This systematic review will follow the reporting guidelines and criteria set in Preferred Reporting Items for systematic review (PRISMA) . Additionally, completed PRISMA-P checklist demonstrating the recommended items to include in a systematic review protocol, along with the location of each item within the document , can be found in Additional file1. The review will be performed within an eight months' time frame (May to December 2020) and will follow the stages proposed in the framework by Arksey, et al.  and Levac  for scoping reviews.
The search will be conducted in English and will include studies published between the 01st of January of 2000 and June 2020. We will also adopt a snowballing approach which involves searching the reference list of all selected studies and citation tracking.
The review will include studies in English, conducted among Aboriginal and Torres Strait Islander peoples. Only studies using quantitative methods will be included. These may include control-case studies, cross-sectional, and cohort studies.
In Australia, there are two distinctly recognised groups of Indigenous peoples: Aboriginal peoples and Torres Islander peoples. The term “Indigenous” is used today to describe both Aboriginal and Torres Strait Islander peoples. However, it is important to acknowledge that each has its own established values and protocols and own unique ways of expressing them [35, 36]. Furthermore, many Aboriginal and Torres Strait Islander people do not like to be referred to as “Indigenous” as the term is considered to generic . This review will study health outcomes on Aboriginal and Torres Strait Islander peoples of Australia. The study will include people of all ages without distinction of gender or socio-demographic characteristics.
The measurement of racism is complex and is not completely developed . However, racism can occur at different levels . Interpersonal racism can be defined as the hierarchical and socially consequential valuation of a racial group  and the unfair treatment of people on the basis of their race or ethnicity . Systemic or Institutional racism is expressed through policies and practices held by institutions that result in less benefits to the oppressed group .
For the purpose of this study, the exposure measure will be perceived interpersonal or institutional racism understood as the perception of receiving an inequal valuation or unfair treatment for being an Aboriginal or Torres Strait Islander person in Australia. This includes self-reported racism and racism reported by a child’s carer or a witness such as family or friends. Studies with all exposure timeframes will be included.
The most universally accepted definition of health is the one proposed by the World Health Organization (WHO) which states that health is "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. The National Aboriginal Community Controlled Health Organisation adopted in 1979 the following definition of health:“Aboriginal health does not mean the physical wellbeing of an individual, but refers to the social, emotional, and cultural wellbeing of the whole community. For Aboriginal people, this is seen in terms of the whole life view" It includes social justice, equity, rights, traditional knowledge, traditional healing and connection to a country  and includes mental, physical, cultural and spiritual health .
Following this definition of health and with the aim of studying health outcomes in an integral way, the outcomes measured will include both physical and mental health components along with other health-related outcomes. Physical health outcomes will include chronic conditions, cardiovascular disease, Diabetes, dysfunctional breathing, blood pressure, cancer and body mass index. It will also include health risk behaviours (for instance, smoking, alcohol consumption and other substance use). Mental health outcomes will include psychological factors like depression and anxiety, psychological distress, social and emotional wellbeing, illness representations (satisfaction with life, quality of life, self-efficacy, satisfaction with illness) and suicide .
We will conduct a systematic search using five electronic databases: PubMed, CINAHL, Embase, Web of Science and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. The search will be performed using combinations of different keywords related to “Aboriginal and Torres Islander peoples”, “Racism”, “Discrimination” and “health”, using “OR” and “AND” as outlined in the Box 1 below.
BOX.1. List of search terms
#1. Racism OR Discrimination OR “Racial Prejudice(s)” OR “Racial discrimination” OR “Covert racism(s)” OR Harass OR Bully OR “Unfair treat” OR Oppress.
#2. “mental health” OR Depression OR Anxiety OR stress OR Distress OR Suicide OR “quality of life" OR "self-efficacy" OR "satisfaction with illness" OR "satisfaction with life" OR "Psychological distress" OR "emotional problems" OR "Psychological illness."
#3. "physical health" OR "wellbeing" OR "cancer" OR "cardiovascular disease” OR “blood pressure” OR “Hypertension” OR “dysfunctional breathing” OR “Respiratory difficulties” OR “Chronic Obstructive Pulmonary Disease” OR “disease “ OR “Life satisfaction” OR “Quality of life” OR “BMI” OR “Body max index” OR “ Asthma” OR “Cardiovascular disease” OR “Blood pressure” OR “Hypertension” OR “Heart disease” OR “chronic conditions” OR “Chronic disease” OR smoking OR tobacco OR “Alcohol” OR Drug OR “Substance use."
#4. Indigenous OR “Indigenous people(s)” OR Aboriginal OR “Torres Strait Islander” OR “First people(S)”
#5. Australia OR “Rural Australia” OR “Remote Australia” OR “Urban Australia”
We will manually consult the bibliography of the review articles to find citations.
The search results will be imported to Endnote, and duplicates will be deleted. Four reviewers will screen titles and abstracts independently to select eligible papers. Pre-selected papers will be full text assessed independently by the five reviewers according to inclusion criteria. Any discrepancies between reviewers during the screening process regarding inclusion criteria will be resolved by discussion and consensus. If consensus cannot be reached, another reviewer will be included to decide on inclusion. The rationale for study exclusion will be recorded as part of the screening process. The screening process will be documented as a PRISMA flow diagram.
The quality appraisal of the studies included in the review will be performed using the Critical Appraisal Skills Programme(CASP) tools, according to each study design . Four authors will independently assess the risk of bias of the included studies and resolve disagreements by discussion to reach consensus or with a vote of majority if they fail to reach consensus. Study authors will be contacted for additional information about the studies and for clarification of any aspect of the study as required. The results of the risk assessment will be portrayed in tables, and the respective commentary about the elements that lead to the overall risk assessment and study judgement will be detailed through a systematic narrative description.
One team member will extract data from the included articles, and another four members will randomly check 10% of the articles meeting eligibility and exclusion criteria. The data to be extracted will include author, year of publication, journal, type of study (study design), location of the study (state or city) sample size, sample demographic characteristics, exposure measure including tools or instruments, exposure timeframe and severity. It will also include the strength and direction of the associations between racism and health outcomes, along with the type of data used to quantify the association (odds ratio, hazard ratio, correlation coefficients). The data will be compared; any discrepancies will be resolved by consensus or with the help of a fifth reviewer.
The data of the studies included will be analysed following a descriptive synthesis process based on the recommendations of the Joanna Briggs Institute Reviewer’s Manual . Two members of this review team who represent Aboriginal and Torres Strait Islander people living in Australia will validate our interpretations of the data.