Logo: to the web site of Uppsala University

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.

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.

We examine the millennium development goals (MDGs) not only because they constitute an attempt by the Global North to steer development in the Global South but, crucially, for their vague articulation of women's reproductive health and rights. Using a postcolonial lens, we highlight some of their shortcomings and paradoxes concerning women's reproductive justice and problematise the absence of discourse focusing on reducing inequalities. At the core of these shortcomings is the limited reflection on or engagement with neoliberalism, neoconservativism and the growing religious fundamentalism, particularly its views on sexual and reproductive rights. While neoliberalism claims to offer women agency to make free choices, its emphasis on individuals as free entrepreneurs holding sole responsibility for their financial situation is a deterrent for most women, because neoliberalism simultaneously undermines the institutions that enable self-sufficiency. In addition, neoconservatism and religious fundamentalism focus on preserving traditional family structures, regarding marriage as a heterosexual institution and the rights of the unborn as central. This is particularly critical for women in the Global South, especially African countries, where the application of the gag rule by Global North funding agencies restricts access to sexual and reproductive rights, including abortion, in the name of protecting the unborn.

This chapter concerns research on racism within healthcare focusing on studies examining how racism influences healthcare interactions and the delivery of and access to care. The chapter starts with an overview of research on racism in healthcare, drawing on a review of 213 English papers, published up until December 2020, the majority of which focus on Western settings, where most research is conducted. The way key concepts such as ‘race’, racism and racialisation are discussed in research on racism in healthcare is presented. How structural racism, meaning the embeddedness of racism in healthcare routines and practices, is presented in this research is discussed. The chapter concludes that research lacks a structural understanding of racism and uses ‘race’ in an essentialist manner, risking reproducing racialisation. The chapter highlights the need for research to conceptualise racism as structural rather than simply consisting in individual poor choices else anti-racist work is bound to fail.

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.

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.

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.