The experience of racism against migrants in healthcare in Europe: a scoping review

BACKGROUND: Racial discrimination is frequently mentioned as a social determinant of migrants’ health. However, in the European context, racial discrimination and its impact on migrants’ access to healthcare is under-researched. This scoping review makes a first step toward filling this void by mapping the literature on racism against migrants in healthcare in Europe and identifying evidence gaps. METHODS: Following PRISMA guidelines, four databases were searched for empirical, peer-reviewed studies on manifestations, experiences, or impacts of racism against migrants in healthcare settings in European countries, published in English between 1992 and 2022. Out of 2365 articles screened, 43 were included in the data extraction. A quality assessment and narrative synthesis were performed. RESULTS: Our synthesis of the extant evidence 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. However, our analysis demonstrates that for many country and healthcare contexts, research on racism in healthcare is lacking. Most studies apply an explorative qualitative research design, while the comparability and generalizability of research results are low. Furthermore, there is a near-exclusive research focus on racism at the interpersonal level, with little data on institutional and structural levels. CONCLUSIONS: The review pinpoints limitations and lacunae in the current body of knowledge; namely a lack of evidence for many country and healthcare contexts, a dearth of generalizable results, and a near-exclusive focus on racism on the interpersonal level as compared to structural levels. At the same time, its findings underscore how racism reinforces inequities in healthcare and health outcomes. It thus highlights the need for systematic research on racism in healthcare in Europe. KEY MESSAGES: • Racism against migrants in healthcare reinforces health inequities through anti-migration bias, health(care)-related prejudice, and differential medical treatment. • Research on racism in healthcare in European countries is scarce; especially systematic and generalizable evidence and evidence on racism on structural levels is lacking.