Discrimination barrier to healthcare for Pacific Rainbow+ communities

A groundbreaking new study from Waipapa Taumata Rau, University of Auckland reveals a strong and concerning link between experiences of discrimination in healthcare settings and the avoidance of healthcare services among Pacific Rainbow+ communities in Aotearoa New Zealand.

Lead author, Waipapa Taumata Rau Senior Lecturer and Senior Research Fellow (and from March 2026, Associate Dean Pacific and Associate Professor at the University of Otago Wellington) Dr Patrick Thomsen, says the publication of Investigating the association between experiencing discrimination in healthcare settings and avoidance of healthcare services among Pacific Rainbow+ in Aotearoa New Zealand in the New Zealand Medical Journal during Pride Month is timely and necessary.

Drawing on data from almost 400 Pacific Rainbow+ participants in the national Manalagi Survey, the study found that six in ten respondents had experienced discrimination when seeking healthcare, with ethnic and race based discrimination reported most frequently, followed by gender and sexuality based discrimination.

Crucially, the study shows that experiencing any form of discrimination significantly increases the likelihood of avoiding healthcare, with each additional discriminatory encounter raising the odds of healthcare avoidance by approximately 60 percent.

“Discrimination can prevent our Pacific Rainbow+ communities from engaging with the New Zealand healthcare system,” says Dr Patrick Thomsen.

The findings highlight the real life consequences of discrimination within the health sector:

“What we wanted to examine was whether experiences of discrimination in healthcare settings impacted the way Pacific Rainbow+ people engage with the health system, and the connection was undeniable. If our communities encounter discrimination, they are far more likely to avoid seeking care in the future. That’s hugely concerning for populations already underserved by the system.”

He notes that Pacific Rainbow+ people often face overlapping forms of marginalisation: racism, homophobia, transphobia and cultural misunderstanding, all of which contribute to barriers to receiving care.

“We already know Pacific communities experience poorer health outcomes. When discrimination becomes an added barrier, it compounds existing inequities and creates significant risks for long term health and well-being.”

Ethnic and race based discrimination the strongest predictor

The study found that being treated differently from Pākehā patients, or experiencing racial or ethnic microaggressions, were the strongest predictors of healthcare avoidance across both cisgender sexuality diverse participants, and transgender and non binary participants.

Among transgender and non binary participants, misgendering, dead naming (the act of referring to a transgender or non binary person by a former name) and being treated differently from cisgender patients were also strongly associated with healthcare avoidance.

Discrimination also drives increased use of mental health services

The research revealed a parallel pattern: participants who experienced racial or ethnic discrimination were also significantly more likely to seek mental health support, highlighting the psychological toll of discrimination and the ways it shapes health seeking behaviour.

A system-wide issue requiring a system-wide response

Dr Thomsen emphasises that addressing these barriers is not about isolated interventions, but about broad cultural and structural change across the health workforce:

“These are system level issues. We can’t expect one silver bullet or a single training session to undo the impacts of discrimination. What we can do is take an education first approach, building the capability and confidence of our healthcare workers to better understand Pacific Rainbow+ communities.”

“At the heart of this is relationality. Our participants consistently told us that feeling welcome begins with building a meaningful relationship with their healthcare provider. When people feel seen, respected and understood, behaviours shift naturally over time. But we must equip our healthcare workforce with the right tools to build those connections.”

Dr Thomsen and the Manalagi team have already begun working with healthcare providers through an HRC funded project to develop training resources supporting more culturally responsive and gender affirming care.

A call for further intersectional research

Pacific Rainbow+ communities face multiple marginalised realities in the healthcare system, and more intersectional, community led research is urgently needed.

“This work isn’t about just spotlighting the trauma of individual community members who may already feel isolated,” says Dr Thomsen. “It’s about transforming systems so that our people, especially those who don’t have strong support networks, can access healthcare safely and confidently, even when no one’s looking.”

The authors say future research must continue to unpack Pacific specific gender identities, address persistent systemic racism, and strengthen provider–patient relationships grounded in respect, cultural competence and understanding.