Anti-Oppressive Practice in Health and Social Care

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Viola Nzira & Paul Williams

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    Preface

    This book is intended for students training for qualifications for professions in health or social care, for example nurses, social workers, therapists or medical personnel. It is also likely to be useful for existing practitioners in these fields. It seeks to provide a foundation for knowledge and practice that is anti-oppressive. We hope that after reading this book, and perhaps engaging in further study relevant to their particular role and circumstances, readers will be able to develop a strategy that constitutes a holistic and comprehensive approach to preventing and tackling discrimination and oppression, in their personal relationships, within the organisations in which they learn or practise, and in the communities in which they live or work or have other activities.

    While covering academic issues that need to be understood if anti-oppression is to be effective, this book is essentially practical in that we hope the reader will gain information and ideas to develop a strategy that will maximise their ability to prevent and tackle discrimination and oppression in all circumstances in which they may be encountered. This is particularly important in the health and social care field, where people come to us with difficulties that can only be made worse if negative discrimination or oppression is also experienced.

    Structure of the Book

    The book is divided into four parts:

    • Part I Concepts: Chapters 1 and 2

      useful concepts for anti-oppression

    • Part II Organisations: Chapters 3, 4, 5 and 6

      implications for organisations, with emphasis on health and social care services

    • Part III Individuals: Chapters 7, 8, 9 and 10

      development of anti-oppression by individuals, with emphasis on students in health and social care

    • Part IV Reflection: Chapters 11 and 12

      developing continuous learning through reflection

    Part I Concepts

    Part I outlines concepts that are useful to understand in order to effectively pursue anti-oppression. An overview of discrimination and oppression is provided in Chapter 1, taking into account some significant historical world events that have shaped current thinking on issues of discrimination and oppression. The prevalence of oppression is highlighted, with examples from African, African-American and Jewish experiences. How such groups responded to acts of oppression, through direct challenges against the oppressors and a determination to be survivors and not victims, is recounted. It is suggested that we can learn from how oppressed people themselves have successfully challenged discrimination and overcome oppression. This chapter also introduces concepts of identity, social devaluation and power and their association with oppression, which are discussed in more detail in later chapters. Frameworks for tackling social devaluation are described as guides for the development of anti-oppressive practice. Exercises are provided within this and subsequent chapters to support individual learning and begin the process of reflective practice, a theme that runs through this book.

    The exposition of the nature of discrimination and oppression is followed in Chapter 2 by a consideration of some concepts in common use in this field, in order to aid understanding, development and maintenance of anti-oppressive practice. The concepts are covered under the headings:

    • community and culture
    • power and empowerment
    • equality and anti-oppression
    • identity and relationships

    Under each heading key concepts are used to provide a focus, and explanations are given as to how an understanding of meaning can support anti-oppressive practice. Some of the concepts from this chapter are developed further in subsequent chapters.

    Part II Organisations

    Anti-oppression can be developed and pursued at the political, social and cultural level, at the level of organisations, and at a personal individual level. Part II covers the political and ideological background and its implications for a commitment to anti-oppressive practice within organisations, particularly health and social care provision.

    Chapter 3 examines the concept of equality from ideological and political perspectives to highlight possible influences on strategic developments. The influence of these ideological and political perspectives on professional practice is discussed. Drawing on the findings of the MacPherson Inquiry (1999) and the subsequent interpretation of institutional racism, a race equality paradigm is used to illustrate some of the difficulties that can be encountered when attempts are made to implement anti-oppressive practices within health and social care organisations, due to the different interpretations attached to race, racial identity, racial group and ethnicity. Reference to legislation is made with regard to how court rulings have influenced the creation of a working definition of a racial group. Examples are included to show how individual and institutional racism can operate. Interpretations of stereotypes and ethnicity are included to show the connections with racism. The importance of being knowledgeable about these areas is highlighted, so that practitioners can assess the impact of actions at individual or organisational levels and decide on remedial action so as to promote anti-oppressive practice. Exercises are given to encourage creativity in approaching equality issues.

    Chapter 4 discusses in more detail ideas about equal opportunities. The arguments for equality are contrasted against natural tendencies towards inequality. An analysis of the distinction between liberal and radical conceptions of equal opportunities provides the reader with a basis from which to contextualise their own organisation. Some of the moral and legal reasons for equal opportunities are stated and summaries of current UK anti-discrimination laws are included within this chapter because they provide the framework for equal opportunities policy development. It is acknowledged that there has been some progress in adopting and implementing equal opportunities policies in health and social care, but the pace of change has remained slow. Health and social care practitioners can use the law to challenge discrimination as part of a package of measures to promote anti-oppressive practice. Commitment to implement their organisation's equal opportunities policy as part of their duty of care is emphasised within this chapter.

    Chapter 5 discusses the importance of respecting and fostering diversity while recognising the complexities involved. A historical and chronological account of changes in terminologies used in relation to equal opportunities from the 1960s to the present day is provided to show the evolutionary nature of the process. Current emphasis is on work organisations being expected to create the conditions conducive to the management of a diverse workforce with diverse needs. Valuing diversity starts from the position that people's differences are an asset rather a burden to be tolerated, particularly in health and social care where the recipients of care come from diverse backgrounds. The business case for diversity management is stated. However, it is recognised that the change in management styles required to effect change could result in negative and destructive conflict. Lack of careful planning and incremental implementation could cause disruption. It is suggested that those practitioners who are ready to embrace the principles of anti-oppressive practice can become diversity champions and offer support to their colleagues.

    In Chapter 6, the discussion focuses on minimalism in terms of meeting just the anti-discrimination minimum legal requirement, and the contrasting approaches in terms of taking an active stance to eliminate discrimination. With minimalism, the criticism is that the impact has been limited because the laws are not easy to enforce. People have to complain before action can be taken, and even then success rates remain low. What the legal framework offers is the opportunity for innovative employers to take proactive steps through specified action to redress identified imbalances. Explanations of positive action and positive discrimination are provided to ensure that the differences and the legal usage are understood. The more recent requirement of a statutory duty for public authorities to have in place equality schemes is explained, leading to consideration of the concept of mainstreaming equality. An integrated mainstreaming equalities approach would ensure that equality ideas become part of everyday practice. To get to that stage a practical incremental model – MPEM – is included for consideration and critique. Practical examples, exercises and discrimination case examples are also included in this chapter.

    Part III Individuals

    Part III presents some frameworks and strategies for the development of a personal anti-oppressive stance by individuals, with examples largely taken from work with students on professional courses in health and social care. Chapter 7 discusses the wide variety of aspects that make up a person's identity as seen by themselves and by others. It is argued that building up a knowledge base about different identities can assist avoidance of stereotypes and engender respect. Researching accounts relating to a particular service user group and culture illustrates the positive characteristics, interests, skills and practices of that group. The importance of appreciating different languages and belief systems is highlighted. Additional knowledge of particular significance is that of understanding how individuals or groups have survived oppression as well as an appreciation of their contribution to society. Readers are encouraged not to be daunted by what they need to know so as to be anti-oppressive. Knowledge will always be limited, but developing and using specific information can be part of preparation ahead of meeting recipients of care, and it can lead to generalisable skills of anti-oppression.

    The chapter describes a framework for anti-oppressive action that can be applied to any groups or individuals at risk of oppression – the WISE principles. The elements are:

    • W = Welcome
    • I = Image
    • S = Support
    • E = Empowerment

    The framework is intended to help students or practitioners to take a holistic approach in considering how to work in an anti-oppressive way during interaction with service users and colleagues. A systematic explanation is provided under each of the four elements that make up the framework to enable students to assess and appreciate possible implications for practice. It is recognised that, as with any model, there will be limitations. However, recognition of limitations is helpful as it enables students to begin to think of alternatives or additions to the framework.

    Chapters 8 and 10 provide curriculum and assignment ideas to support students in developing their anti-oppressive knowledge base. Examples of students' research and assessed assignments have been included to illustrate the level of engagement over two years of a three-year social work degree programme. Students share their research findings with their peers as well as creating an evidence-based individual action plan for anti-oppressive practice. Students' work highlights the value of a holistic approach to anti-oppressive practice.

    Application of theoretical knowledge is tested when students go out on practice placements. Fieldwork experience using social work practice placements as the main focus is discussed in Chapter 9. Specific areas covered include:

    • assessment of suitability of the placement
    • student preparation prior to going out on placement
    • supervision while on placement
    • monitoring and evaluation of the placement.

    The process followed should enable the student to learn about anti-oppression before, during and after the placement and to put into effect knowledge gained and skills developed. Students are assessed on their ability to practise in an anti-oppressive way by skilled practice teachers, using guidelines from professional bodies such as the General Social Care Council. Included in the chapter are case examples of some of the complexities that can arise. Implementation of equal opportunities policy among placement agencies is discussed in order to illuminate further the gaps between equality theories and practice, as well as raising questions about suitability of placements to support students to practise in an anti-oppressive way. It is concluded that recognition by students of the gaps between equality theory and practice is invaluable, because it provides a basis for work with service users to identify ways of tackling organisational structural limitations.

    Part IV Reflection

    Promoting anti-oppression at the cultural and structural levels as well as through personal interaction can be supported by continuous assessment and evaluation. This is the main focus of Chapter 11. Through a series of questions readers are encouraged to check and assess their own actions and the state of affairs within work organisations. The assessment and evaluation process can assist the discussion and understanding of essential aspects of knowledge and actions that can be taken within organisations, communities and society as a whole. Assessing anti-oppression within organisations is included as well as ideas about ways to be involved and be informed about communities. Cultural acceptability issues are also featured. Action at different levels and through a variety of agencies to promote anti-oppression is strongly recommended. Full recognition is made of the dangers inherent in fighting oppression.

    Finally Chapter 12 revisits some of the political and ideological issues that complicate the process of developing anti-oppressive practice. Approaches to resolving these issues are suggested, through reflection, involvement of and partnership with service users, and an incremental approach to change. Anti-oppressive practice is presented as a political task based on respect for the wide diversity of identities.

    A Brief Note about Terminology

    We have adopted the convention, sometimes seen as controversial, of referring to ‘Black people’ with a capital ‘B’ while using a small ‘w’ to refer to ‘white people’. Our rationale for this is that:

    • it acknowledges the phenomenon of ‘white privilege’ discussed in Chapter 2
    • it acts as a counter to the relatively negative connotations of ‘black’ compared with ‘white’ in the English language
    • it recognises the social and political construction of the concept of ‘Black people’ in the context of both oppression and liberation
    • in the context of the holistic approach to anti-oppression that we advocate and our wish to avoid any suggestion of a ‘hierarchy’ of oppressions, it nevertheless expresses our particular solidarity with people who are at risk of oppression based on skin colour or ethnic origin.
    Main Aim

    The main message we aim to put across throughout this book is that anti-oppressive practice in health and social care is possible, despite the many perceived barriers at individual and organisational levels. Our intention is to assist and inspire students and practitioners to become creative in developing an anti-oppressive stance in work and life, with enjoyment and enthusiasm and without embarrassment or denial.

    ViolaNzira
    PaulWilliams

    Acknowledgements

    This book emerges from almost twenty years of teaching modules on social justice and inclusion and social policy. Our style and approach to writing this book has been guided by what students taking these modules have found useful as well as their suggestions for improvement. We thank them for their feedback.

    The book has also been informed by our personal experiences and our own learning. We see ourselves as on a journey towards anti-oppressive practice – a journey that never ends. We acknowledge all the help and support we received from a wide variety of sources along the way.

    We would like to thank June Jackson, Manager of the Centre for Ethnic Minority Studies (CEMS) at Royal Holloway University of London, for her ideas, support, directed reading and access to CEMS equalities research reports.

    We would like to acknowledge the learning we have gained from colleagues at the University of Reading who have contributed to our understanding and teaching of social justice and anti-oppression, particularly Horace Lashley Phil Mignot, Doug Badger, Nick Ashwell and Alison Cocks.

    We are very grateful to the students who kindly gave their permission for the inclusion of extracts from their assignments (Chapters 8 and 10): Myrleene Beckford, Francesca Booth, Paul Brewster, Nalene Edwards, Kathryn Holman, Natasha Hutchings, Daniel Jones, Jane Lynch, Alison Miller, Matt Neads, Nikki Osborne, Laura Pitman, Louisa Stock and Maddie Willens.

    We also thank Robert Elsie for his kind permission to reproduce the Albanian poem in Chapter 8, and Peggy McIntosh, Catherine Jones and the University of Reading for extracts from their publications.

    Finally, our thanks are due to the reviewers and editors at SAGE for their encouragement and valuable advice.

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