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Racism in healthcare: a scoping review
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.ORCID iD: 0000-0001-8547-8772
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology. (Welfare and life course)ORCID iD: 0000-0002-0664-1170
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology. Skaraborg Institute for Research and Development, Skövde, Sweden. (welfare group)ORCID iD: 0000-0003-1670-2843
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.ORCID iD: 0000-0002-1962-410x
2022 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, article id 988Article, review/survey (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
London. United Kingdom: Springer Nature, 2022. Vol. 22, article id 988
Keywords [en]
Racism, Discrimination, Healthcare, Review
National Category
Sociology
Identifiers
URN: urn:nbn:se:uu:diva-474825DOI: 10.1186/s12889-022-13122-yISI: 000796560000002PubMedID: 35578322OAI: oai:DiVA.org:uu-474825DiVA, id: diva2:1660185
Funder
Swedish Research Council
Note

Sarah Hamed, Hannah Bradby, Beth Maina Ahlberg and Suruchi Thapar-Björkert contributed equally to this work.

Available from: 2022-05-23 Created: 2022-05-23 Last updated: 2023-08-30Bibliographically approved
In thesis
1. Healthcare Staff's Racialised talk: Examining Accounts of Racialisation in Healthcare
Open this publication in new window or tab >>Healthcare Staff's Racialised talk: Examining Accounts of Racialisation in Healthcare
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis contributes to the literature on racism in healthcare and the scholarship on racism and racialisation by moving the current focus of healthcare literature from demonstrating the existence of racism to examining accounts of racialisation through analysing healthcare staff’s racialised talk. Drawing from critical ‘race’ and postcolonial theories, the thesis departs from the premise that racism is a structural phenomenon embedded in nation states and institutions, including healthcare across the globe. Through a scoping review ofstudies on racism in healthcare, this thesis maintains that the current literature does not conceptualise racism as structural, and does not attempt to uncover accounts of racialisation. The review argues that the trends uncovered are part of why racism continues to reproduce itself in healthcare, despite equality regulations and policy makers’ efforts to eradicate racism. The thesis posits racialisationas a process situated within the sociohistorical playing out of colonial domination, where in groups of people are stratified somatically and culturally within groups of subordination and supraordination. Societies, institutions, and interactions are viewed as racialised such that an analysis ofracialised talk captures the seemingly subtle racialisation intrinsic tohealthcare. Analytically, the excavation of racialised talk regards talk as reflective and constitutive of the dominant structures within which talk is situated. Drawing on qualitative interviews with 58 healthcare staff in Sweden, the thesis examines how healthcare staff’s racialised talk is used to devalue minority healthcare users and obfuscate racism. The findings of this thesis contradict previous characterisations of racism in today’s society as covert. Racialised talk against minority healthcare users is found to be overt and used to categorise minority users as ‘bad’ users and their health complaints as ‘unworthy’ by labeling symptoms as ‘ethnic’, ‘cultural’ or ‘functional’. The devaluingof minority healthcare users through talk further justifies differential and suboptimal care. Besides demonstrating that racialised talk in healthcare is overt, this thesis proposes that by emphasising healthcare neutrality and equality regulations, blaming minorities for racism, viewing racism as an individual aberration, locating racism outside both national and institutional contexts, healthcare staff manage (albeit inadvertently) to obfuscate racism. It is suggested that obfuscation of racism may serve to allow racism to be perpetuated, resulting in a culture of resignation, where resistance to racism isnegligible.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2022. p. 111
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 204
Keywords
Racism, racialisation, racialised talk, healthcare, healthcare staff, critical ’race’ theory, postcolonial theory, Sweden
National Category
Sociology
Research subject
Sociology
Identifiers
urn:nbn:se:uu:diva-488470 (URN)978-91-513-1659-8 (ISBN)
Public defence
2023-01-23, Humanistiska teatern, Thunbergsvägen 3C, Uppsala, 10:15 (English)
Opponent
Supervisors
Available from: 2022-12-16 Created: 2022-11-17 Last updated: 2022-12-16

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Hamed, SarahBradby, HannahAhlberg, Beth MainaThapar-Björkert, Suruchi

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