Racism against racialized migrants in healthcare in Europe: a scoping review

Abstract

Background Racism is frequently mentioned as a social determinant of migrants’ health and a barrier to health services. However, in the European context, racism and its impact on racialized migrants’ access to healthcare is remarkably under-researched. This scoping review makes a first step toward filling this void by mapping the existing literature on racial and ethnic discrimination against racialized migrants in healthcare in Europe, identifying evidence gaps, and offering recommendations for future research on this topic. Methods Following PRISMA guidelines, four databases were searched for empirical studies published in English between 1992 and 2022. Studies were included if they report findings on manifestations, experiences and/or impacts of racial or ethnic discrimination against racialized migrants in a healthcare setting in a European country. They were summarized by study characteristics (geographical scope, study design, research question and measures) and research findings were synthesized. Results Out of 2365 initial hits, 1724 records were included in the title/abstract-screening, 87 records in the full text-screening, and 38 records in the data extraction. For many country and healthcare contexts, evidence on racism in healthcare is lacking. Most studies 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 and quality for racialized migrants. It also highlights the need for more research on racism in Europe across a greater scope of country contexts, healthcare settings and migrant/racialized categories in order to understand specific forms of racism and capture race as a context-contingent social construct. It is critical that future research includes the consideration of individual-level racism as embedded in racism on institutional and structural levels. Methods and insights from other disciplines may help to critically examine concepts in light of underlying historical, sociopolitical and socioeconomic processes and structures, and to improve methods for researching racialization and racism in healthcare.

Perceived discrimination in health care in Germany– results of a population survey

“…Nong et al [ 22 ] found that such experiences also are associated with lower trust in the health care provider and a reduced willingness to share information with the provider, possibly resulting in lower quality of medical decision-making and care. These findings, together with the results presented here underline that discrimination is an important aspect of inequalities in health and health care [ 5 – 7 , 23 , 24 ].…”

Prevalence of perceived discrimination, determinants and associations with self-rated general and sexual health, healthcare utilization and self-perceived integration: a cross-sectional survey of migrants in Sweden

“…Evidence suggests that ethno-racial minorities are more likely to receive welfare sanctions in the US and to be denied social insurance benefits, stopped or subject to discriminatory profiling by the police in Sweden [ 12 , 50 ]. Experiences of discrimination within healthcare have also been reported in various settings [ 21 , 31 , 32 ]. Such discrimination is worrisome as it can contribute to a distrust in public institutions and reluctance to seek available services and support, and result in unequal opportunities in accessing these services between migrant and non-migrant groups [ 12 ].…”

“…The association between experiences of ethno-racial discrimination and access to healthcare has also been highlighted in several studies. Perceived ethno-racial discrimination has been identified as a barrier to care for migrants that reinforce inequities in healthcare access and quality for racialized migrants in several studies in Sweden and elsewhere [ 21 , 31 , 32 , 34 ].…”

“…Migrants have limited access to health care services in receiving countries due to complex barriers, including discrimination [ 21 , 31 , 32 ]. Evidence shows that racial or ethnic discrimination can negatively affect access to care and treatment, trust in healthcare system [ 10 , 33 ].…”

Patterns of healthcare use among children with immigrant and non-immigrant backgrounds in 2019 and 2020: evidence from the CRIAS cohort study in the metropolitan area of Lisbon, Portugal

“…Racism towards racialized immigrants in accessing and receiving healthcare has been observed at interpersonal and structural levels and constitutes a barrier to equity in healthcare. Racism has been associated with delay in seeking healthcare, lack of trust, feelings of being ignored and with differential medical treatment [ 30 – 32 ].…”