Health equity resources -- a starting point

“I’m doing a talk with a big group of physicians and I want to talk a bit about internalized misogyny, implicit bias and systemic racism. Do you have any suggestions for resources so I can incorporate into planning my talk?”

This was a request from a client last week, but I get this kind of question frequently. So I thought I’d capture a few useful resources on systemic inequity/ racism in health I’ve come across recently — while being clear that this is one tiny bit of a large and growing body of resources. (And locating myself as Not an Expert — just one White queer able-bodied settler on my own journey through reckoning with internalized racism, privilege and systemic bias).

One of the most current, concise and eye-opening recent papers is called Experiences of everyday racism in Toronto’s healthcare system: a concept mapping study (O’Campo, Lofters, Shankardass, Salmon and Muntaner, published in 2021). This study maps out some of the different ways that racialized health care users experience “everyday” racism — the subtle and not so subtle ways — and describes five types of experiences: racial/ethnic and class discrimination; dehumanizing the patient; negligent communication; professional misconduct and unequal access to health and health services. This is a must read for anyone trying to understand systemic inequity from a person-centred perspective.

Another important way to understand systemic racism is by looking at the health impact of implicit bias in our culture. There are a ton of exhaustive resources that demonstrate gaps in care and understanding because of gender and racial bias in research (i.e assuming that white men are “the norm” and extrapolating from there), biased models and assessment tools, the lack of race-based health data (see: Transforming race-based health research in Canada), colonization and systemic anti-Indigeneity, the health impact of the lifelong stress of navigating the world as a racialized person, and the multi-layered health inequities created through biased access to care or discriminatory treatment in the health system (among many, see: the summary of the 2020 Black Experiences in Healthcare Symposium, a 2015 systemic review and the recent Nature piece about reducing racial bias in clinical settings) .

Another lens to understand systemic inequity in healthcare is by looking at the clever ways that resistance to equity efforts shows up. Two papers I’ve found useful in coaching healthcare and academic healthcare leaders are: 1) “Gender-based disparities in medicine: a theoretical framework for understanding opposition to equity and equality” (Ruzycki et al, 2021), which uses a health behavioural impact framework to understand opposition to equity (in simple terms, if people don’t see a benefit for themselves, they don’t see the value); and 2) “I wanted more women in, but…’: Oblique Resistance to Gender Equality Initiatives” (Jones et all, 2021). The context for the last one is the British Labour Party, not healthcare, but the notion of oblique resistance (claiming agreement with the purpose but finding ways to reinforce dominant culture) is useful in many contexts.

If you have something useful to add to the list, pop it into the comments.

Don't stuff the balloons in the car -- making space to notice what’s here right now

“I just feel overwhelmed.”

This is one of the most common sentences I’m hearing from my clients — and from the people around me in general — right now.

No matter what you are dealing with, our emotional landscape is stuffed at this point in history. Confusing protocols and timelines for reopening workspaces, conflicting advice on social distancing, fear of risk, the overwhelming emotional experience of recognizing that centuries of structure oppression are cracking open, and that we have to work together to find new pathways. There was a sentence this morning in the Ask a Manager blog — one of my favourite workplace resources — that captured just how unprecedented this time is: “how do I participate in civil disobedience without getting fired during a pandemic?”

I’ve noticed how many people in my world are trying to meet deadlines, deal with all of the work stuff in front of us — as though these needs exist outside of our tender, emotional, human selves.

I was talking with a client about what this time feels like, and we came up with an unlikely metaphor: it feels like we’re trying to stuff too many balloons into a car and then drive. It seems doable, and balloons are light, and we feel pressure to just keep getting on with our lives, but stuffing those balloons in the car means they’re going to bob around and get into our faces and block our view. We can handle individual balloons — we know how to do our jobs, and how to parent, and how to be a friend, and how to be with our aging parents, and how to keep ourselves physically and mentally well. But we don’t know how to do all of those things at once, at home, in a seismic landscape. And some of those balloons that are edging in front of our faces? They hold pretty big truths we can’t keep ignoring.

We need room to make sense of those truths. We need to be open to responding to the fear and anxiety of people around us who have been told “stay home” and now are being told “come back to work,” when it feels like not that much has shifted in terms of risk. We need room to #dothework of changing centuries of structural and institutionalized racism, of the complex system of intersectional inequity. We all need room to participate in the rapidly unfolding changes in front of us. Those of us with leadership roles need to make space for the important conversations about diversity, anti-oppression, equity and inclusion, and to make changes in our own spheres. We all need room to be thoughtful about the parts of our jobs that matter the most right now as this phase of the pandemic unfolds, and to support each other through uncertainty and fear of risk. We all need room to let the thoughtful, listening, learning parts of ourselves emerge.

We can’t drive when things are blocking our view. We need to pause for a moment and pay attention to what’s right in front of us — not try to duck our heads around the balloons and keep driving in the direction we were going in.

Coaching vs. therapy?

“What’s the difference between coaching and therapy?”

This is one of the most common questions people ask me about coaching. And it’s not that easy to answer.

People come to coaches and therapists for some of the same reasons — they want to change something in their lives. Sometimes those are even some of the same things — dissatisfaction with relationships or work, a sense that there is something else out there that might make you happier, repeating patterns that aren’t getting you what you want, support for living with grief or health issues.

And the role of coaches and therapists isn’t really that different: we both create a non-judgemental, accepting space for you to explore the thing you want to change. We help you find new ways to think about or interpret the things that feel stuck. We provide a safe place to be with the things that are hard to talk about or feel. We encourage you to name and be comfortable with new feelings or ideas. We help unravel and clarify situations that feel tangled or overwhelming.

So what’s the difference?

From my vantage point — and I don’t speak for all coaches and I certainly don’t speak for all therapists — there are a few key differences.

One of the differences is the role of your past in the relationship. Both coaches and therapists encourage clients to identify how the patterns of their past are showing up now, and causing unhappiness or stuckness — but coaches are less likely to explore why a pattern exists, or the circumstances that caused it. This doesn’t mean you won’t talk about your parents or your childhood — one of my clients recently said “I had no idea how much your family of origin affects how you behave at work.” But the focus in coaching is more on how that pattern is showing up today, and how to look forward and start to move into the life you want to live. In other words, coaching helps you move out of a stuck place — and, there still might be a need to heal from past traumas in a way more suited to therapy. For some of my clients, coaching is a great adjunct to therapy — they work to understand long-entrenched patterns with their therapists, and on moving toward their desired future in coaching.

This sense of looking forward is the central unique feature of coaching. While both therapy and coaching support you to learn more about yourself and what you want, coaching is designed to “forward the action.” This action might “look” small from the outside — writing one sentence a day or meditating to gain more ability to be with a deep loss — or it might be a big, transformative change, like starting a business, starting a podcast, writing a book or taking a courageous stand on a topic you care deeply about. Coaching is about helping you stay in the learning place long enough to know what really matters, to feel confident, and to really identify what you want — whether that’s new work or a new way of being — and then coaching supports you to make concrete changes that help you move toward that.

There aren’t super rigid lines between coaching and therapy — they are both aimed at helping people find their most functioning, creative, flourishing selves. On any given day, a coach or therapist might ask you the same questions. Both can be utterly transformative But coaching is about learning to train your gaze on what you want to create for yourself — and then supporting you to move toward it. A good coach will know when to suggest a therapist might be helpful for a client — and a good therapist will also know when a coach is a helpful choice.