Sharpening our critical edge: Occupational therapy in the context of marginalized populations

[SarahLyon]

Read Full Text: Sharpening our critical edge: Occupational therapy in the context of marginalized populations (Available for free through ProQuest with your NBCOT membership)
Journal: Canadian Journal of Occupational Therapy
Year Published: 2015
Ranked 88th on our 2015-2020 list of the 100 most influential OT-related articles

As always, this week’s article comes from our list of the 100 most influential OT-related research articles from the past 5 years.

I will admit that I am approaching it differently than I would have 2 weeks ago—before George Floyd’s death further underscored the amount of work needed to dismantle the systems of racism and discrimination.

While I approached this article with gratitude for its importance, I have to confess: I was also left wanting more from it.

The article lays out how systemic injustice impacts individual and community health, and should thus influence our occupational therapy delivery. So, in this way, the topic could not be more important right now.

But, the article also isn’t perfect.

Even though it was only published 5 years ago, some of the language already feels dated. But, what really stood out to me is that it was written solely from a white, middle-class perspective. (The same as my own.)

That said, our goal is always that the research we present will encourage discussion. Ideally, the concepts in this article will also elicit some self-examination.

And, most importantly, I hope this article will drive us to action.

What were the main arguments of this paper?

This paper is an opinion piece and call-to-action, and it was written by an occupational therapist working in Canada. The author is calling on the profession to sharpen our critical thinking when it comes to working with marginalized populations. Her interest in this topic came from working with indigenous people.

She wants to challenge you and the profession in three ways:

1. To rethink assumptions we make about individualism and choice.
2. To use the concept of intersectionality to add more complexity to our current understanding of how discrimination works.
3. To use critical reflexivity to rethink and address how we have historically positioned ourselves in relation to marginalized people.

Let’s start with the goal in mind: health equity.

Before diving into her calls for action, the author refreshed us on the concept of health equity.

The World Health Organization (WHO) has an official definition of health equity, which you can find here.

But, essentially, health equity means that everyone should have a fair opportunity to achieve their full health potential.

Obviously, we have not achieved health equity around the world.

But, as WHO points out, the biggest opportunities to address the current inequities in healthcare are through policy changes and by addressing social determinants of health.

As a reminder, social determinants of health are the conditions in which people live, work, and play. (These differ from clinical determinants of health, which include medical treatments and lifestyle choices.)

The Club recently discussed social determinants of health in this landmark OT study, which shed new light on the topic. In fact, the Canadian Medical Association estimates that social determinants of health account for 50% of health outcomes in the Canadian population!

The author points out that for the indegnious people of Canada, some social determinants of health have included:

• Patriarchal and colonial government relations
• Systemic racism and discrimination
• Economic and political marginalization
• Barriers to self determination

Basically, the argument she is making is that if we truly want to impact individual health, we can’t just pay attention to half of the puzzle. We have to address social determinants of health.

Here’s what she is calling on us to do:

Call-to-action #1: Rethink assumptions we make about individualism and choice.

In some ways, thinking about social determinants seems to perfectly complement occupational therapy—after all, thinking about the environment is our jam! (Right?!)

But, the reality is that our focus has tended to be on the immediate physical and social environments, rather than on the broader socioeconomic, historical, and political contexts.

Even though we know that health problems are, in large part, related to broader social determinants of health, we will often find ourselves promoting solutions that are primarily focused on individual choice.

And, honestly, that’s the best case scenario—one where we are simply ignoring unjust systems that lead to health inequities.

The worst-case scenario, and one we all need to personally confront, is that we might be actively contributing to oppressive systems.

As the author says:

“Imposing a particular view of occupation and daily life that is reflective of white, gendered, and middle class norms of occupational therapy risks that our interventions in the context of marginalized populations are experienced as oppressive and disempowering.”

Call-to-action #2: Use the concept of intersectionality to better understand how discrimination works.

The health inequities and discrimination that seem baked into our systems are sobering…and it can be hard to know what to do to make things better.

The author suggests we begin by adding more complexity and nuance to how we think and talk about marginalization.

One problem we experience in our work (and our world) is a tendency to group people into simple, fixed subgroups, such as “immigrant,” “indigenous person,” or “mentally ill.” We do this so we can make assumptions about them, without having to do the active work of getting to know their strengths and their struggles.

Intersectionality is a concept that helps us break out of this reductive thinking.

Scholars of of intersectional thinking argue that “gender, race, and class are not experienced as separate phenomena but as equally important, interlocking systems of inequalities, subordination, and domination that are shaped differently by women’s historical, geographical, and social contexts and their capacity for agency and resilience.”

Basically, intersectionality calls on us to take the time to listen to each person, because individuals are complex and many forces have intersected to create their unique circumstances. It also calls on us to be cognizant of individuals’ agency, resistance, and competence, instead of looking at them through a deficit lens.

Here’s one of cited authors from the paper, summing up intersectionality in a YouTube clip:

Kimberlé Crenshaw: What is Intersectionality?

Call-to-action #3: Use critical reflexivity to rethink and address how we have historically positioned ourselves in relation to marginalized people.

This is where the article left me wanting a little more, because call-to-action #3 kind of feels like step one on our path to making change.

The author highlights the concept of critical reflexivity, which is slightly different from critical reflection. In fact, you might even consider it a precursor to self-reflection.

Critical reflexivity is when we “turn our gaze inward and question how we are individually located historically, politically, and socially in relation to our clients; the organizational contexts in which we work; and the broader society in which we live.”

Once we do this work, we can then begin to critically reflect on how we can be part of the needed deconstruction and reconstruction of systems to make our world more just.

The author sums up why we do this in the conclusion of her article:

“I believe we have a moral responsibility to do nothing less.”

Takeaways for OT practitioners:

1. We all have a lot of self-work to do to understand how we participate in unjust systems.

I’ve been truly humbled these past few weeks, realizing how much self-work I have to do when it comes to race. And how often I’ve been complicit with systems that serve people like me at the expense of others.

The self-work of understanding our own personal biases (and the biases of the systems in which we work) will be a lifelong process for all of us. If you’ve found any resources that you’ve found particularly helpful in your practice, please share them in the comments.

2. This self-work should lead to action.

The point of all of this self-work is to lead to action. Ideally, this action means not just changing the ways we talk and act, but also working to correct the systems that are unjust.

If you’ve been struggling with what to do as an OT professional, I recommend you explore organizations that are already spearheading this important work. Here in the United States, we are lucky to have The Coalition of Occupational Therapy Advocates for Diversity (COTAD).

One simple action step you could take today is to donate to them.

3. Please let us know which voices and research you think might improve the OT Potential Club (and the OT profession).

This article really underscored the fact that if we care about individual health, we also have to care deeply about community health. That means we need to address systemic issues like racism and injustice.

We plan to continue to do that in the Club. If you know of any important research related to these topics, please let us know! While we tend to work through our list of the 100 most influential OT-related journal articles, we work hard to integrate member requests whenever possible.

Here’s to learning and changing, together, as an occupational therapy community!

(Possibly) Earn CEUs/PDUs for reading this article.

Many of you can receive continuing education credits for reading this article. Here’s a form to help you do it, along with information to help you understand who qualifies.

And, here’s the full APA citation you many need:

Gerlach, A. J. (2015). Sharpening our critical edge: Occupational therapy in the context of marginalized populations. Canadian Journal of Occupational Therapy, 82(4), 245–253. doi: 10.1177/0008417415571730

Lastly, thank you to our guest co-moderator for the week!

I’m thrilled to welcome Lauren Jones (@lauren4) as a co-moderator of this week’s discussion! Lauren is the author of Gotta Be OT and serves on the Executive Board of the Coalition of Occupational Therapy Advocates for Diversity (COTAD).

[cynthia3 (Cynthia Bell)]

Thank you Sarah and Lauren for posting this timely article. I would agree the article provides some key points, but the call to action needs to be stronger and in light of recent events OT as a profession needs transformation. I have been struggling to find my voice as a Caucasian women with privilege…I am now wide awake and listening and trying to learn how I can best do my part, but I am still finding my voice and deciding my actions. I have worked in academia at an Historically Black College and University (HBCU) for over 20 years, I have witnessed a systemic problem within our profession to lack the urgency to acknowledge our composition that is less than 10% diverse. I co- authored a motion in 2008 to the AOTA Representative Assembly to add this to the AOTA Strategic Plan and were were told “we already have that covered” and it was defeated by the RA. Since then, there has been little to no action until recently, with a new Executive Director and I hope can begin some real reform within our profession.I fear without addressing this at a professional organization level, we will limit our effectiveness at growing the profession to meet population needs.

What can I do? I have been awakened first by the data of COVID-19 and then by the murders of Ahmaud Arbery and George Floyd. My own critical reflexivity lead me to the action of listening and seeking, to want to know more from a perspective that is not my own. One of the things I did that I want to highly recommend to all is I watched 13th a couple of nights ago, which is a documentary -13TH refers to the 13th Amendment to the Constitution, which reads “Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States.” However, it goes on to give historical accounts of how “Crime” in that statement has fueled incarceration rates, laws (differences in time served for Crack vs Cocaine), 3 Strikes and your out for minor felonies, privatized prisons needing to stay full, as some examples. This work by DuVernay is a “grand historical synthesis”. (trailer: https://youtu.be/K6IXQbXPO3I).

I am still processing this provocative documentary and all that it presented as it was a departure from any history I ever learned and I suspect it may never be taught. I will continue to listen, critically reflect, and work toward change, personally and professionally.

[SarahLyon]

Hi @cynthia3! Thank you for sharing your processing. And, that you for the work you did in 2008 trying to get more explicit action to be taken about the lack of diversity in our profession. I agree that more concrete action needs to be taken at our professional level, and I know many of us are eager to support change. Maybe, @Lauren4, will have insight into the work COTAD is doing that we could all rally behind?

I know I have been completely humbled by the what I have learned over the past week. I’m working on a public facing blog post on OT and Racial Injustice with resources for understanding the current problems, as well as resources for change. I’m eager to get it posted, but wanted to make sure I had the right voices speak into it beforehand.

[carol2 (Carol Myers)]

The following article, Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health-An Integrative review written by nurses, which elaborates on the importance of understanding social determinants in the context of client care. https://pubmed.ncbi.nlm.nih.gov/30488635/
I am currently writing an article on Population Health-Implications for OT and PT, which introduces a much broader framework/model of health than what we now practice. In my opinion, OT lives in a bubble with a myopic view of human occupation. My eyes were opened to our narrow lens when working in home health, and a non-traditional skilled nursing facility with a homeless population, many of whom experienced unimaginable trauma in their lives. I have felt incomplete working as an OT without a broader understanding of the social, environmental, and economic determinants that shape our clients’ lives. My employers, corporate rehab companies, were shocked when they would visit my facility. My co-workers and I did our best to educate them, but they were genuinely clueless as to how to provide meaningful therapy to this population. Our standard evaluation were utterly inappropriate.

As an older OT who has been involved in social justice for most of my life, I have felt a disconnect from my own values and the practice of OT.
I have yet to find the link to connect the two.

[lauren4 (Lauren Jones)]

It may be that in my perspective as a Black woman in the United States, I’m very familiar with the pressure to conform to the [Eurocentric, middle-class] norm. As a result, the author’s description of her experience recognizing her own privileges and co-creating knowledge with marginalized populations was not particularly eye-opening for me. While I recognize that different readers will have different experiences with this concept, I believe the greatest value in the article was in the author’s consideration of the ways in which social factors that are often out of our clients’ control and that were put into place hundreds of years before and kept in place by those with privileges are hugely important to occupational therapy practice. Apparently, this is something that is minimally considered by most OT clinicians and educators beyond a general consideration of the importance of “context” in treatment – that is, if they are White. If they are not, then, like me, they are typically well aware of the often unjust systems that exist and impact the health outcomes of our clients who are marginalized or not.

Although I am still a fairly new practitioner and younger person (27 years old), I find that the older I get the more I am able to reflect on the many privileges I have and how they have shaped my life and consider this when interviewing and planning treatment for clients. For example, I have a high literacy level, had the benefit of financial support from my family to achieve personal and professional goals, had strong emotional supports, and have a steady income that allows me to get my basic needs met so that I can participate in pursuits like the OT Potential Club! When I consider that many of the clients I serve in an inpatient mental health setting have not only not had any of these supports consistently but they are also part of a marginalized community that most often experiences even worse outcomes…it’s much clearer to me the important of the systemic factors that are dragging them down.

I also agree with the author’s points about not letting the knowledge of systemic ills such as racism and other forms of marginalization supersede the knowledge of each person as an individual . Intersectionality is a concept that is often discussed in OT as a consideration of a person’s roles (mother, teacher, basketball player, etc.), but not fully realized as the components of their identity that may lend themselves to positions of marginalization or dominance.

Although I think the author made several important points, I was ultimately left wanting at the conclusion of this article. There was little in the way of recommendations for people seeking to engage in critically reflexive practices, disrupt the systems and structures discussed, or implement interventions on an individual, family, or community-wide scale. I can imagine many readers finishing this article and wanting to know where to begin to change their self-awareness, practice, and advocacy in order to make a meaningful difference beyond simply being aware of one’s privileges and careful not to re-create power dynamics in treatment sessions. Unfortunately, for all the author’s clear awareness of the importance of disrupting and ultimately ending the “social factors” that are “largely responsible for health equities,” there was very little in the way of practical information or strategy that was shared! (Thanks, Sarah, for posting some action steps in your article breakdown!)

Although I plan to write more this week about some concrete strategies people can utilize if they plan to help disrupt systems that continue to marginalize people, I would like to hear other club members’ perspectives on what they are planning to do differently to avoid the dangers the author discussed (i.e. re-traumatizing individuals/communities, assuming colonial or paternalistic roles, viewing all interventions and expectations through the lens of a White, educated, middle-class person/researcher) after having read this article.

[SarahLyon]

Thank you SO MUCH, @lauren4, for sharing your initial takeaways! I’m eager to see what concrete strategies you are thinking about.

I’ve been trying to imagine what it would like like for OT to be more active in building healthy communities and dismantling our current unjust systems that lead to health inequities.

Below are some initial ideas that have been swirling around in my mind, and I will be curious to hear what other people have been imagining for the future of our profession and to grow and change as individuals…

• Providing OT services as part of first responder services, as our skillset would add tools currently available to law enforcement and paramedics, hopefully reducing emergency room visits

• Continue to expand our role in prevention, early intervention and primary care, as these are such cost-effective investments for the community and promote long term health

• Work more closely with colleagues from various disciplines such as social workers and public health officials to coordinate services when needed

• Mobilize as a profession at the state and national level not just for legislation directly related to OT, but also on policy changes that would promote health equity

• Improve our listening skills, and recognize when we are becoming defensive to views that are different from our own

• Take steps to promote more diverse perspectives our classrooms and workplaces.

• For OT Potential, I keep re-reading this article on diversifying online businesses, and thinking about how we can bring some new and different voices into leadership.

(Side note: @lauren4, I didn’t know you were working in MH now! I would love to catch up on the phone sometime!!)

[sanchala (Sanchala Sen)]

Sarah,

Thank you for such a timely article. Although the article is written from a white person’s perspective, it opens up discussion and dialogue. The author points that the knowledge of systemic ills such as racism and other forms of marginalization should supersede the knowledge of a person as an individual (L. Jones). For this to happen, I think that a dialogue needs to start at an individual level between persons.

Although this is not about me now, I would like to share my experience here (a brown person). As a person of Indian origin (person from India and not American Indian as most people here think), I am considered a “model minority”. I have had the privilege of a good education, a stable family, and good financial support. Though I have been in the US for over 20 years and have friends from all communities, I have always been surprised that very few have been curious to know about me- what my religious practices are, what festivals I celebrate, and things like that. Though we work and entertain at times together, we have very little knowledge of the other person’s life. Most people are just happy to be on a superficial level. This is the cause of most misunderstanding in my belief.

We need to be aware of our own implicit biases and refrain from stereotyping people. Much of it comes from ignorance and so educating ourselves about others and genuinely seeking information will go a long way in bridging this gap. I have not seen blatant racism but have seen it in experiences for myself and others. During a diversity workshop I attended years ago, we were asked to write anonymously our impressions of a “black female, white female and a Hispanic female”. I was aghast to see the derogatory remarks written about black and Hispanic females in our society. I was surprised to see that the people I worked with were very sweet to each other on their faces but harbored such negative thoughts about other races without really knowing them.

Recognizing and acknowledging racism will go a long way in trying to eradicate it. I have been trying to educate myself by talking to my black friends, watching documentaries, seeking resources, and learning the history of my adopted country. With my students, I have opened up a dialogue and encouraged them to talk of their fears and provided support. Being willing to listen and ask questions is the first step, I think in creating an equitable world. More needs to be done at all levels. People in power have the responsibility of starting this conversation and listening to the folks working for them. Only then a change will come.
For myself, I will continue to listen and reflect on my own biases and try to improve as a person and a professional.

[SarahLyon]

Hi @sanchala , I always feel like I learn so much from you, and was especially glad to read your thoughts on this pressing and personal topic.

I was really struck by your observation about a lack of curiosity and eagerness to learn more about you. It reminded me of a quote from Austin Channing Brown that Brene Brown mentioned on her podcast this past week. It really struck home for me:

“When you believe niceness disproves the presence of racism, it’s easy to start believing bigotry is rare, and that the label racist should be applied only to mean-spirited, intentional acts of discrimination…. Your politeness will not save you from the dehumanization white supremacy reeks on yourself and on the world. Niceness is yet to save us from the distortions of racism—and it won’t. Niceness will never be enough”

I know that erring on the side of superficiality and niceness is something that I am definitely guilty of. I even think of my interactions with you, when I could have taken more time to understand your connection to India. I’m sorry for missing that opportunity.

I also wanted to let you know I’ve been working a blog post about OT and racial injustice, and your thoughts have definitely informed me as I’m writing it, especially about the importance of doing self-work to confront our own biases.

Thank you so much for being part of this community!

[lauren4 (Lauren Jones)]

@Sanchala - I noted your feedback on my feedback on the author’s comments about knowledge of systemic ills and its impact on the clinician’s interactions with individual clients (That’s a real mouthful!) To clarify, I recognize that the author’s overarching point is that systemic ills like racism are inherently part of a minority client’s background and are relevant to treatment. However, I would like to reaffirm my point that the knowledge of systemic issues should NOT supersede the consideration and treatment of each client’s individual experience and circumstances.

For example, the author refers to the way in which clinicians were “blinded” by their focus on health conditions and issues that were direct results of systems-level factors, specifically racism, marginalization, and discrimination against Canadian First Nation peoples:

Thus, an important contribution of taking up a critical perspective is that it sharpens our attention to the politics and impact of our professional discourses on the individuals we are describing and aiming to serve. This is exemplified in health care providers’ dialogues in relation to Indigenous peoples in Canada as they are frequently instilled with negative assumptions and judgements that equate being Indigenous with poverty, substance abuse, and dependency. Such assumptions are a serious deterrent in Indigenous peoples’ accessing health care and contribute toward the high prevalence of health inequities in this population (Browne, Smye, et al., 2011). Similarly, the highly racialized and decontextualized prevailing discourse on foetal alcohol syndrome disorder in relation to Indigenous children has led to the ‘‘blaming and shaming’’ of Indigenous mothers and is a significant deterrent in accessing support and intervention for their children (Salmon, 2007).

I understood the author to be highlighting the dangers of healthcare providers focusing TOO closely on systemic issues or assuming that all Indigenous individuals were predisposed to experience negative health outcomes rather than considering each individual’s unique circumstances, contexts, and occupational performance in addition to systemic ills.

P.S. - @sanchala, I believe we’ve met before at NCOTA conferences! What a small world!!

[lauren4 (Lauren Jones)]

On the topic of learning about others’ experiences, especially for people who are White or part of another majority culture, COTAD is hosting the IGNITE series with panels, education, and listening sessions addressing issues of race, self-awareness, and the OT practitioners’ role in addressing and dismantling systemic racism to achieve occupational justice for all.

Our first session last Saturday had over 325 attendees from across the country, and it was a time for COTAD leaders and supporters to check in with one another, offer support and a listening ear, and educate attendees about the dire circumstances the Black community has been and is currently facing if significant changes are not made to our political, healthcare, and economic systems.

Further, the session included feedback from students, faculty members, OT practitioners, and pre-OT students from diverse backgrounds discussing their experiences with racism and anti-racism within our profession. Some of their comments were encouraging, and many were chilling – especially those referencing the response (or lack thereof) from OT educators and educational systems.

As I’ve noticed that several people in this week’s group are educators (and if you’re not a “formal” educator, you are ALWAYS in the role of self-educator!), I would also like to recommend the viewing and analysis of the Black Lives Matter (BLM) Syllabus designed by Frank Leon Roberts for yourself, colleagues, and students. It provides a well-organized, curated collection of publications, films, poems, and other works that explain the power, purpose, and plans of the Black Lives Matter movement. Although teaching the course in its entirety is unlikely to be taught as part of an OT program, it is an excellent resource.

Here are a few ways I envision components of the syllabus being used as part of an OT education program:

• Political Activism & Advocacy: Discussing the impact of grassroots community organizing, disruptive protest, and its efficacy (or lack of efficacy) for issues in the Black community or other marginalized communities; protesting and political advocacy as an occupation
• Social Determinants of Health: Watching films and reading literature explaining how systemic racism has impacted the safety, health, and wellbeing of Black people. (Netflix has now added an entire category of films related to understanding the realities of Black history by Black artists and filmmakers.) As others have stated, 13th is a good place to start. Ava Duvernay’s new website Array 101 also will offer “free learning guides for students to accompany TV and film productions.” Naturally, every film and resource will have bias, but DuVernay has been widely recognized for her talent in capturing the darkness, complexities and human cost of systemic racism on Black lives in the past and present.
• Occupational Engagement: Consideration of the differences and similarities between the occupational engagement of Black, Brown, and White people in the United States (or abroad) and the causes and impact of these differences
• Mental Health: Education about racial trauma and its impact on physical, psychological, and emotional wellbeing of Black people and the resulting impact on occupational performance
• Clinical Skills: Utilizing assessments to determine the impact of racial trauma or discrimination-related stress on patients and develop relevant plans of care
• Critical Reflexivity & Therapeutic Use of Self: Conducting self-assessments of implicit biases using the IAT or other tools and discussing outcomes and the actual/potential impact on therapeutic interventions
• Professional Development: Comparison of the marginalization of Black people throughout U.S. history to their marginalization or silencing within the state and national governing bodies for OT

What resources do you currently use for educating students or peers about issues of systemic racism, discrimination, and bias as it relates to occupational therapy service provision? What has your experience been like with teaching or discussing these topics?

Note: If you are interested in attending future sessions of the IGNITE series, you can register at the COTAD website. You can also share any ideas you have for future sessions, as we want our events to be responsive to the needs of the OT community.

[jillian (Jillian Clancy)]

I am speaking from a position of privilege.

I will continue to advocate with legislators, peers, and build towards a better occupational therapy profession as well as global community overall. And to make sure that all practitioners and persons are treated equally.

Models of trauma, including the newer SAFE PLACE model are great for assessing and treating clients with a history of trauma. I will read the links supplied on racial trauma- and will also read about historical trauma.

When searching for occupational-therapy evidence on inequity in relation to access to practice for POC, I found nothing. I did not find any models that even began to discuss disparity, inequality and lack of equity for healthcare. Any articles that provided statistical information in relation to occupational therapy, inclusion, and attention to marginalized populations, were expensive and inaccessible. As a profession that assesses, treats in, and approves access to a variety of contexts, it is disinheartening, disappointing, and NOT okay that there is not more information on this topic. I am hopeful that this discussion and specifically the information provided above can help us to evolve, grow, and decrease disparity in healthcare access.

I think it is also important to discuss that marginalized communities are often subject to toxic environments due to pollution from large corporations as well. It is important to make sure that our clients have access to positive social determinants of health.

[rebecca12 (Rebecca Evans)]

Thank you for this article and the opportunity to discuss this topic. I started to look at health inequity research recently and was frustrated by the lack of call to action that the research offers.

The first call to action for this article is an essential first step in the process of addressing systematic health inequities. When I was younger, I assumed that everyone had the same advantages as me. Then I went to college and met people from different backgrounds and learned about the many -isms that are built into our society. These -isms were largely invisible to me because I am part of the advantaged group in most cases (I am white, middle class, straight, cis, able bodied, and female). But once exposed, I could see that these systems have a huge amount of power in shaping our lives and our health by influencing the distribution of wealth and income, where people live, and social and educational opportunities available. Once I realized how much power systems have in our lives, I saw that my good health was not so much attributed to me making the right choices in diet and lifestyle, but built upon all the advantages that I had since birth. This realization is the first step that individual OT practitioners have to take because you can’t address a problem that you cannot see. (I realize that I learned about systemic racism later in life than minorities and that many minority practitioners would have grown up with this knowledge. That’s why the push for diversifying the workforce is so important.)

David Williams’s research has been very helpful to me in learning to what extend race and racism impact health. I listened to his recent interview (“Why the coronavirus is so deadly for black America”, The Ezra Klein Show, 5/10/2020, https://podcasts.apple.com/us/podcast/why-the-coronavirus-is-so-deadly-for-black-america/id1081584611?i=1000474196638) where he discusses how the racial disparities in COVID19 patients reflects the racial inequalities in health in general. I highly recommend it if you have time. If you don’t have much time, I recommend his TED Talk for 2016 (https://www.ted.com/talks/david_r_williams_how_racism_makes_us_sick/transcript?language=en). It is much shorter but less thorough and older.

David Williams co-authored a 2019 article “Reducing Racial Inequities in Health: Using What We Already Know to Take Action” that is the most helpful article that I found in defining actionable steps to addressing racial inequalities. He lists three categories of action: 1. Creating communities of opportunity through early childhood development, work/income/and housing supports, 2. Changing the healthcare system to increase access to healthcare, increasing preventative care, addressing social needs as part of health care, and diversifying the workforce and 3. Increasing political action to address racism at a state and national level. After learning how incredibly powerful racism is in undermining health, it was nice to find an article that presented workable solutions. I think OTs can contribute to these steps in many ways that @SarahLyon already listed:

-Expanding OT role in preventative care. I work in home health care and often feel that I am a part of the primary care team as I communicate with primary care physicians so often. It would be great if OT were a more formalized role in primary care to help with managing chronic conditions and health maintenance instead of OT getting involved after there is an exacerbation or hospitalization. OTs working as case care managers is a possibility to implement this.
-OTs advocating and participating in early childhood development programs to invest in health and development from the start
-OTs collaborating with social workers to connect patients with community resources to address housing or food insecurity, financial assistance and social support. Our system is not easy to navigate so I view part of OTs role as helping our patient navigate this system to get the help that they need and is available, but not easy to access (Medicaid and disability applications, food stamps, obtaining DME through insurance, contacting landlords to increase compliance with ADA standards). I think OTs should also be advocating for making these processes more streamlined to get patient the supports they need in a more timely fashion.
-OTs advocating for political changes. For elections, individual practitioners can research candidates through a public health lens to determine if candidates are receptive to the kinds of change and investment in public health that addressing health inequalities requires. They can participate in public meetings on health, education and neighborhood development to promote measures that would reduce inequality. OT associations both at the state and national level can advocate for policies that would address systematic inequality. I am excited to learn about COTAD, as I was unaware of this organization before this week.

I think that OTs can play a large role in reforming health care to address the inequalities that structural racism and other -isms create, but I worry that many OT practitioners do not have the awareness of the problem or the interest in participating in the larger political advocacy work that addressing the problem would require. The lack of comments for this article is discouraging, but maybe I am being pessimistic. @lauren4 did say COTAD had a good amount of participation for the IGNITE series. I think a key to collective action by the OT profession will be viewing racial inequities in health as a problem that all practitioners should be addressing and not just a problem for minorities.

[SarahLyon]

Wow, @rebecca12 the research article that you shared (Reducing Racial Inequities in Health: Using What We Already Know to Take Action) is AMAZING! I skimmed through it online, but definitely will have to print it off to spend more time with it. Honestly, I wish that I had known about it so we could have covered it this week! But, I have already worked in a mention of it in next week’s review

I definitely hear what you are saying about wishing more people would chime in on this incredibly important topic, but I’m also hopeful that we can play our own small role in helping to tip the scales towards justice. I’ve been thinking about this quote a lot this week:

Never doubt that a small group of thoughtful, committed citizens can change the world: indeed, it’s the only thing that ever has.
— Margaret Mead

[sridevi (Sridevi Surampudi)]

I felt EXACTLY as you did. I too saw 13th only last week and it was quite an eye opener.
Although I am an immigrant minority I too mostly experienced privilege rather than discrimination. And the few times I perhaps did experience it, I felt it was more of a personal attack than racial because I was always very confident and transparent in all that I did professionally and personally. My work was usually appreciated and I was very willing and happy to learn what I did not know. Perhaps I was too naive to have even recognized racial undertones.
I have lived and worked in this country for many years now and have always longed to have a ‘black’ therapist to work with and befriend. I have interacted with some black traveling therapists and aides very sporadically. And loved them, their work and their humor. I have worked in several diff states.
Now I know the reason-just not enough opportunities and inclusion at every level of their lives perhaps ?? My brain is just beginning to process all this. And much awareness has creeped in.
Thanks to all

[sridevi (Sridevi Surampudi)]

Agree with all that you stated in your post. Thank you

[sridevi (Sridevi Surampudi)]

Very happy to know you Lauren

[SarahLyon]

@jillian (and anyone who wants to dig deeper into issues of race and OT) I just read this article that was shared by COTAD, about occupational consciousness. The author is from South Africa and shared gems like this:

Occupational consciousness is thus concerned with how the things people do every day, individually and collectively, sustain systems and structures that support and promote certain occupations or certain ways of doing, to the exclusion of others. It is also about uncovering the trappings of human occupation that perpetuate these systems and structures.

Also, I’ve been wanting to watch 13th for a long time now, and this group has really convinced me I need to get it watched this week!!

[jillian (Jillian Clancy)]

Thank you Sarah!! I am excited to take a look and learn a lot more on the COTAD website. Just got my boss to put this on our resources page!