The Swedish health care system does not offer care on equal terms for all its end-users. Discrimination toward patients can take the form substandard communication toward women or foreign born patients. Discrimination is also embedded in the organizational context. Health care is under pressure to increase efficiency and quality of care at the same time. There is a risk that demands for equality will be pushed aside. This thesis aims to contribute to our understanding of how discrimination is expressed in interpersonal- and organizational communication within health care, and highlight educational implications for health care practices. This thesis is comprised of three empirical studies and one conceptual study. In the first study, critical discourse analysis (CDA) is used to categorize gender patterns in communication between health care workers and patients, and finds that both patients and health care workers reproduced the gender order. Open questions created a setting less prone to be limited by gender stereotypes. In the second study, CDA is used and complemented with Linell’s dialogic perspective in order to explore whether patients who were native speakers of Swedish were constructed differently than those who were not, in patient-physician consultations. Findings indicated that the non-native speakers actually were model, participative patients according to patient-centered care. Notwithstanding this they were met by argumentation, whereas the more amenable native patients were met by accommodating responses. In the third study, qualitative content analysis is used to analyze how health care workers talked about patients in their absence. The results revealed that communication about patients who were perceived as not acting according to socially accepted gender norms contained negative and disparaging statements. The final study focused on Clinical Microsystems, a New Public Management-based model for multi-professional collaboration and improvement of health care delivery. Drawing on theories of New Public Management, gender, and organizational control, this study argues that the construction of innovative and flexible health care workers risks reproducing the gender order. The thesis concludes that gender and ethnic stereotypes are reproduced in health care communication, and that an efficiency-inspired organizational and institutional discourse may be an impediment to equal care. This calls for focus on learning about communication for prospective and existing health care workers in a multicultural health care context.

ldentity research in relation to ethnicity and migration has tended to focus an younger people whilst identity research in relation to ageing and old(er) age has not focused an migrants. This inadvertent mutual neglect has led to a lack of identity research that examines the identity categories of old(er) age and migrancy together, a lacuna that this dissertation aims to redress. This dissertation departs from a social constructionist understanding of identity as situationally accomplished in the interplay between how one defines oneself (internally) and how others define one (externally). The questions raised by this perspective and addressed in this dissertation are: When (in what situations) and in relation to whom do old(er) age and migrancy (respectively) seem to become meaningful for identification? How do the identity categories of old(er) age and migrancy seem to be negotiated? The empirical material consists of in-depth interviews with 24 older migrants (13 men, 11 women) aged between 55 and 79 who have been living in Sweden for 18 to 61 years. Interviewees come from 12 different countries that vary in perceived cultural distance from Sweden. The findings suggest that identifications with old(er) age and migrancy seem to be dynamic and flexible rather than necessarily permanently meaningful, thus gaining meaning in specific situations and in relation to particular Others. External definitions furthermore do not always seem to match with internal ones. Regardless of how old(er) age and migrancy are constructed, they seem to be negotiable. This dissertation thus contributes to identity research by studying old(er) age and migrancy together and furthermore sheds light onto how the social constructionist lens allows us to see variability where stability otherwise would be presumed. / ldentitetsforskning rörande etnicitet och migration har huvudsakligen fokuserat på yngre medan identitetsforskning kring äldre och åldrande inte har fokuserat på utrikesfödda. Som en konsekvens därav har identitetsforskningen inte studerat hög(re) ålder och invandrarskap tillsammans, en lucka som denna avhandling avser att fylla. Avhandlingen utgår ifrån en socialkonstruktionistisk förståelse av identitet som situationsbunden och formad genom samspelet mellan hur man definierar sig själv (internt) och hur andra definierar en (externt). Frågorna som väcks genom detta perspektiv och som avhandlingen fokuserar på är: När (i vilka situationer) och i förhållande till vem verkar hög(re) ålder respektive invandrarskap bli betydelsefulla för identifikationer? Hur verkar identitetskategorierna hög(re) ålder och invandrarskap förhandlas? Det empiriska materialet består av djupintervjuer med 24 utrikesfödda äldre (13 män, 11 kvinnor) i åldrarna mellan 55 och 79 som har bott i Sverige mellan 18 och 61 år. lntervjupersonerna kommer från 12 olika länder med olika upplevt kulturellt avstånd från Sverige. Resultaten tyder på att identifikationer med hög(re) ålder och invandrarskap är dynamiska och flexibla snarare än nödvändigtvis permanent meningsfulla, och får därmed betydelse i vissa situationer och i förhållande till särskilda andra. Externa definitioner verkar inte alltid stämma överens med interna definitioner. Oavsett hur hög(re) ålder och invandrarskap är konstruerade så framstår de som förhandlingsbara. Avhandlingen bidrar därmed till identitetsforskningen genom att studera hög(re) ålder och invandrarskap tillsammans och belyser dessutom hur det socialkonstruktionistiska perspektivet tillåter oss att se variation och föränderlighet där stabilitet annars förutsätts.