There is strong global action towards improving diversity and inclusion in order to provide equitable healthcare for all people1. Providing the “highest attainable standard of health” is recognised as “a fundamental right of every human being”2, 3. WCPT recognises and supports the international declarations and work programmes of the United Nations and World Health Organization in support of diversity and inclusion4-10. Recognising and including different experiences, opinions, skills, and abilities enriches individuals and organisations11, 12.
Diversity encompasses ability, age, culture, ethnicity, gender, indigeneity, race, religion, sexual orientation, socio-economic status, and other factors such as, educational background, health status, occupation and personality traits. The outcomes of most discussions on diversity and inclusion, agree that improving them requires meaningful and ongoing involvement of people who have received systematic discrimination and marginalisation. Further, inclusion involves positive action towards reducing inherent biases and assumptions that influence the way people behave and interpret situations. Increasing diversity and inclusion ultimately works towards ensuring equity.
WCPT is committed to diversity and inclusion in its activities and recognises these are areas where further progress is needed more broadly in the profession, and society as a whole not just in healthcare, to foster greater equity for all people.13-16 WCPT promotes strategies to increase diversity, inclusion and equity across physical therapy including in policy, education, professional and employment practices, and research. Further, as an organisation WCPT is committed to ensuring a diverse and inclusive workplace for its employees.
In a physical therapy context, those developing standards of education and practice need to actively engage people from underrepresented communities in order to ensure diversity within the profession, and to provide a foundation for an inclusive environment. Physical therapists should be equipped to embrace diversity in any interactions they have with others. Understanding how social inequality, advantage and disadvantage operate, their consequences and how to address these issues17 are ethical responsibilities18, 19 of physical therapists and physical therapy organisations. Lack of inclusive policies can makes clinical services inaccessible for some people and the profession may not be inclusive in terms of educating and supporting employment for those from minority groups.
WCPT recognises that contextual variations and significant co-existing diversity considerations significantly contribute to the complexity of implementing diversity and inclusion strategies. There is the potential for unintended consequences with well-meaning implementation of policies when such complexities are not recognised.20, 21 Contextual variations can include, for example, different national legislations that affect legal and social practices, cultural norms and socio-economic factors. Different groups of people receive discrimination in different circumstances, and the same groups can be discriminated against differently. There are considerable individual variations within particular ‘groups’ and some people are discriminated against for two or more factors, such as gender, ethnicity and age.22. As a result, policies promoting inclusion need to be relevant to the specific needs of the communities they serve, while being agile enough to account for individual differences and future changes.
WCPT recommends that member organisations:
Across all areas
- foster environments which actively encourage the elimination of discrimination by developing, implementing, promoting/endorsing, evaluating and monitoring inclusive policies, procedures, standards of practice, and codes of conduct
- develop local diversity and inclusion policies and action plans in all physical therapy settings including clinical, governance, management, research and education
- develop diversity and inclusion resources specific to the physical therapy profession
- positively influence perceptions and good practice within the profession, and in how physical therapists interact with all individuals: patients, clients, populations, other health and social care professionals, and each other
- encourage ongoing reflection about the assumptions and norms within the physical therapy profession, including considering ways in which the profession (intentionally or unintentionally) may discriminate against, marginalise and/or exclude certain people or groups of people
- create leadership roles within associations to promote diversity and inclusion practices in the profession
- involve people whose views have previously been marginalised to ensure diversity issues are recognised and addressed
- include people from relevant diverse backgrounds in governance activities and when developing policy
Amongst physical therapists (e.g. in professional bodies, education settings, workplaces)
- encourage employment of people from diverse backgrounds and lived experiences across all facets of the profession, particularly in middle to senior positions to ensure appropriate leadership and sustainable change
- build capacity by accessing diversity and inclusion training provided by dedicated organisations experienced in delivering training to health and social service contexts
- support research that considers elements of diversity, inclusion and equity in physical therapy contexts, and include members of marginalised groups within the research teams
For patients/service delivery
- work towards equity of access to high quality physical therapy services for groups who are at risk of discrimination 18, 23, and recognise that at times there may need to be extra efforts for these groups24, as they have often not had equitable access to services
- build capacity, confidence and competence for physical therapists to deliver equitable care to diverse populations by developing strong knowledge, reflective practice skills and communication strategies in physical therapist entry-level and continuing professional education programmes
Broader advocacy and social change
- address broader social determinants of health by advocating for social and political change towards greater equity in society in general, including those from minority groups in these initiatives
- work with other organisations and institutions to promote and implement positive diversity and inclusion policies, procedures, and standards of practice
- consider how physical therapists (as individuals or organisations) can engage with external institutional and government stakeholders in order to facilitate the development of initiatives, policies, and legislation that are reflective of good practice in diversity and inclusion
Glossary of terms
Diversity: Diversity means having people with different characteristics in a given setting. Characteristics include ability, age, culture, ethnicity, gender, indigeneity, race, religion, sexual orientation, socio-economic status, and other factors such as, educational background, health status, occupation and personality traits. Recognising and valuing diversity must be accompanied by concerted efforts to ensure inclusion of diverse populations, and that individuals are and feel valued, respected and supported.
Inclusion: Inclusion is about valuing diversity and providing equitable access and opportunity to all by removing discrimination and other barriers to involvement. Inclusive cultures enhance opportunities, access to resources, voice and respect for rights. They make people feel respected, welcomed and valued for who they are as an individual or group.
Equity: The principle of equity moves beyond that of equality (the same resources are distributed to everyone regardless of differences between them) to work towards parity of access to resources.28 Equity recognises differences between people, and that at times there may need to be extra efforts for some individuals or groups.24
- United Nations. Committee on Economic, Social and Cultural Rights. General Comment No. 20, Non-discrimination in economic, social and cultural rights. New York, USA: United Nations; 2009. http://www.refworld.org/docid/4a60961f2.html (7th August 2018)
- Organisation WH. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: Commission on Social Determinants of Health; 2008.
- Wilkinson R, Marmot M. Social determinants of health. The solid facts. Copenhagen: World Health Organisation. Geneva, Switzerland: World Health Organization; 2003. http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf (7th August 2018)
- UNESCO. Declaration on Race and Racial Prejudice. Paris, France: UNESCO; 1978. http://portal.unesco.org/en/ev.php-URL_ID=13161&URL_DO=DO_TOPIC&URL_SECTION=201.html (7th August 2018)
- UNESCO. Universal Declaration on Cultural Diversity. Paris, France: UNESCO; 2001. http://portal.unesco.org/en/ev.php-URL_ID=13179&URL_DO=DO_TOPIC&URL_SECTION=201.html (7th August 2018)
- United Nations. Declaration on the Elimination of All Forms of Intolerance and of Discrimination Based on Religion or Belief. Geneva, Switzerland: United Nations; 1981. http://www.un.org/documents/ga/res/36/a36r055.htm (7th August 2018)
- United Nations. Declaration on the Rights of Indigenous Peoples. New York, USA: United Nations; 2007. http://www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf (7th August 2018)
- United Nations. Transforming our World: The 2030 Agenda for Sustainable Development. New York, USA: United Nations; 2015. https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf (7th August 2018)
- United Nations Human Rights Office of the High Commissioner. Declaration on the Rights of Persons Belonging to National or Ethnic, Religious and Linguistic Minorities. New York, USA: United Nations; 1992. https://www.ohchr.org/en/professionalinterest/pages/minorities.aspx (7th August 2018)
- World Health Organisation. Gender, equity and human rights.: World Health Organization; 2018 [Available from: http://www.who.int/gender-equity-rights/understanding/equity-definition/en/.
- Cox T. Cultural diversity in organizations: Theory, research and practice. San Fransisco, USA: Berrett-Koehler Publishers; 1994.
- Thomas D, Ely R. Making differences matter: A new paradigm. Harvard Business Review. 1996;September-October:1-13.
- Wojciechowski M. Who are tomorrow's PTs and PTAs? . PT InMotion. 2018;10(5):30-41.
- Andrion J. IEPT: Imagining an encompassing physiotherapy. Physiotherapy Practice (Canada) - Diversity in Practice Issue. 2017;7(2).
- Harman K. On considering your role in creating a safe environment for trans populations in physiotherapy. Physiotherapy Practice (Canada) - Diversity in Practice Issue. 2017;7(2).
- Setchell J. What has stigma got to do with physiotherapy? Physiotherapy Canada. 2017;69(1):1-4.
- Thompson N. Anti-discriminatory practice: Equality, diversity and social justice. 6th ed. London, UK.: Palgrave; 2016.
- World Confederation for Physical Therapy. Ethical Principles. London, UK: WCPT; 2017. www.wcpt.org/ethical-principles (Access date 10th March 2017)
- World Confederation for Physical Therapy. Policy statement: Ethical responsibilities of physical therapists and WCPT members. London, UK: WCPT; 2017. www.wcpt.org/policy/ps-ethical-responsibilities (Access date 10th March 2017)
- Goodman NR. Taking diversity and inclusion initiatives global. Industrial and Commercial Training. 2013;45(3):180-3.
- Teachman G. Interrogating inclusion: Critical research with disabled youth who use augmentative and alternative communication: University of Toronto; 2016.
- Jones J, Dovidio J. Change, challenge, and prospects for a diversity paradigm in social psychology. Social Issues and Policy Review. 2018;12(1):7-56.
- World Confederation for Physical Therapy. Policy statement: Standards of physical therapist practice. London, UK: WCPT; 2017. www.wcpt.org/policy/ps-standards (Access date 10th March 2017)
- Goddard M. Quality in and equality of access to healthcare services in England. Centre for Health Economics, University of York, UK; 2008. https://ehma.org/wp-content/uploads/2016/08/healthquest_england_en.pdf (7th August 2018)
- World Confederation for Physical Therapy. Policy statement: Standards of physical therapist practice. www.wcpt.org/policy/ps-standards. London, UK; 2017.
- World Confederation for Physical Therapy. Ethical Principles. http://www.wcpt.org/ethical-principles. London, UK; 2017. Access date 10th March 2017
- Link B, Phelan J. Conceptualizing stigma. Annual Review Sociology. 2001;27:363-85.
- World Health Organisation. Gender, equity and human rights. http://www.who.int/gender-equity-rights/understanding/equity-definition/en/