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The unprecedented transnational protests following the killing of George Floyd highlighted the need to re-examine institutions that uphold various social injustices experienced by racialised minorities. Black Lives Matter protests thus created a serious reckoning with racism and facilitated global conversations. Against the backdrop of these protests, we evaluate our study of healthcare workers, exploring racialisation in Swedish healthcare including the design and implementation of an anti-racist initiative in healthcare education. We reflect on how the silencing of discussion around racism in Sweden led to difficulties in recruiting participants and the effect of the shift in public discourse following the Black Lives Matter uprising of 2020. The project was ultimately successful in recruitment and outreach to professional and regional authorities. However, this success is contrasted by the lack of structural change in embedding anti-racism as a core value in healthcare practice. We conclude by noting that conversations about anti-racism differ from implementing anti-racist practice in commissioning, evaluation, and service delivery.

Ability in the local national language is a central object for discourses that de/legitimise immigrants and shape ideas of social reality and social action. In the context of Swedish health care settings, examples of reported speech from patients are offered to show how a presumed migrant’s accent in speaking a national language is conceptually multi-valent in terms of the regulation of legitimacy. Staff who are presumed to be migrants are regularly de-legitimised on the grounds of their speaking style, with foreign accents emphasised as a sign of illegitimacy. Staff who speak without an accent are de-legitimised as speaking Swedish that is too fluent to be compatible with status as an immigrant. The delegitimising of both accented and unaccented language in health care settings indicates the exclusionary and racist nature of language practice, mobilised to delegitimise presumed migrants.

Forced migration has reached unprecedented levels as millions are forced to seek refuge from conflict, persecution, and violence. This exodus includes women enduring the traumas of displacement alongside sexual and gender-based violence (SGBV). Upon reaching supposed places of refuge, they encounter the structural violence of immigration and asylum regimes. Against this backdrop, the intersection of SGBV, forced migration, and structural violence emerges as an urgent area of study. Drawing from extensive qualitative interviews in Australia, Sweden, and the United Kingdom, we set out to examine the impact of structural violence on the lives of forced migrant survivors of SGBV. The article introduces a novel framework to analyze how SGBV, forced migration and structural violence intersect and impact on the lives of survivors. The framework synthesizes (a) the intimate violence of dependency, (b) the slow violence of everyday life, and (c) the gender insensitivity characteristic of determination regimes. Survivors endure a range of injustices: the intimate violence of dependency traps women in controlling relationships; the asylum system’s slow violence leaves them in substandard and undignified conditions; and gender-insensitivity renders their SGBV experiences invisible, often retraumatizing survivors. Within this framework, we describe how these intersecting forms of structural violence underpinning immigration systems, systematically fail those at risk of SGBV, rendering them vulnerable to interpersonal violence instead of protecting them. We call for immigration and asylum systems to prioritize the protection and well-being of women, many of whom are SGBV survivors. As forced migrants face increasingly hostile statutory regimes, we must recognize and address the structural violence that perpetuates harm and denies them protection. Failure to act risks further perpetuating the cycle of violence, trauma and injustice, undermining principles of safety and refuge for those in dire need.

Introduction: Homelessness among women of reproductive age is a globalproblem. Several unique gender-based issues affect homeless women’s wellbeing, including reproductive health issues, their homelessness experiences,and a high rate of sexual violence. In this study, we aimed to describe women’sexperiences of street homelessness in their own terms and their suggestions toaddress their unmet needs.Methods: This photovoice study draws on photos, focus group discussions, andsemi-structured interviews. We conducted the study in collaboration with womenin their reproductive years experiencing homelessness (n = 9). A total of 80 photoswere taken, and 40 were chosen to be discussed in interviews and further focusgroup discussions. The participating women selected photographs, explained theirsignificance, and codified them based on how they related to their lives. Data fromthese discussions were then analysed using a reflexive thematic approach.Results: Four themes were developed from the data: (a) deprivation of basicneeds; (b) experiencing dependency, shame, and seclusion while dealingwith the burden of street life; (c) the vulnerability and neglect of children; and(d) being resilient to harsh conditions. In this study, women’s street life wascharacterised by numerous unfavourable aspects, including unmet needs,human rights violations, social exclusions, substance use, and child protectionissues. Participants provided suggestions for change and confirmed their beliefthat adequate housing represents one of the most urgent unmet basic needsof people experiencing homelessness. They also emphasised the critical needfor employment opportunities, non-discriminatory provision of social support,treatment programs for substance misuse, and legal and social protection.Conclusion: This study contributes to understanding how women experiencinghomelessness describe and articulate their living circumstances and whatthey perceive needs to be addressed. Based on participants’ proposal forchange, comprehensive services are needed to address women’s multifacetedissues. However, the mitigation strategies and long-term effects of women’shomelessness require further research.

Antimicrobial resistance (AMR) can be considered a wicked problem because the phenomenon is characterisedby multiple, interdependent factors, functioning within ostensibly intractable dynamics. Collaborative or net-worked governance is often seen as the most appropriate approach to address wicked problems, and there is oftenscepticism regarding the scalability of micro-level local solutions contributing to neglect in the literature of therole that street-level actors play. Our study focuses on AMR stewardship practices in Northern Europe(Netherlands, Sweden and England), a region which has been relatively successful in controlling antibiotic use inhealthcare. We conducted purposively sampled, theoretically-informed, qualitative interviews to explore stew-ards’ practice as policy actors – how they carried out their tasks, worked with others, and dealt with tensions intheir role. Using abductive analysis, we demonstrate that participants pursued sustained engagement withantibiotic prescribers and sought creative ways of working with, rather than against, embedded professionalvalues. They deployed deliberative and diplomatic relational practices to build trust. Street-level diplomacyoffers a theoretical framework for understanding how policy actors can work in the context of wicked problems.Street-level diplomats operate, with high levels of discretion, within complex, adaptive systems utilising theirrelational skills to build dynamic forms of influence amongst those implementing policies that have direct impacton citizens and services users. This provides a pragmatic analytical route through the extremes of romanticisedcalls for ‘collaboration’ to solve wicked problems or critical perspectives that suggest that wicked problems areintractable.

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.

Introduction: Globally, homelessness is a growing concern, and homeless women of reproductive age are particularly vulnerable to adverse physical, mental, and reproductive health conditions, including violence. Although Ethiopia has many homeless individuals, the topic has received little attention in the policy arena. Therefore, we aimed to understand the reason for the lack of attention, with particular emphasis on women of reproductive age.

Methods: This is a qualitative study; 34 participants from governmental and non-governmental organisations responsible for addressing homeless individuals' needs participated in in-depth interviews. A deductive analysis of the interview materials was applied using Shiffman and Smith's political prioritisation framework.

Results: Several factors contributed to the underrepresentation of homeless women's health and well-being needs in the policy context. Although many governmental and non-governmental organisations contributed to the homeless-focused programme, there was little collaboration and no unifying leadership. Moreover, there was insufficient advocacy and mobilisation to pressure national leaders. Concerning ideas, there was no consensus regarding the definition of and solution to homeless women's health and social protection issues. Regarding political contexts and issue characteristics, a lack of a well-established structure, a paucity of information on the number of homeless women and the severity of their health situations relative to other problems, and the lack of clear indicators prevented this issue from gaining political priority.

Conclusions: To prioritise the health and well-being of homeless women, the government should form a unifying collaboration and a governance structure that addresses the unmet needs of these women. It is imperative to divide responsibilities and explicitly include homeless people and services targeted for them in the national health and social protection implementation documents. Further, generating consensus on framing the problems and solutions and establishing indicators for assessing the situation is vital.

Access to good healthcare and the conditions for good health is one of the central dimensions of immigrant integration. National health policies play a major role in equipping residents with the necessary entitlements to accessible and acceptable healthcare services. Rarely analysed so far is the contribution of migration-related health policies to equity in access to healthcare between immigrants and the general population. To address this gap, this study analysed whether the extent to which migration is considered within national health policies moderates the association between immigration status and subjectively perceived unmet medical need in Europe. Using data from the 2019 European Union Statistics on Income and Living Conditions (EU-SILC) survey in combination with the Migration Integration Policy Index (MIPEX) a multilevel analysis was carried out assessing the cross-level interaction between immigration status and MIPEX scores controlling for individual-level factors such as age, gender, education and employment status. While our results showed that immigrants are more likely to report unmet medical need than the general population (adjusted Odds Ratio (aOR) = 1.32; 95% confidence interval (CI) 1.22–1.43), the cross-level interaction indicated increased relative inequality in unmet medical need between immigrants and the general population in countries with high MIPEX scores compared to countries with low MIPEX scores (aOR = 1.39, 95% CI: 1.18–1.63). The main reason for this increase of inequality on the relative scale was the overall lower prevalence of unmet medical need in countries with high MIPEX scores. In conclusion, our findings indicate that even in countries with relatively migration-friendly health policies inequalities in access to healthcare between immigrants and the general population persist.

Background: Mental health conditions are among the health issues associated with homelessness, and providing mental healthcare to people experiencing homelessness is challenging. Despite the pressing issue of homelessness in Addis Ababa, Ethiopia, there is scant research on how service providers address women's mental health and psychosocial needs. Therefore, we explored service providers' and programme coordinators' perceptions and experiences regarding mental healthcare and psychosocial services delivery to women experiencing street homelessness in the city.

Methods: We conducted a descriptive qualitative study with selected healthcare and social support providers and programme coordinators. The study involved 34 participants from governmental and non-governmental organisations in Addis Ababa, Ethiopia. Data were analysed using an inductive thematic approach.

Results: Four themes were derived from the analysis. The first of these was "divergent intentions and actions". While service providers and programme coordinators showed empathy and compassion, they also objectified and blamed people for their own homelessness. They also expressed opposing views on mental health stigma and compassion for these people. The second theme addressed "problem-solution incompatibility", which focused on the daily challenges of women experiencing homelessness and the types of services participants prioritised. Service providers and programme coordinators proposed non-comprehensive support despite the situation's complexity. The participants did not emphasise the significance of gender-sensitive and trauma-informed care for women experiencing street homelessness in the third theme, "the lack of gendered and trauma-informed care despite an acknowledgement that women face unique challenges". The fourth theme, "mismatched resources," indicated structural and systemic barriers to providing services to homeless women.

Conclusions:Conflicting attitudes and practices exist at the individual, organisational, and systemic levels, making it challenging to provide mental healthcare and psychosocial services to women experiencing homelessness. An integrated, gender-sensitive, and trauma-informed approach is necessary to assist women experiencing homelessness.

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.