POWER, PRIVILEGE AND DISADVANTAGE IN PHYSIOTHERAPY – WHO DECIDES?
J Hammond1, J Setchell2, A Pathak3, M-L Busuttil4
1Kingston University and St George’s, University of London, Rehabilitation Sciences, London, United Kingdom, 2The University of Queensland, Health and Rehabilitation Sciences, Brisbane, Australia, 3University of Otago, Department of Surgical Sciences, Dunedin Hospital, Dunedin, New Zealand, 4Malta Association of Physiotherapists, Gzira, Malta
Learning objectives:
- To reflect critically on physiotherapy practice, policy, research and education in relation to power, privilege and disadvantage.
- To explore how power enables and controls decisions both explicitly and implicitly and how this can lead to simultaneous disadvantage and privilege.
- To explore strategies that that enable recognition of power dynamics and identifying possible actions toward equity.
Description: Growth of the profession continues globally with 121 member organisations in WCPT representing more than 625,000 physiotherapists1. While there are well meaning processes to ensure equity, quality assurance across the profession globally, there may be (un)intentional consequences of creating in/out groups that operate around privilege/disadvantage binaries such as high/low income countries, DPT/BSc entry level qualifications, positivist/realist research, medical/social models, western/non-western etc. We need to acknowledge these power relationships both as individual professionals and as a profession as a whole.
Similarly health inequalities are persistent globally and the political, economic and social factors are a greater influence than individual biological or behavioural factors2. In physiotherapy education and practice we try to recognise and challenge sexism, racism, ageism, ableism, homophobia, xenophobia and others for the populations we serve3,4. However, we do not always recognise the inequities in our own professional groups, research communities or policies and how this might lead to disadvantage or unearned privilege.
In this interactive symposium, we will begin with a brief introduction by Dr John Hammond to outline the basic tenets of power, privilege and disadvantage5 and introduce some frameworks for critical reflection6 and how these relate to physiotherapy2,7 and the subsequent discussions. Each speaker will then explore an applied example within their own physiotherapy contexts and policy. Anupa Pathak will consider power and implications for physiotherapy with an emphasis on cross-cultural issues and using examples from the context of Nepal. Dr Jenny Setchell will use examples from her own research and experience8,9,10 to explore how power operates within the physiotherapy membership organisations and profession generally. Ms Busuttil will explore how power operates in physiotherapy research and education and will propose change to minimise the exclusionary effects of privilege and enhance equity. An advocacy model through a transformational leadership style will be adapted to make these professional objective a living reality within global physiotherapy.
An interactive session with the audience will follow. This session will include facilitated opportunities for the audience members to discuss and reflect on their own experiences of power, privilege and disadvantage in physiotherapy. There will also be opportunities to ask questions of the speakers. The session will conclude with summary remarks from the chair.
Implications/conclusions: This focused symposium will encourage physiotherapists to critically reflect on the professions practice, policy, research and education and uncover systems of inequality. It will help delegates explore their own 'blind spots' of 'taken for granted' social structures that not only lead to disadvantage and oppression of some groups but to unearned privilege for others. Approaches and strategies will be highlighted that physiotherapists can use in a variety of professional settings to examine other social structures that operate in their context.
References:
1. WCPT (2020) Name change for global physical therapy body. Available at: https://www.wcpt.org/news/name-change-forglobal-physical-therapy-body
2. Nixon, S.A. (2019) The coin model of privilege and critical allyship: implications for health, BMC Public Health, 19 (1), pp. 1-13
3. Matthew DB (2015). Toward a Structural Theory of Implicit Racial and Ethnic Bias in Health Care, Colorado Law Scholarly Commons, 25 Health Matrix 61, http://scholar.law.colorado.edu/articles/52
4. Page-Reeves J, Niforatos J, Bulten R, et al. (2013). Health Disparity and Structural Violence: How Fear Undermines Health Among Immigrants at Risk for Diabetes. Journal of Health Disparities Research and Practice, 6(2), 30-47.
5. Foucault, M. (1980) Power Knowledge. Selected Interviews and other writings. Brighton: Harvester Press.
6. Brookfield, S. (2015) So what exactly is critical about critical reflection? in Fook,J., Collington, V., Ross, F., Ruch, G., West, L. (eds) Researching critical reflection. Abingdon, Oxon:Routledge, pp. 23-34.
7. Gibson, B.E., Nicholls, D.A., Setchell, J. and Groven, K.S. (eds.) (2018) Manipulating practices: A critical physiotherapy reader. Oslo, Norway: Cappelen Damm Akademisk.
8. Setchell J. (2017) Invited editorial: What has stigma got to do with physiotherapy? Physical Therapy Canada, 2017; 69(1), 1-4.
9. Setchell J, Dalziel B. (In press) Using critical reflexivity to enhance clinical care: a clinician perspective. Journal of Humanities in Rehabilitation.
10. Setchell J, Nicholls D, Gibson B. (2018) Objecting: Multiplicity and the practice of physiotherapy. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine. 22(2):165-184
1. WCPT (2020) Name change for global physical therapy body. Available at: https://www.wcpt.org/news/name-change-forglobal-physical-therapy-body
2. Nixon, S.A. (2019) The coin model of privilege and critical allyship: implications for health, BMC Public Health, 19 (1), pp. 1-13
3. Matthew DB (2015). Toward a Structural Theory of Implicit Racial and Ethnic Bias in Health Care, Colorado Law Scholarly Commons, 25 Health Matrix 61, http://scholar.law.colorado.edu/articles/52
4. Page-Reeves J, Niforatos J, Bulten R, et al. (2013). Health Disparity and Structural Violence: How Fear Undermines Health Among Immigrants at Risk for Diabetes. Journal of Health Disparities Research and Practice, 6(2), 30-47.
5. Foucault, M. (1980) Power Knowledge. Selected Interviews and other writings. Brighton: Harvester Press.
6. Brookfield, S. (2015) So what exactly is critical about critical reflection? in Fook,J., Collington, V., Ross, F., Ruch, G., West, L. (eds) Researching critical reflection. Abingdon, Oxon:Routledge, pp. 23-34.
7. Gibson, B.E., Nicholls, D.A., Setchell, J. and Groven, K.S. (eds.) (2018) Manipulating practices: A critical physiotherapy reader. Oslo, Norway: Cappelen Damm Akademisk.
8. Setchell J. (2017) Invited editorial: What has stigma got to do with physiotherapy? Physical Therapy Canada, 2017; 69(1), 1-4.
9. Setchell J, Dalziel B. (In press) Using critical reflexivity to enhance clinical care: a clinician perspective. Journal of Humanities in Rehabilitation.
10. Setchell J, Nicholls D, Gibson B. (2018) Objecting: Multiplicity and the practice of physiotherapy. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine. 22(2):165-184
Key-words: 1. Power 2. privilege 3. inequalities
Funding acknowledgements: No
All authors, affiliations and abstracts have been published as submitted.
