australia’s \nmulticultural statement31 that identify racism and discrimination as key barriers to social cohesion. At a state level, \nthe Victorian Aboriginal Affairs Framework 2018-202332 identifies addressing racism and promoting cultural safety \nas key priorities and enablers of self-determination. Elimination of racism is explicitly identified as a goal, with \naddressing systemic and everyday racism in health, community services, education and learning, justice and other \nenvironments explicitly identified as areas for action. The Victorian Aboriginal and Local Government Action Plan33 \nprovides a practical framework to help councils engage with Aboriginal communities and promote reconciliation. \nEngagement of Aboriginal people in planning, decision-making, employment, programs and services is identified \nas a foundational practice for councils. This includes working with Aboriginal people to respond to and address \nracism. Balit Murrup: Aboriginal social and emotional wellbeing framework34 which aims to support Victorian \nAboriginal people, families and communities social and emotional wellbeing and mental health also explicitly \nidentified racism as a key social determinant of health requiring attention, including for children and young people. \nThe Productivity Commission’s recently released Indigenous Evaluation Strategy provides a framework agencies to \nuse when selecting, planning, conducting and using evaluations of policies and programs affecting Aboriginal and \nTorres Strait Islander people. \n35 This framework puts Aboriginal and Torres Strait Islander people at its centre and \nrecognises that the perspectives, priorities and knowledges of Aboriginal and Torres Strait Islander people must \nbe central if outcomes are to be improved. \nThis rapid synthesis review comprises 3 main sections. First, an overview of race and racism, pathways and \nmechanisms by which racism and racial discrimination influence child and youth health, and a narrative review of \ncurrent empirical findings is provided. Second, an key data collected in the last 5years (2016-2020) on the prevalence \nof self-reported racial discrimination among 5-25 year olds in Victoria and Australia is presented. Third, evidence \nfor addressing racism and racial discrimination among 5-25 year olds is reviewed.