What is equality and diversity?

Although sometimes used interchangeably, the terms ‘equality’ and ‘diversity’ are not the same.

Equality is about ‘creating a fairer society, where everyone can participate and has the opportunity to fulfil their potential’ (DH, 2004). It is about identifying patterns of experience based on group identity, and the challenging processes that limit individual’s ‘potential’ health and life chances.

For example, occupational segregation. Women make up almost 75% of the NHS workforce but are concentrated in the lower-paid occupational areas: nursing, allied health professionals (AHPs), administrative workers and ancillary workers (DH, 2005). People from black and minority ethnic groups comprise 39.1% of hospital medical staff yet they comprise only 22.1% of all hospital medical consultants (DH, 2005).

An equalities approach understands that our social identity – in terms of gender, race, disability, age, social class, sexuality and religion – will impact on our life experiences.

Diversity literally means difference. When it is used as a contrast or addition to equality, it is about recognising individual as well as group differences, treating people as individuals, and placing positive value on diversity in the community and in the workforce.

Historically, employers and services have ignored certain differences. However, individual and group diversity needs to be considered in order to ensure that everybody’s needs and requirements are understood and responded to within employment practice and service design and delivery.

One way in which organisations have responded to the issue of diversity in recent years has been the development of flexibility in working practices and services. For example, an employer may allow an employee to work a flexible working pattern to accommodate child care arrangements, or a GP surgery may offer surgeries at the weekends in accommodate those who work full time during the week.

These approaches recognise that in order to be inclusive and equal to all, organisations may need to respond differently to individuals/groups.

Therefore, a commitment to equality in addition to recognition of diversity means that different can be equal.

Learning outcomes

Understand concepts of equality, diversity & rights in relation to Health and Social Care.

Equality and diversity is becoming more important in all aspects of our lives and work for a number of reasons.

We live in an increasingly diverse society and need to be able to respond appropriately and sensitively to this diversity. Learners in the healthcare setting will reflect this diversity around gender, race and ethnicity, disability, religion, sexuality, class and age.

Your organisation believes that successful implementation of equality and diversity in all aspects of work ensures that colleagues, staff and students are valued, motivated and treated fairly.

Every member of society is likely, at some point, to be a recipient of health and social care. The Department of Health can only achieve its aim of better health, care and well-being for all, by building an explicit commitment to equality, diversity and human rights throughout the health and social care system. All public organisations including the Department of Health and public providers and commissioners of health and social care services have a duty to promote equality. Successfully delivering these duties is a core part of the health and social care system’s objective to offer services that deliver high quality care for all.

To do this, the diversity of the population has to be recognised, in policy development through to service delivery and patient care, acknowledging the diverse experiences, aspirations and needs of staff, patients and service.

The Department of Health and local health and social care organisations continue to take proactive steps to address unequal access and outcomes experienced by some sections of the community. DH is working to ensure the principles and practicalities of fairness, equality, diversity and human rights are a central to the work of the Department.

In 2007 the UK established a new single equalities body, to bring together the existing equality Commissions dealing with gender, disability, and race and ethnicity into a Commission for Equality and Human Rights. The promotion and enforcement of ‘equality and diversity’ is one of the three duties of the new body. This paper briefly explores diversity in relation to the theory of gender equality and also examines developments in policy at the EU level, which has provided much of the impetus for change. Our focus is on the policy approach and the tensions that the policy documents reveal about the emphasis on equality and diversity approach, in particular the extent to which attention to gender issues may get lost in the diversity bundle, and the extent to which a focus on the individual may be strengthened over the group. This page lists some of the guidance materials produced by the former equality commissions and guidance produced by external organisations, who have given us permission to reproduce their materials on our site.

Guidance from ACAS

Age, Religion or Belief, Sexual orientation

There are no statutory Codes in force covering sexual orientation, religion or belief, or age discrimination. However,ACAS has published guidance documents covering each of these areas. The following guides are also available on the ACAS website.

Guidance from the EOC – advising young people

The Equal Opportunities Commission produced guidance to help advisers who work with young people to work out whether they might have experienced unlawful discrimination. The main focus was sex discrimination but other forms of discrimination are also referred to.

Young people need advice too..

Guidance from the TUC – mental health issues

The TUC produced guidance ‘to help trade union reps and officials provide a good service to members with mental health problems. It aims to equip reps in workplaces with the information they need to deal as well with mental health issues as they do with the other issues that crop up on daily basis.’

Guidance from the Refugee Council – employing refugees

We have worked with theRefugee Council to produce guidance on employing refugees. The guidance explains which documents can provide evidence of entitlement to work. This guidance is aimed at employers but could be useful for advisers as well.

Guidance from Advocacy Action – Human rights toolkit for advocates

Action for Advocacy, the independent advocacy organisation has developed a toolkit based on an initial series of Commission-funded training days to advocates across England and Wales. The toolkit is a resource to promote further thinking and better use of resources that can support advocates to use human rights in their advocacy work.

Understand discriminatory practice in health and social care.

Discrimination is less favorable or bad treatment of someone because of one or more aspects of their social identity.

Understanding how discrimination can impact on individuals’ lives is essential to prevent potential discrimination within in teaching and learning situations and ensure that you are confident in dealing with discrimination issues if and when they arise.

Our social identity comprises our:

gender

race or ethnicity

sexuality

religion or faith

age

class

disability.

While we can face discrimination because of any of these aspects, it is important that we also identify the links between social identities and individuality and/or a state and situation. Bad treatment can be multi-layered and occur because of:

an aspect of individuality, e.g. some aspect of personal appearance, size, personal likes, etc.

our state/situation, e.g. homelessness, being a lone parent, misuse of drugs or alcohol, citizen status, health, etc.

Valuing diversity

It is important that you consider how an individual’s social identity may impact on their experience of the programme/teaching session of clinical activity in which the learner is engaged.

The ways in which discrimination works include stereotyping, making assumptions, patronising, humiliating and disrespecting people, taking some people less seriously.

To ensure that we value diversity and consider the individual’s identity appropriately in clinical teaching, the following principles may be useful:

recognise that we need to treat all learners as individuals and respond to them, and their social identity, in an individual manner

understand that treating people fairly does not mean treating people in the same way – we need to recognise difference and respond appropriately

respect all learners regardless of their social identity

try to increase our knowledge and understanding of aspects of social identity that may be different from our own

avoid stereotyping or making assumptions about learners based on their social identity

recognise that some course content may impact on some learners in a negative/difficult way because of an aspect of their social identity

recognise that the course structure, e.g. timing of lectures, unsociable hours, weekend working, and so on, may impact on some learners more than others due to their social identity

recognise that your own social identity may impact on learners in different ways

avoid using inappropriate and disrespectful language relating to social identity

Institutional discrimination

Institutional discrimination is concerned with discrimination that has been incorporated into the structures, processes and procedures of organisations, either because of prejudice or because of failure to take into account the particular needs of different social identities.

Looking at the long historical perspective, there is a very fundamental evolution of how

public institutions have dealt with the notion of anti-discrimination. Whereas the typical 19th

century anti-discrimination arrangements were developed for settling the case of

philosophical and religious minorities, contemporary legislation is facing the challenge of

addressing new issues such as, for instance, those raised by the massive immigration of

colonial and guest workers immigrants. If racial discrimination is among the most

problematic forms of discrimination, it is far from being the only one. The struggle against

discrimination is an ongoing process, which is now facing the challenge of, not only

addressing new social realities, but also addressing old ones innovatively. The inclusion of

disability, sexual orientation and age as a basis for anti-discrimination struggle reflects the

feeling that the law must be adapted to processes of social change, which are marked today

by an unprecedented diversity in terms of lifestyles, ethnic, cultural and religious

backgrounds.

Three features distinguish institutional discrimination from other random individual forms of bad treatment.

Triggered by social identity

– the discrimination impacts on groups (or individuals because they are members of that group).

Systematic – it is built into:

– laws, rules and regulations. For example, selection criteria for jobs or courses, laws such as the Minimum Wage, pension regularities, etc.

– ‘the way we do things round here’, including the use of authority and discretion, e.g. how training opportunities are allocated, how flexibility in learning practices is authorized

– the popular culture and ways of describing ‘normality’, e.g. long working hours culture/expectations.

Results in patterns

– incidents of discrimination may appear isolated or random but where institutional discrimination occurs they are part of a wider pattern of events which often may be hidden. Patterns of discrimination can often be surfaced by effective organizational information relating to social identity. For example:

• which groups of people get promoted in an organization?

• which groups of people get accepted onto a training course?

• which groups of people leave an organization after six months of employment?

Questions such as this may point to some people experiencing the organization in a different/more negative way than others.

Understand how National initiatives promotes anti-discriminatory practise in Health education and Social care.

The concept of discrimination adopted in the legislation derived from Article 13 is inspired by

the EU legislation on the equality of treatment between men and women.5 Equality of

treatment is defined as the absence of any direct or indirect discrimination. By direct

discrimination,

The same document defines indirect discrimination as follows:

“indirect discrimination shall be taken to occur where an apparently neutral provision,

criterion or practice is liable to affect adversely a person or persons to whom any of

the grounds referred to in Article 17 applies, unless that provision, criterion or practice

is objectively justified by a legitimate aim and the means of achieving it are

appropriate and necessary”

Harassment is also considered a discrimination in its own right. Harassment is any form of

action that creates a disturbing, intimidating, offensive or hostile working environment, such

as verbal abuses and gestures. As in the equality of treatment between men and women

legislation, the two anti-discrimination directives following Article 13 place the burden of

proof on the defendant in case of legal action.

Discrimination can happen in many different ways but you have rights to protect you

By law people are protected from discrimination on the grounds of:

race

sex

sexual orientation

disability (or because of something connected with your disability)

religion or belief

being a transsexual person

having just had a baby or being pregnant 

being married or in a civil partnership (this applies only at work or if someone is being trained for work)

age (this applies only at work or if someone is being trained for work)

These are known as ‘protected characteristics’.

Race discrimination

Wherever you were born, wherever your parents came from, whatever the colour of your skin, you have a right to be treated fairly.

Gender equality – sex discrimination

Women and men should not be treated unfairly because of their gender, because they are married or because they are raising a family.

Sexual orientation

Whether you are gay, lesbian, bisexual or straight should not put you at a disadvantage.

Disability discrimination

If you have a physical or mental impairment you have specific rights that protect you against discrimination.

Religion and belief

Your religion or belief, or those of somebody else, should not affect your right to be treated fairly. This could be at work, school, in shops or while using public services like health care.

Transgender discrimination

Trans people should be able to live with dignity. There are protections for some of the forms of discrimination that trans people experience.

Age equality

By law you cannot be treated less favourably in your workplace or in training for work because of your age. For example, it would be unlawful to not employ someone because of their age.

The EU notion of anti-discrimination offers a minimal standard of legal protection, not an

extensive and uniform one. This means that some countries will remain more advanced than

others in their struggle against discrimination even after the implementation of the two

directives. The legislation also suggests that equality of treatment is expected to result from

combating discrimination.8 It does not enact a positive duty on public and private authorities

to promote positive action or equal opportunities policies. In this respect, one suspects that

this absence will in the long run be felt as a major shortcoming. Lessons from both the

perspective of gender studies and from ethnic and racial studies have taught that a thin

notion of equality of treatment is far from being a promise of equality.

Human rights

Human rights are the basic rights and principles that belong to every person in the world. ‘They are based on the core principles of dignity, fairness, equality, respect and autonomy’ (E and HRC, 2008). Human rights protect an individual’s freedom to control their day-to-day life, and effectively participate in all aspects of public life in a fair and equal way.

Human rights help individuals to flourish and achieve potential through:

being safe and protected from harm

being treated fairly and with dignity

being able to live the life you choose

taking an active part in your community and wider society (E and HRC, 2008).

Intrinsic to these statements should be the principles of equality and diversity.

Since 1998 the UK has also included human rights within its legal framework. The Human Rights Act applies to all public authorities and bodies performing a public function. The Human Rights Acts places the following responsibility on your organisation.

Organisations must promote and protect individuals’ human rights. This means treating people fairly, with dignity and respect while safeguarding the rights of the wider community.

Organisations should apply core human rights values, such as equality, dignity, privacy, respect and involvement, to all organisational service planning and decision making.

The Human Rights Act provides a complementary legal framework to the anti-discriminatory framework and the public duties.

The legal context

As a clinical teacher you will want to ensure that you understand the legal framework regarding equality, and that you can relate this framework to your everyday role. The UK framework has two elements to it: the anti- discriminatory framework (which gives individuals a route to raise complaints of discrimination around employment and service delivery) and the public duties (which place a proactive duty on organisations to address institutional discrimination).

Overview of anti-discriminatory framework

Sex Discrimination Act 1975

Race Relations Act 1976

Disability Discrimination Act 1995

Employment Equality (Sexual Orientation) and (Religious Belief) Regulations 2003

Employment Equality (Age) Regulations 2006

Equality Act 2006 (covers service delivery in relation to sexual orientation and religious belief)

It is important to note that at the current time, age legislation only protects individuals in the area of employment and not service delivery.

The SEN and Disability Act 2001

The SEN and Disability Act 2001 extended the Disability Discrimination Act 1995 to education with effect from September 2002. This act requires teachers to explore the provision of reasonable adjustments for students who may have disabilities, including learning disabilities, to enable them to participate effectively.

The EU took great care to avoid national and EU anti-discrimination provisions becoming

concurrent. The solution introduced for solving this difficult question was to adopt the most

appropriate technique of legislation. By choosing the directive, the EU has in effect opted for

flexibility.

The Directive, contrary to the regulation, offers Member States general guidelines,

which should be implemented within two years after the adoption of the two directives. The

anti-discrimination package proposed by the Commission and later adopted by the Council

of Ministers defines minimal common standard of legal protection for victims of

discrimination, without prejudice of what the Member States already have on offer in their

internal legal order

.

It is particularly crucial for the success of the legislation that Member States take the EU

initiative as a motivation for upgrading their internal standard of protection and not as a

justification for lowering them. This is why the two directives contain a “non-regression

clause” which will in practice lead to better legislation in all Member States. Another reason

why EU legislation should be seen as complementing national initiatives is the material

scope of the Article 13.

As indicated above, the sphere of competence of the EU in the area

of anti-discrimination is restrictively defined by the Treaty on the European Union. The main

area where it will be relevant to think in terms of Article 13 is the labour market. Therefore,

there is a whole range of areas of potential discrimination where the role of the Member

States will remain primordial.

Know how anti-discriminatory practice is promoted in Health & Social Care setting

Active promotion of anti-discriminatory practice:

ethical principles; putting the patient/service user at the heart of service provision, eg providing active support consistent with the beliefs, culture and preferences

of the individual, supporting individuals to express their needs and preferences, empowering individuals,

promoting individuals’ rights, choices and wellbeing; balancing individual rights with the rights of others;

dealing with conflicts; identifying and challenging discrimination

Personal beliefs and value systems: influences on, eg culture, beliefs, past events, socialisation,

environmental influences, health and wellbeing; developing greater self-awareness and tolerance of

differences; committing to the care value base; careful use of language; working within legal, ethical and policy guidelines.

Beliefs are the assumptions we make about ourselves, about others in the world and about how we expect things to be. Beliefs are about how we think things really are, what we think is really true and what therefore expect as likely consequences that will follow from our behavior.

Since the last comprehensive review in 1974, the Health Belief Model (HBM) has continued to be the focus of considerable theoretical and research attention. This article presents a critical review of 29 HBM-related investigations published during the period 1974-1984, tabulates the findings from 17 studies conducted prior to 1974, and provides a summary of the total 46 HBM studies (18 prospective, 28 retrospective).

Twenty-four studies examined preventive-health be haviors (PHB), 19 explored sick-role behaviors (SRB), and three addressed clinic utilization. A “significance ratio” was constructed which divides the number of positive, statistically- significant findings for an HBM dimension by the total number of studies reporting significance levels for that dimension. Summary results provide substantial empirical support for the HBM, with findings from prospective studies at least as favorable as those obtained from retrospective research. “Perceived barriers” proved to be the most powerful of the HBM dimensions across the various study designs and behaviors.

While both were important overall, “perceived sus ceptibility” was a stronger contributor to understanding PHB than SRB, while the reverse was true for “perceived benefits.” “Perceived severity” produced the lowest overall significance ratios; however, while only weakly associated with PHB, this dimension was strongly related to SRB. On the basis of the evidence compiled, it is recommended that consideration of HBM dimensions be a part of health education programming. Suggestions are offered for further research.

It is important for care workers to promote equality, value diversity and respect the rights of service users. There are various ways of how they can challenge discriminatory issues and practices in health and social care.

One of the ways in which care worker can promote equality, value diversity and respect the rights of service users is to always put the patient/service user at the heart of the service provision. This means that the patients’ individual needs will be met and achieved

Human rights’ are the basic rights and freedoms that belong to every person in the world.

Ideas about human rights have evolved over many centuries. But they achieved strong international support following the Holocaust and World War II. To protect future generations from a repeat of these horrors, the United Nations adopted the Universal Declaration of Human Rights in 1948. For the first time, the Universal Declaration set out the fundamental rights and freedoms shared by all human beings. These rights and freedoms – based on core principles like dignity, equality and respect – inspired a range of international and regional human rights treaties. For example, they formed the basis for the European Convention on Human Rights in 1950. The European Convention protects the human rights of people in countries that belong to the Council of Europe. This includes the United Kingdom.

Until recently, people in the United Kingdom had to complain to the European Court of Human Rights in Strasbourg if they felt their rights under the European Convention had been breached.

for example; a personal eating plan to a specific individual. Putting the service user at the centre of the provision generally makes a happier and healthier patient in all areas. Care workers can help achieve this by: * Understanding what it is like to use those services * Involving those who use the services

Another example can be quoted as, Rights of one patient will clash with the rights of another A patient has the right to watch TV or listen to the radio, while the patient in the next bed has the right the right to an undisturbed sleep the rights of these two patients clash. By providing earphones could help resolve this.

If patients share a room one wants the door propped open and the other one doesn’t although this is a clash of rights the rights of the patient who wanted the door closed would outweigh the other as propping open doors is a fire risk

Care settings must provide services in such a way that all service users get equal benefit for them. For example a person who does not have English as their first language may require a translator in order to understand the services available and to express a choice about them. One of the most beneficial ways in which a social care setting can challenge anti – discriminatory is through staff development and training this may be done formally through supervision sessions or more informally in the course of day to day working. The manager should supervise the work of their staff, offer advice and guidance in difficult situations and help the workers identify training opportunities to improve their practise.