Racism against migrants in healthcare in Europe: a scoping review

Abstract

Background Racial discrimination is frequently mentioned as a social determinant of migrants’ health and a barrier to healthcare. However, in the European context, racial discrimination and its impact on migrants’ access to care is remarkably under-researched. This scoping review makes a first step toward filling this void by mapping the existing literature on racism against migrants in healthcare in Europe, identifying evidence gaps, and offering recommendations for future research. Methods Following PRISMA guidelines, four databases were searched for empirical studies published in English between 1992 and 2022. Studies were included if they report on manifestations, experiences and/or impacts of racism against migrants in a healthcare setting in a European country. Findings were summarized by study characteristics (geographical scope, study design, research question and measures) and thematically (manifestations and experience of racism, and impacts of racism on healthcare). Results Out of 2365 initial hits, 1724 records were included in the title/abstract-screening, 87 records in the full text-screening, and 43 records in the data extraction. For many country and healthcare contexts, evidence on racism in healthcare is lacking. Most study apply an explorative qualitative research design; comparability and generalizability of research results are low. Our analysis furthermore shows a near-exclusive research focus on racism on the interpersonal level as compared to institutional and structural levels. Our synthesis of study results identifies three interrelated ways in which racism manifests in and impacts migrants’ healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. Conclusions Our review underscores how racism reinforces inequities in healthcare access, healthcare quality, and health outcomes for racialized migrants. It also highlights the need for more research on racism in healthcare across a greater scope of country contexts, healthcare settings and migrant/racialized communities in order to understand specific forms of discrimination and capture race as a context-contingent social construct. Methods and insights from other disciplines may help to critically examine categories and hierarchies in light of underlying historical, sociopolitical and socioeconomic processes and structures. It is critical for future research to consider individual-level racism as embedded in racism on institutional and structural levels.