Introduction

Racism is a fundamental determinant of health and significantly influences the severity of social, economic and environmental inequalities.1 Recent events have shed light on the persistent issue of racism within healthcare systems across several jurisdictions, and the devastating impacts on the quality of life for both racialised healthcare providers and clients.2 Racism impacts the accessibility, availability and acceptability of healthcare services, contributing to poor health outcomes and increased costs to health systems.1 Literature on racism and healthcare has been growing significantly over the last few decades. Existing scholarship illustrates that racism continues to be manifested within healthcare institutions in North America and Europe, resulting in differences in how healthcare is delivered, accessed and received among racialised minorities.3 This existing literature focuses on both the experiences of healthcare staff and users, the impacts of racism on treatment and care, attitudes and beliefs about racism among healthcare staff and the development of education and training focused on antiracism.3

Recently, there has been a trend among healthcare institutions such as education and service delivery bodies to focus resources on equity, diversity, inclusion and antiracism. While these efforts are important for addressing institutional and interpersonal racism, other key players such as health practitioner regulators, also have a significant role to play in creating antiracist healthcare systems. Regulators have an influential role as they oversee practitioner pathways from education to registration to practice.4 Regulatory schemes differ around the world; however, in general, the goal of health practitioner regulation is to protect the public by ensuring practitioners provide high-quality care in accordance with standards and codes of ethics.5 Professional regulation represents authority over specific knowledge and practices and helps to clearly articulate what is acceptable for healthcare practitioners.6

Through licensure policies, the implementation and enforcement of standards of practice and codes of ethics, policies for continuing professional development, and management of unprofessional conduct, regulators work to ensure the public is protected through high-quality safe care. Regulators are often viewed as the gatekeepers to safe patient care; however, the actions or inactions of regulators can also perpetuate and reinforce racism within health systems. For example, licensure policies may be used to unjustly exclude internationally educated healthcare professionals, and complaints and discipline processes may be influenced by unconscious bias. Further, the absence of clear standards of practice articulating healthcare practitioners’ accountabilities related to antiracist practice can contribute to the conditions that give rise to racism.

Increasingly, not only are regulators claiming their role in combatting racism within health systems, but they are also taking steps to address regulatory policies and practices that contribute to or perpetuate interpersonal and institutional racism. For example, in British Columbia, Canada, several health profession regulators have collaborated to develop standards of practice to address Indigenous cultural safety, humility and antiracism.7 Regulators in other Canadian jurisdictions have also taken steps to work towards equity, diversity, inclusion and addressing anti-Indigenous and anti-Black racism through issuing formal apologies for historical failures, creating structures and mechanisms to improve regulatory functions, developing education and training, and creating standards and policies to set clear expectations for regulated professionals.8 9 Similarly, in Australia, the Australian Health Practitioner Regulation Agency recently introduced new governance changes where Indigenous representatives will guide profession-specific regulatory boards in reviewing allegations of racism.10

Leading regulatory consortiums such as the Professional Standards Authority (PSA) for Health and Social Care in the UK have also noted the urgency in addressing racism, discrimination and inequalities faced by regulated professionals from minority ethnic groups. Existing research shows that Black and minoritised ethnic professionals are over-represented in all stages of fitness to practice processes.4 11 12 The PSA has suggested that regulators can play a role in addressing discrimination by developing and enforcing clear standards and guidelines, providing education and training, and reviewing fitness to practice processes to address racist or discriminatory behaviour. These efforts are promising, and to ensure regulators are positioned to reform their approaches, evidence must be available to inform decision-making.

We conducted a preliminary search on MEDLINE, the Cochrane Database of Systematic Reviews and Johanna Briggs Institute (JBI) Evidence Synthesis and identified no current in-progress systematic reviews or scoping reviews on this topic. Several knowledge syntheses have been completed on racism and healthcare,13–16 but to our knowledge, no scoping review has focused on racism and health practitioner regulation. A comprehensive understanding of the current state of literature can help identify knowledge gaps and inform the development of research agendas that can build the evidence base required to improve health practitioner regulators’ approaches to addressing racism across professions and jurisdictions. We identified a scoping review as the most appropriate methodology because our focus is on mapping the existing literature and providing an overview of evidence, concepts and studies related to racism and health practitioner regulation.17 18