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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.

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.

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.