equality and diversity eric bater intending trainers ‘ course phase 4i 26 th september 2012
TRANSCRIPT
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EQUALITY AND DIVERSITY
Eric Bater
Intending Trainers ‘ course Phase 4i 26th September 2012
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Why are we doing this?
Equality and diversity is a section of the GP curriculumRelevant to clinical care, relationships with patients, working with colleaguesAnd to you as an individual and society as a wholeAnd it makes routine everyday work more interesting
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Aims of the session
By the end of the session to have developed an understanding of:-• What equality and diversity are• The legal framework• The influences of culture• Models of disability• Some applications in our professional
setting
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Equality
• Equality is the principle by which all persons or things under consideration are treated in the same way
• It is about creating a fairer society in which everyone has the opportunity to fulfil their potential
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Diversity
All of the characteristics that make individuals different from each. A term used to describe the relative uniqueness of the individual in the population- including characteristics or factors such as personality, work style, religion, race, ethnicity, gender or sexual orientation, having a disability, socioeconomic level, educational attainment, and general work experience.
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Not uniformity
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Not conformity
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But diversity
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‘This is me’
• Where do you live?• What is your job?• What clothes do
you wear/• What sort of car do
you drive?• What hair style
have you got?
• What do you do in your spare time?
• What newspaper do you read?
• Where do you go on holiday?
• What sort of food do you eat?
• What sort of music do you listen to?
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Part 1
Equality
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1. A CONCEPT• Equal opportunities and valuing
diversity are not the same thing.• Equal ops = law, difference, isolates
groups• Valuing diversity = maximising
strengths, complementing each other, inclusiveness
• Paradoxically, both are important
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2. A TRUISM
• We all have prejudices• “That which you acknowledge you
can control; that which you do not acknowledge controls you”
de Mello, Awareness
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Some definitions
• Stereotype• Prejudice • Discrimination
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Definition of ‘stereotyping’
Ascribing a general
characteristic of a group to
everyone irrespective of the
individual’s characteristics
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What is prejudice?
• To make a judgement without having the facts
• Having a negative attitude towards another based solely on membership of a group
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Jackanory
• A man and his son were out driving one afternoon and were involved in a serious car crash. The father was killed at the scene, but the son survived and was rushed to hospital and prepared for surgery for his life threatening injuries.
• As the son was wheeled from the anaesthetic room the surgeon walked out of the theatre exclaiming “I can’t operate on this man, he is my son”
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What is discrimination?
‘less favourable treatment on the grounds of sex, race, disability, sexual orientation and religion or belief’
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The Equality Act (October 2010)
• Protected characteristics• Seven types of
discrimination
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• Protected characteristics:-1. Disability (including mental health and
obesity)2. Race3. Religion or belief4. Sexual orientation5. Gender reassignment6. Marriage and civil partnership7. Pregnancy & maternity8. Age
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7 Types of discrimination
1. Direct2. Associative3. Indirect4. Harassment5. Harassment by a third party6. Victimisation7. Discrimination by perception
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Discrimination –receiving less favourable treatment’
• Burden of proof is on employer to prove that discrimination did not occur
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1) Direct discrimination
• Discrimination because of a protected characteristic
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2) Associative discrimination
• Direct discrimination against someone because they are associated with another person with a protected characteristic (including carers of disabled people and elderly relatives)
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3) Indirect discrimination
• Where a rule or policy applies to everyone, but disadvantages a person with a protected characteristic, and is not justified by the requirements of the job (e.g possession of a UK degree)
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4) Harassment
• Behaviour deemed offensive by the recipient .
• (Employees can claim they find something offensive even when it is not directed at them)
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Harassment
• ‘engaging in unwanted conduct which has the purpose or effect of violating another person’s dignity, or is creating an intimidating, hostile, degrading, humiliating or offensive environment…… having regard to all the circumstances, including, in particular, the perception of the victim’
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5) Harassment by a third party
• Employers are potentially liable for the harassment of staff or customers by people they do not employ
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Bullying
• ‘ a particular form of harassment involving a misuse of power to criticise, condemn, abuse , humiliate or otherwise undermine a person (or group’s) ability to the extent that they cannot perform their job properly of suffer stress as a result’
(TUC definition)
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6) Victimisation
• Discrimination against someone because they made or supported a complaint under Equality Act legislation
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7) Discrimination by perception
• When someone thinks a person has a particular protected characteristic, even if they do not. (e.g. rejecting a job application from a women with an African sounding name, whom an employer infers must be black even though she is white).
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‘Unwitting’ or ‘Institutional’ discrimination(The McPherson Report into Steven Lawrence Inquiry)
• ‘the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin.
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Equality Act 2010 definition of ‘disability’
• ‘a person who has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities’ (i.e. longer than 12 months)
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DDA Act 1995. Part III October 2004
• ‘Service providers should make reasonable adjustments to remove physical barriers ‘ (e.g steps, stairways, entrances and exits)
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DDA :-at least one of the following affected
• Mobility• Manual dexterity• Physical co-ordination• Continence• Ability to lift, carry or move objects• Speech, hearing or eyesight• Memory, ability to concentrate, learn or
understand• Understanding of the risk of physical danger
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Defining disability
Examples of disabilities:-• Physical impairments (ME)• Sensory impairments (visual/hearing)• Medical conditions (Cancer,
HIV/AIDS)• Mental Health conditions
(Depression/schizophrenia)• Learning difficulties (Dyslexia)
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Examples of ‘reasonable adjustments’
• Equipment • Policies• Buildings • Procedures
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Positive discrimination
• Choosing to hire a candidate from an under-represented group, providing they are as qualified for the role as other candidates.
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3 situations of allowable discrimination
• For reasons of modesty • For reasons of authenticity• Genuine occupational requirement
(the service being best provided by a person from that group)
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Human Rights Act 1998
• Right to life• Right to a fair trial• No punishment without law• Right to respect for private and family life• Freedom of thought, conscience and
religion• Right to marry• Right to education
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Other relevant laws
• Rehabilitation of offenders act (1974)• Human Rights Act 1998• EU Part-time work directive 2002• Flexible Working Regulations 2002.
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Responsibility
• NHS is one organisation• Deliberate discrimination illegal• Accidental organisational
discrimination illegal• Onus of proof is on us, not claimant• Therefore keep records
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What is new or coming?
• NHS Litigation Authority standards• DH recruitment guidance• Care Quality Commission standard
7e• DH Human Rights in Healthcare• Northeast SHA Single Equality
Scheme
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Your new GPR turns up for work on their first day, having arrived by bus. “Didn’t you know I have epilepsy, so
can’t drive at the moment?” she asks.
What are your options?
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A patient at your practice is seeking to make an appointment. When offered an
consultation with your Irish GPR he comments “No, I don’t want to see no
‘Mick’”. The GPR is within earshot.
How would you handle the situation?
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Having seen your Nigerian GPR walk through the waiting room, a patient comments to another patient ‘you don’t see many chocolate Niggers
round these parts do you?’
What should you do?
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Your GPR informs you they suffer from migraine which is provoked by sleep
deprivation. They request that they not be allocated any night OOH shifts
during their attachment.
How would you respond?
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‘For religious reasons I won’t be free to work on Friday afternoons’ your
GPR tells you.
Is this an acceptable request?
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You are a partner working in a practice with a large Bangladeshi population. You wish to
employ a new nurse, primarily to work with the Bangladeshi girls and young women. Both your existing nurses are elderly. You would ideally like a young nurse who is
bilingual, and who is not likely to go off on maternity leave.
Compose a job advert.
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At a practice party one evening you overhear a member of your employed
staff making racist remarks about another member of your staff. The other person ignores the remark.
What should you do?
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Part 2
Diversity and Culture
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Diversity
• The recognition and valuing of difference between people
• Creating a working culture and practices that recognise, respect, value and harness difference for the benefit of the organisation and individual patients.
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Dimensions of Diversity
• Gender• Age/generation• Ethnicity• Nationality• Language/dialect• Skin colour• Religion• Class (wealth, family
background, education)
• Region(N/S, urban/rural)
• Country/region of origin• Country/region of
residence• Educational level• Occupation• Sexual orientation• Political orientation• Disability• Culture (beliefs,
expectations, behaviours)
• Subculture
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Ethnicity
• Identification with a social group on grounds of culture, common origin, and shared history
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Genetic inheritance (‘Race’?)
Geographical origin
NationalityHistory/
Migration
Language
Culture
ReligionEthnicity
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Percentage of local population from Asian and Black groups
0.28 0.07
3.42
0.62
4.37
2.19
00.5
11.5
22.5
33.5
44.5
5
Asian Black%
CarlisleNorth westEngland and Wales
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Ethnic Population in Cumbria
• Ethnic Population 0.7% (8.7% UK)• Even spread across county (no concentration
in one area)• Immigration significant - especially from Poland• Tourist sector in lakes, seafood industry main
factor• No stats available on health inequalities in
Black and Minority Ethnic Groups - stats too small!
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A definition of ‘culture’
The sum of one’s beliefs, rituals,
customs and practices that guide thinking, decisions and actions in a patterned way. They are learned throughout a lifetime, and passed on through generations.
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Culture
• Complex social phenomenon• Shared beliefs, values and attitudes
that guide behaviour of members• Dynamic concept - keeps changing• We are all multicultural, but often
don’t recognise it
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This is me
What 10 features would best
describe you to someone
you had never met?
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“Iceberg model” Kreps and Kunimoto (1994)
GenderAge
EthnicityLanguage
Skin colour
Socio-economic statusOccupation
Sexual orientationPolitical ideology
Disability and healthCultural beliefs, expectations
Sea level
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Your cultural identity
• Which cultural groups would others say you belong to (top of iceberg)?
• Which other cultural groups do you feel you belong to (bottom of iceberg)?
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Question 1
Is it reasonable to take time off work to look after a sick child. If so, who should do it?
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Question 2
Should families look after their own elderly members, or is it OK to put them in a residential home?
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Question 3
Would it be OK for a GP to go to work wearing jeans and trainers?
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Cultural acceptance
Culturalknowledge
Well meaning blunders
Bigotry
Cultural competence
Tendency to stereotype
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Introducing Geert Hofstede
A survey of over 100,000 employees of IBM in forty different countries (1980) looking at different cultural dimensions
Five cultural dimensions which chart the general characteristics of a society (though not necessarily each individual member of that society)
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Areas in which cultures differ(Hofstede 1991)
• Power and distance • Individualism v Collectivism • Masculinity v Femininity• Uncertainty avoidance• Long-term v short-term
orientation / Confucian work dynamism
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1) Power and distance
The extent to which less
powerful members of a culture expect and accept unequal power distribution
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2) Collectivism v individualism
People integrated into a cohesive group that provides protection, or everyone looking after themselves?
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3) Femininity v masculinity
In masculine cultures traditional
distinctions between the gender roles are maintained. In Feminine cultures the distinctions are blurred.
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4) Uncertainty avoidance
Differences in the avoidance
of uncertainty or unknown matters, tolerance of ambiguity.
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5) Long-term v short-term time orientation / Confucian work dynamism
Perseverance Persistence Observing status
distinctions (older people having more authority)
Valuing thrift, frugality
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Cultural dimensions
• Universalist vs particularist (values vs relationships) (UK/Arab countries)
• Individualist vs communitarian (individual vs group) (UK/Germany)
• Neutral vs affective (range of expressed emotion) (UK/Italy)
• Specific vs diffuse (range of involvement) (UK/Asian countries)
• Ascription vs achievement (how status accorded) (Asian countries/UK)
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Universalist (UK) / Particularist (Arab, Indian subcontinent) e.g. recruitmentUniversalist• Rules more
important than relationships
• A deal is a deal• Fairness is
treating everyone the same
• Consistency is valued
Particularist• Relationships more
important than rules
• Relationships evolve
• So deals can be modified
• Treating cases on special merits is valued
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Neutral (UK) / affective (Italy) e.g. communication styles
Neutral• Don’t show feelings• Little physical
contact, strong facial expressions and gestures
• Coolness admired• Subconscious
verbal/paraverbal signals important
Affective• Reveal thoughts and
feelings• Touching and use of
large gestures is common
• Speak passionately• Heated, animated
expression admired
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Specific (UK) / diffuse (Eastern countries) e.g. meetings
Specific• Direct and purposeful• Precise and
transparent• Do not mix business
with pleasure
Diffuse• Indirect, aim of
communication not obvious
• Tactful, maybe ambiguous or opaque
• Personal trust important
• Mix business with pleasure
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Achievement (UK) / ascription (Asian countries) e.g. respect for teachers and doctors
Achievement• Respect for what
you do• Use of titles only
when relevant• Age and gender
(etc) don’t determine level of responsibility
• ‘What have you studied?’
Ascription• Respect for
position• Extensive use of
titles• Older males in
positions of responsibility
• ‘Where did you study?’
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‘Watching the English’
• Kate Fox
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What is prejudice?
To make a judgement without having the facts
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Be aware of System1 / System 2
• ‘Thinking Fast and Slow’• Daniel Kahneman
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Part 3
Disability
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Five factors which give you your sense of identity.
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Which aspects of your identity would you refuse to give up?
Which aspects do you feel could not be changed even if you developed impairments?
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What do we mean by ‘disability’?
• A physical or mental impairment which has a substantial and long term adverse effect on the ability to carry out normal day to day activities
• Disability Discrimination Act 1995
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• Blindness• Learning disability• Psychiatric illness• Paraplegia
Which do you feel least able to cope with? Which do you feel best able to cope with?
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The individual or medical model of disability
• Sees each disabled person as an individual bound up with their own condition or malfunction
• Impairments are seem as a problem• The individual must strive to ‘overcome the
impairment• The aim is to be/act as ‘normally’ as possible• Assumes every disabled person wishes to be ‘cured’• ‘Cures’ lie with doctors or therapists
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The social model of disability
• Disabled people are disabled by physical, organisational, attitudinal/behavioural barriers in society
• ‘Disability’ refers to the restrictions society causes, not to the impairments themselves
• The aim is a world fully accessible to all• If everyone is free to participate fully there
would be no ‘disabilities’
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WHO classification of Impairment, Disability and Handicap 1980
Disease (Pathology)
Impairment (Symptoms and signs)
Disability (Activities of daily living)
Handicap (social roles)
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An Odeon moment
www.celebratingthejourney.org/talk-videos.asp
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Ask the elephant
LancetKvalsvig A. 2003:362(9401): 2079-
2080
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