EQUALITY AND DIVERSITY

Eric Bater

Intending Trainers ‘ course Phase 4i 26th September 2012

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

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

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

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.

Not uniformity

Not conformity

But diversity

‘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?

Part 1

Equality

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

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

Some definitions

• Stereotype• Prejudice • Discrimination

Definition of ‘stereotyping’

Ascribing a general

characteristic of a group to

everyone irrespective of the

individual’s characteristics

What is prejudice?

• To make a judgement without having the facts

• Having a negative attitude towards another based solely on membership of a group

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”

What is discrimination?

‘less favourable treatment on the grounds of sex, race, disability, sexual orientation and religion or belief’

The Equality Act (October 2010)

• Protected characteristics• Seven types of

discrimination

• 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

7 Types of discrimination

1. Direct2. Associative3. Indirect4. Harassment5. Harassment by a third party6. Victimisation7. Discrimination by perception

Discrimination –receiving less favourable treatment’

• Burden of proof is on employer to prove that discrimination did not occur

1) Direct discrimination

• Discrimination because of a protected characteristic

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)

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)

4) Harassment

• Behaviour deemed offensive by the recipient .

• (Employees can claim they find something offensive even when it is not directed at them)

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’

5) Harassment by a third party

• Employers are potentially liable for the harassment of staff or customers by people they do not employ

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)

6) Victimisation

• Discrimination against someone because they made or supported a complaint under Equality Act legislation

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).

‘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.

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)

DDA Act 1995. Part III October 2004

• ‘Service providers should make reasonable adjustments to remove physical barriers ‘ (e.g steps, stairways, entrances and exits)

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

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)

Examples of ‘reasonable adjustments’

• Equipment • Policies• Buildings • Procedures

Positive discrimination

• Choosing to hire a candidate from an under-represented group, providing they are as qualified for the role as other candidates.

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)

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

Other relevant laws

• Rehabilitation of offenders act (1974)• Human Rights Act 1998• EU Part-time work directive 2002• Flexible Working Regulations 2002.

Responsibility

• NHS is one organisation• Deliberate discrimination illegal• Accidental organisational

discrimination illegal• Onus of proof is on us, not claimant• Therefore keep records

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

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?

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?

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?

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?

‘For religious reasons I won’t be free to work on Friday afternoons’ your

GPR tells you.

Is this an acceptable request?

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.

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?

Part 2

Diversity and Culture

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.

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

Ethnicity

• Identification with a social group on grounds of culture, common origin, and shared history

Genetic inheritance (‘Race’?)

Geographical origin

NationalityHistory/

Migration

Language

Culture

ReligionEthnicity

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

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!

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.

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

This is me

What 10 features would best

describe you to someone

you had never met?

“Iceberg model” Kreps and Kunimoto (1994)

GenderAge

EthnicityLanguage

Skin colour

Socio-economic statusOccupation

Sexual orientationPolitical ideology

Disability and healthCultural beliefs, expectations

Sea level

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)?

Question 1

Is it reasonable to take time off work to look after a sick child. If so, who should do it?

Question 2

Should families look after their own elderly members, or is it OK to put them in a residential home?

Question 3

Would it be OK for a GP to go to work wearing jeans and trainers?

Cultural acceptance

Culturalknowledge

Well meaning blunders

Bigotry

Cultural competence

Tendency to stereotype

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)

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

1) Power and distance

The extent to which less

powerful members of a culture expect and accept unequal power distribution

2) Collectivism v individualism

People integrated into a cohesive group that provides protection, or everyone looking after themselves?

3) Femininity v masculinity

In masculine cultures traditional

distinctions between the gender roles are maintained. In Feminine cultures the distinctions are blurred.

4) Uncertainty avoidance

Differences in the avoidance

of uncertainty or unknown matters, tolerance of ambiguity.

5) Long-term v short-term time orientation / Confucian work dynamism

Perseverance Persistence Observing status

distinctions (older people having more authority)

Valuing thrift, frugality

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)

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

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

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

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?’

‘Watching the English’

• Kate Fox

What is prejudice?

To make a judgement without having the facts

Be aware of System1 / System 2

• ‘Thinking Fast and Slow’• Daniel Kahneman

Part 3

Disability

Five factors which give you your sense of identity.

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?

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

• Blindness• Learning disability• Psychiatric illness• Paraplegia

Which do you feel least able to cope with? Which do you feel best able to cope with?

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

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’

WHO classification of Impairment, Disability and Handicap 1980

Disease (Pathology)

Impairment (Symptoms and signs)

Disability (Activities of daily living)

Handicap (social roles)

An Odeon moment

www.celebratingthejourney.org/talk-videos.asp

Ask the elephant

LancetKvalsvig A. 2003:362(9401): 2079-

2080