Monday 1 November saw the launch of RCOT’s #OTsForEquity campaign and Occupational Therapy Week 2021, where we pledged to focus on working with you to shine the light on the role occupational therapists currently play in addressing health equity.
Occupational therapist from across the UK tuned in to the #OTsForEquity: Launch event and to watch Professor Sir Michael Marmot’s opening plenary Social justice and health equity, originally broadcast at Annual Conference 2021. Marmot called on governments to “put a fair distribution of health and wellbeing” at the heart of its policies. This was followed by a lively and engaging Q&A session with a live panel.
You can catch up on the #OTsForEquity: Launch event recording if you didn’t make the live event or want to rewatch it.
Professor Diane Cox, RCOT Chair of Council, said: “The COVID-19 pandemic has highlighted the increase in health inequalities across the UK. Whilst in theory, everyone in the UK has the same access to health care, in reality the causes of ill health are very different depending on where you live, your socio-economic class and your ethnicity.
“The pandemic has highlighted how poverty, deprivation, employment and housing are closely related to health and mortality.”
In his presentation, Sir Michael talked about taking action to reduce health inequalities as a matter of social justice. Comparing statistics on life expectancy between 1980 and 2010, he said that while poorer people do have worse health than everyone else, the real message is that the less the deprivation, the longer the life expectancy.
In stark figures, he demonstrated that for over 100 years, life expectancy had been consistently improving “for about one year for every four years” for both women and men, but that between 2010 to 2011 “there was a break in the curve” and the rate in increases slowed dramatically.
Looking at other countries’ annual life expectancy in weeks, between 2011 to 2017, Sir Michael concluded that the UK had the slowest life expectancy improvement of any rich country, apart from Iceland and the US.
He identified four culprits: poor governance and political culture; increased social and economic inequalities; reduction in spending on public services; and the UK being unhealthy coming into the pandemic.
“My overall recommendation is to put a fair distribution of health and wellbeing at the heart of government policy,” he urged. In essence, his message was that in developing strategies for tackling health inequalities, we need to confront the social gradient in health, not just the difference between the worst off and everybody else.
Questions flooded in from the audience. Key issues raised included: the barriers people face to accessing healthcare; what occupational therapists working in the higher education sector can do to increase awareness of our professional role in reducing health inequalities; and whether we should be prioritising poverty itself, as an identifying factor, as we might a particular demographic or condition.
Karin was the first to address where RCOT sits currently in terms of addressing health equity, saying we are at the “awareness” stage of the Public Health England and the King’s Fund framework for AHPs which talks of “awareness, action and advocacy”. She urged people to use Occupational Therapy Week as an opportunity to have wider conversations around health equity.
Hannah moved on to discuss the barriers that people from the LBTGQIA+ community face in accessing healthcare full stop, regardless of whether this is in mental health, physical health or social care. They said that fundamentally the issue is about “the little nuanced things that we can all do on a day-to-day basis to make that access easier.”
When Rachel called on staff across the whole of the NHS to “think further than just their field,” Hannah added, to panel-wide agreement: “Isn’t that occupational therapy’s chance to shine? We are the uniquely bio-psycho-socially-trained profession. We bandy these words around – holistic, humanistic – they’re fundamental to our profession. And if we continue to see people as these sections and boxes, we are never true to our values.”
Dai stressed that wherever occupational therapists work – be it in housing, work or with children – you are already influencing health equity. “Every occupational therapist today has done something to improve health inequality, it’s just they might not have realised it,” he said.
Karin called for researchers to work more closely with practitioners in understanding our population make up, thinking about our existing services, questioning whether people are using those services, and providing the evidence.
“It’s that combination of knowing your local population, knowing what the needs are, then proactively reaching out…so we are reaching the people with the highest needs,” she said.
From a student perspective, Sheherazad stressed the importance of structural questioning of how systemic factors influence those wider social determinants of health. She said that learners have lots of opportunities to talk to service users and practitioners “to get that stakeholder representation, which is really important when we think about how we are going to achieve health equity.”
One audience member, Keir Harding, asked the panel if a different political approach to environmental adaptation is needed for health equity to be a reality. Rachel agreed that as a profession we do need to be more politically aware and activated, but Dai responded by saying “it’s not a left/right problem, it’s a societal problem.”
“All the parties are concerned about this; they’ve just got different methods. We just ned to identify who the stakeholders are and how you can get a problem solved in relation to that stakeholder in that government…you have to have a broad-minded relationship [as] ultimately it is the service user that gets disadvantaged. It’s about working the best you can in the political environment you are in.”
A final discussion point was around engaging with climate change and sustainability, and how closely this is linked to tackling health inequalities. A ‘hot topic’ with Cop26 simultaneously taking place, it was an emphatic “yes, yes, yes” from the panel.
Karen talked about RCOT’s sustainability action plan , as a baseline to where we are as an organisation and a profession, and the work RCOT is doing to signpost members to best practice guidance. Reiterating this is a societal problem, as occupational therapists she urged us to think about housing, equipment, how we can better recycle equipment or encourage sustainable use of our assets.
However, Rachel, using the example of the banning of plastic straws having the unintended consequence of making it difficult for some disabled people to have a drink, she reminded people to think, yes, we need to engage in this and look after the environment, we also need to remember that some people need things differently.
Linda concluded that “both these things [sustainability and health inequalities are such big issues that you could think that they can only be achieved at a global level…but every individual has a role to play.”