Mednotes

L1 Early Professional Experience Disability equity training and panel discussion

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aliasesL1 Early Professional Experience Disability equity training and panel discussion

14 min read

Overview

A disability equity training session delivered by John Marrable (Access Consultant and Educator, Livingwell Disability Resource Centre, over 50 years’ lived experience, Accredited Barrier Free Adviser). It moves from attitude and unconscious bias, through a brief history of disability in New Zealand, disability statistics from the 2023 Census, four models of health, and practical etiquette and language guidance, closing with the UN disability rights framework and NZ’s Whaikaha - Ministry of Disabled People.

Aims and attitude

Three expected outcomes framed the session: (1) identify and address discriminatory practice towards disabled people and understand why some disabled people can develop negative attitudes, (2) find ways to challenge behaviour that reinforces negative myths and values which prevent disabled people achieving equality and full participation in society, (3) recognise unconscious bias in self and others.

  • Graeme Innes (former Australian Disability Rights Commissioner): one of the greatest barriers for disabled people is the “soft bigotry” of low expectation.
  • A podium/lectern can physically hide a wheelchair user from an audience, making them invisible to others in the room.

Unconscious bias and ableism

  • Unconscious bias: a learned assumption, belief or attitude in the subconscious. Everyone has these biases; they are used as mental shortcuts for faster information processing, can date back years, and become so ingrained they are no longer actively considered. Unchecked, they can reinforce negative impressions, a problem for both medical staff and disabled patients in the medical sector.
  • Ableism: a learned belief that people with typical abilities are superior to those with physical or cognitive disabilities. It appears as prejudice towards disabled people, shown in words and actions, consciously or unconsciously. It is the idea that society places higher value on certain types of bodies, brains, forms of communication and ways of being in the world than others. The world is built for non-disabled bodies and neurotypical brains and does not go out of its way to accommodate people who do not fit those moulds.
  • Examples of ableism given: fear of disability, inaccessible environments, failing to provide reasonable accommodations, intrusive questions about someone’s disability.

History of disability in New Zealand

  • Pre-colonisation (Māori): disability was part of human and whānau diversity. Māori were generally fit and healthy before European contact; many illnesses common elsewhere were absent, though pneumonia, arthritis and rheumatism did affect Māori. Illness was believed to result from not obeying rules about tapu or offending the gods. Healing was sought from tohunga, who knew rongoā rākau (plant medicines) and appropriate karakia.
  • 1800s, colonisation: European colonists brought views that disabled people had defects needing to be fixed, or were people society needed protection from. Disability was unwelcome, as it challenged the idea of a new society and could be a burden when hard physical work was a daily necessity. Support was left to the benevolence of families or charitable aid.
  • 1840-1891: disease and social/economic change had serious negative effects on Māori health and population. Government hospitals for Māori were set up from the 1840s; as the non-Māori population grew, hospitals became increasingly Pākehā-dominated, built and run by settler communities. Many Māori were suspicious of hospitals for cultural reasons and were also deterred by fees.
  • Key legislation:
    • Lunatics Ordinance Act 1846: provided for safe custody and prevention of offences by persons dangerously insane, and for care of persons of unsound mind; initially housed in jails, then from 1854 in “lunatic asylums”.
    • Imbecile Passengers’ Act 1882: discouraged disabled people from settling in New Zealand by requiring a bond from whoever was responsible for a ship that discharged a person “lunatic, idiotic, deaf, dumb, blind or infirm” who might become a charge on public or charitable institutions.
    • Tohunga Suppression Act 1908: imposed penalties on tohunga.
  • 1970s onward: a move to deinstitutionalise mental health patients began, as asylums were seen as failing to treat patients. Cherry Farm closed in 1992; deinstitutionalisation was completed nationwide in October 2006.
  • Legacy: Kingseat Hospital, Auckland, is now “Spookers Haunted Attraction Theme Park”. Former patients find this insulting; former patient Debra Lampshier: “For me knowing the turmoil and anguish that went on there, and to see it turned into some form of entertainment I find it a little bit difficult to deal with.”
  • Immigration: NZ’s immigration medical form asks whether the applicant has “any physical, psychological, communication, developmental or intellectual disabilities which may affect your ability to earn a living or take full care of yourself now or in later life” and whether they are receiving special support services.

Disability statistics (2023 NZ Census)

  • 83% of the population non-disabled, 17% disabled (2023), compared with 24% disabled in the 2013 census.
  • Of the disabled population, 65% are under 65 and 35% are over 65.
  • 29% of all disabled people (245,000 people) were unable to see a health professional when they needed to at least once in the 12 months before the census.
  • Tangata whaikaha Māori (Māori disabled people) had a higher-than-average rate of unmet need for health professionals: 37%.
  • Top three health professionals disabled people needed: GPs (164,000 disabled people), medical specialists (42,000), mental health professionals (34,000).

Models of health

Four models were presented: Medical, Social, Biopsychosocial, and Te Whare Tapa Wha.

  • Medical model: the individual is equated with “the problem”; impairments and chronic illness pose real difficulties but are framed as the main problem. Traditional view: disability is caused by physical, sensory or mental impairment; the individual is impaired and is the problem. Focus of the medical profession: cure the impairment, or alleviate its effect.
  • Social model of health: barriers are external to the individual, imposed by society, not caused by the person’s impairment. Social barriers break into: (1) attitudes leading to prejudice, stereotyping, discrimination; (2) environment being inaccessible in buildings, language, services and communication; (3) organisations being inflexible in procedures and practices.
  • Medical vs social model, worked examples:
    • A wheelchair user faces stairs at a building with a sign reading “Everyone Welcome”: medical model framing is “their impairment is the problem, they should be cured or given prosthetics”; social model framing is “the stairs are the problem, they should build a ramp.”
    • Communication: medical model treats communication as taking place in “standard” ways (e.g. size 12 print), with disabled people expected to adapt (using magnifiers, or asking someone to read for them); social model tailors communication to individual needs, with information available in a range of formats.
  • Biopsychosocial model: views health as both a scientific construct and a social phenomenon, looking at biological, social and psychological factors together (e.g. physical health and genetic vulnerabilities; peers and family circumstances; coping skills, self-esteem and mental health), which overlap and combine to influence health.
  • Te Whare Tapa Wha: the four cornerstones of Māori health. If one of the four dimensions is missing or damaged, a person or collective may become “unbalanced” and unwell. The four pillars are taha tinana (physical health), taha wairua (spiritual health), taha whānau (family health), and taha hinengaro (mental health).

Inclusion

Historically, disabled people have received “special” services rather than access to mainstream services, including sport and recreation. Inclusion (and the impact of exclusion) matters for everyone. Questions posed for reflection: for which activities is inclusion important to you; who ensures you are included; how do you feel if you are not included; what is an ordinary life; what are the barriers to inclusion of disabled people; and what can you do in practice to increase accessibility and inclusion.

Assumptions, hidden disabilities and etiquette

  • Never make assumptions: not all disabilities are visible (“not all disabilities look like this” for a wheelchair user; “some disabilities look like this” for a standing figure) — assuming can make an “ASS U ME”.
  • Hidden disabilities: recognised by the sunflower symbol.
  • Disability etiquette basics: ask before you help; do not assume someone needs help just because they have a disability; people with disabilities want to be treated as independent people; consider how you offer assistance and physical contact.
  • A karate class video (not transcribable, link only) showed a wheelchair-using practitioner training alongside standing practitioners. [slide does not elaborate further, video content not available]
  • Two further linked videos on common mistakes when interacting with disabled people, and “A Day in the Life”, were not transcribable (removed due to file size; only YouTube links given). [flag: video content unavailable]
  • Message reinforced twice: “you will get it wrong, even the experts can” — even Whaikaha’s own published guidance can get it wrong (see Language section below).

Language

Language shapes and reflects thoughts, beliefs and feelings; how people are referred to affects how they are seen by others and how they feel about themselves.

  • Speak directly to the disabled person, not to a companion or interpreter.
  • Respect a person’s privacy; asking about someone’s disability unprompted can make them feel treated as a disability rather than a human being.
  • Cartoon example: a woman asks a wheelchair user “So, what do you prefer to be called? Handicapped, disabled or physically challenged?”; his answer: “John would be fine” — caption: “The most appropriate label is usually the one people’s parents have given them.”
  • Cartoon example (patronising attitudes): a reporter asks a wheelchair user “Can I ask what it’s like to be a tragic but brave member of society?!”; the reply: “Only if I can ask what it’s like to be such a patronising bastard!” — illustrating how patronising language can be, and can be pushed back on.
  • Even official guidance can get language wrong: Whaikaha - Ministry of Disabled People’s own website advises, under “people who are mobility impaired”, to “place yourself at eye level in front of the person to facilitate the conversation” when speaking to someone using a wheelchair or crutches — presented as an example of well-meaning official guidance still getting it wrong. [slide does not elaborate on exactly what is wrong with this advice]

Speech impairments

When communicating with someone with a speech impairment: give full attention; do not interrupt or finish their sentences; if you have trouble understanding, do not just nod; if after trying you still cannot understand, ask them to write it down or suggest another way to communicate; keep your manner encouraging rather than correcting; a quiet environment makes communication easier.

Rights framework

  • United Nations Convention on the Rights of Persons with Disabilities (CRPD): created a framework shaping what government and disabled people aspire to. Key principles: respect and dignity, full participation, autonomy, inclusion, accessibility, equality.
  • In New Zealand, the Office for Disability Issues (ODI) was integrated into Whaikaha - Ministry of Disabled People on 1 August 2023.

Self-test

  1. What did Graeme Innes identify as one of the greatest barriers for disabled people?
  2. Define unconscious bias and explain why it matters particularly in the medical sector.
  3. Define ableism, and list two examples of it given in the session.
  4. Describe how disability was understood by Māori before European colonisation, including how illness was explained and who provided healing.
  5. Name three pieces of New Zealand legislation from the 1846-1908 period discussed, and state what each one did.
  6. Describe the process and timeline of deinstitutionalisation of mental health patients in New Zealand from the 1970s.
  7. According to the 2023 NZ Census, what percentage of the population is disabled, and how does this compare to the 2013 figure?
  8. What percentage of disabled people were unable to see a health professional when needed in the 12 months before the 2023 census, and how did this differ for tangata whaikaha Māori?
  9. Distinguish the medical model of disability from the social model, using the wheelchair-user-and-stairs example.
  10. Describe how the medical model and social model differ in their approach to communication.
  11. List the four pillars of Te Whare Tapa Whā and explain what happens if one pillar is missing or damaged.
  12. What three types of factors does the biopsychosocial model of health consider?
  13. A colleague assumes a patient without a visible disability has no impairment. Explain, using material from the session, why this assumption is a problem and what “hidden disabilities” refers to.
  14. List three disability etiquette basics for offering help to a disabled person.
  15. Explain, with reference to the session’s language examples, why asking a disabled person “what do you prefer to be called?” (offering a menu of labels) is not the recommended approach.
  16. Describe the recommended approach to communicating with someone who has a speech impairment if you are having trouble understanding them.
  17. List the six key principles of the UN Convention on the Rights of Persons with Disabilities (CRPD).
  18. What NZ government body did the Office for Disability Issues become part of, and when?

Answers

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