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Research points to the existence of racial bias and beliefs among healthcare staff but does not explicate accounts of racialization in healthcare and the day-to-day utterances that have racializing effects excluding minoritized users' right to care. This study understands racism as structural and embedded in societies and institutions, including healthcare, as well as in interactions and talk. Through excavating accounts of healthcare staff's talk that devalues minoritized users, this study posits talk as reflective and constitutive of the dominant structure of racism within which it is situated. Drawing on qualitative interviews with 58 staff in Sweden, the study delineates three categories through which racialized talk differentiates between minoritized and majoritized users. These are: Characterizing minoritized users as ‘bad’ users, Characterizing minoritized users' health complaints as unworthy and finally, Devaluing minoritized users as justification for suboptimal and differential care. Healthcare staff accounts show that continuous racialization of minoritized users maintains existing power-relations representing Western users as civilized and non-Western users as uncivilized and problematic. Through reiteration, these practices of exclusion become invisible, normalized, and assume the status quo. It is imperative to address racialization as it has implications for the core ethics of healthcare.

This paper highlights the embeddedness of xenophobia in institutions through a theoretical but empirically under-researched concept of structural violence. Drawing on in-depth qualitative interview data with refugee women in Gauteng, South Africa, we explore the empirical utility of the concept of structural violence in shaping refugee women's everyday experiences of xenophobia through three analytical themes: (a) unequal access to resources (b) constrained agency and (c) dehumanization. While keeping an empirical grip on experiential narratives on xenophobia, we draw attention to three public institutions that enhance the vulnerability of those already vulnerable: The Department of Home Affairs, The South African Police Service and Public Hospitals. Our paper elucidates how refugee women experience xenophobia and how they manage their "everyday" in these circumstances- an aspect that remains underdeveloped in existing research.

An educational intervention, based on qualitative evidence of racism in healthcare, is described. Using vignettes from a previous project, interviews were conducted to gather qualitative evidence of racism in healthcare settings from a wide range of healthcare staff in Sweden. From this interview material, case studies were devised that were subsequently presented to trainee healthcare professionals, in a seminar discussion. After the seminar, trainees responded to reflective questions. The order of work, as well as the materials used, are described. This intervention was successful in facilitating discussion about racism in an educational context, despite the difficult nature of these conversations for some participants.

Aim: The aim is to illustrate and analyse reflections from graduate nursing studentsover their experience of discussing racism in healthcare in an educational intervention.Design: A qualitative, descriptive design was adopted.Methods: Data were collected through written reflections and analysed through con-tent analysis. In total, 81 students participated in the intervention; 39 paediatric and42 public health care nursing students. Of those, 27 participants gave consent to havetheir written reflections included in the study.Results: Three main categories were developed in the content analysis of studentreflections: (a) the implicit embeddedness of racism in healthcare organization; (b) theeffect of racism on interactions with patients; and (c) a growing awareness of one'sown understanding of racism. This study indicates that student nurses discussed rac-ism as relevant to understanding good clinical practice for the benefit of patients andwork-based wellbeing of staff. This recognition of the organizational nature of racismwarrants nursing leaders and managers to include racism as a social determinant ofhealth in the undergraduate and graduate curricula to educate the next generation ofnursing about racism.

Vulnerability is a pivotal concept for understanding transnational commercial surrogacy and the ethics of reproductive travel. While implicitly recognizing vulnerability as important, existing scholarship falls short of understanding the dynamism of vulnerability. Placing our empirical analysis in conjunction with the rich theoretical literature on this concept, we explore vulnerability in surrogacy arrangements in India as a "mode of openness," defined by its multilayeredness and context specificity. We focus on two retellings of vulnerability. In the first narrative, we analyse the journey of an intended parent who becomes an agent, while in the second narrative, we focus on the trajectory of a surrogate and egg donor becoming an agent. In both narratives, the layers of vulnerability across different interconnected circuits of reproduction-of intended parent, agent, and surrogate-are explicated. Our analysis illustrates the complex and conflicting meanings of vulnerability and illustrates vulnerability as an instigator of agency and resistance; how it can propel upward social mobility and animate attempts to transform an unjust system, but also how such individual agency and empowerment may serve to uphold exploitative relationships.

While regularly applied to globalized migration, conceptualizations of hospitality have rarely been used to understand healthcare settings. Drawing on interviews with healthcare staff in Sweden, our article contributes to the current conceptualization of hospitality accounting for: the internal contradictions of hospitality that racialized staff experience in their everyday interactions with patients and other staff; the shifting boundaries between host and guest in everyday healthcare practices, especially when examined through the lens of racialization and finally; the subtle though troubled coexistence of hostility and un(conditional) hospitality that weakens resistance against racism. The analysis maps the complex contingencies of professional, ethnic and national relations between staff and patients, in light of their racialized and gendered nature, to suggest that the ambivalences theorized as part of the concept of hospitality show how the hurts of racism are so hard to pinpoint.

Encountering racism is burdensome and meeting it in a healthcare setting is no exception. This paper is part of alarger study that focusedonunderstandingandaddressingracismin healthcare in Sweden. In the paper, we draw on interviews with 12 ethnic minority healthcare staff who described how they managed emotional labor in their encounters with racism at their workplace. Data were analyzed using thematic analysis. The analysis revealed that experienced emotional labor arises from two main reasons. The first is the concern and fear that ethnic minority healthcare staff have of adverse consequences for their employment should they be seen engaged in discussing racism. The second concerns the ethical dilemmas when taking care of racist patients since healthcare staff are bound by a duty of providing equal care for all patients as expressed in healthcare institutional regulations. Strategies to manage emotional labor described by the staff include working harder to prove their competence and faking, blocking or hiding their emotions when they encounter racism. The emotional labor implied by these strategies could be intense or traumatizing as indicated by some staff members, and can therefore have negative effects on health. Given that discussions around racism are silenced, it is paramount to create space where racism can be safely discussed and to develop a safe healthcare environment for the benefit of staff and patients.

This article analyses processes of social change in rural India through an ethnographic analysis of everyday politics in two Indian states, Andhra Pradesh and Uttar Pradesh. Its main argument is that even if overt resistance or 'noisy' collective action by the poor is rarely seen, a great deal of social change is occurring through a subtle 'politics of negotiation' whereby poor, low-caste agricultural labourers are questioning social norms that underpin their oppression. These negotiations are structured around labour relations and caste norms, which are so inextricably intertwined that a modification of one set of 'rules' necessarily has an impact on the other. The processes of democratization, the erosion of patron-client relations, the spread of education, an enduring agrarian crisis aggravated by climate change and the availability of alternative employment opportunities for the poor are chipping away at the dominance of India's rural elite. This continuous negotiating process between the (upper-caste) landed elite and the (lower-caste) labouring classes is non-confrontational and while it would be ambitious to suggest that it overturns the existing power relations, it nonetheless challenges and modifies them in a way that results in progressive social change.

Background

Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts.

Method

The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim.

Results

The review yielded the following categories: healthcare users’ experiences of racism in healthcare; healthcare staff’s experiences of racism; healthcare staff’s racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff’s reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff’s racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff’s racial bias may influence medical decisions negatively. Studies examining healthcare staff’s reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace.

Conclusions

The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism’s structural embeddedness, which could aid in tackling racism to provide good quality care.

In this paper, we present a novel, survey-based method to measure people's empowerment, across different domains of their lives. The method includes three elements: (i) a direct measurement of decision-making, defined as the ability to make choices; (ii) a measure of whether people have reasons to value those choices; and (iii) a measure of the role that prevailing social norms play in determining people's ability to make strategic life choices. We build an Empowerment score that is computed using these three elements. In the second part of the paper we, first, evaluate the effectiveness of the tool, using original survey data from India. We show that using the Empowerment score makes a substantial difference compared to a simpler (and less theoretically rigorous) score based on direct measurement of decision-making only. Second, we apply the Alkire-Foster method to compute an Empowerment index that allows for comparisons of empowerment levels across locations, contexts, social groups and time. The Empowerment score has important policy applications. It can be used as a variable in policy and programme evaluations and to identify not only those who make or do not make a certain choice, but also individuals who do not value making those choices and if they might be conforming to social norms. In this way, the tool can assist in directing government attention to work with marginalised groups in making choices they want to make rather than pressing them into making choices that they do not value.