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EQUALITY AND DIVERSITY. Eric Bater Intending Trainers ‘ course Phase 4i 26 th September 2012. Why are we doing this?. Equality and diversity is a section of the GP curriculum Relevant to clinical care, relationships with patients, working with colleagues

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equality and diversity


Eric Bater

Intending Trainers ‘ course Phase 4i

26th September 2012

why are we doing this
Why are we doing this?

Equality and diversity is a section of the GP curriculum

Relevant to clinical care, relationships with patients, working with colleagues

And to you as an individual and society as a whole

And it makes routine everyday work more interesting

aims of the session
Aims of the session

By the end of the session to have developed an understanding of:-

  • What equality and diversity are
  • The legal framework
  • The influences of culture
  • Models of disability
  • Some applications in our professional setting


Equality is the principle by which all persons or things under consideration are treated in the same way

It is about creating a fairer society in which everyone has the opportunity to fulfil their potential



All of the characteristics that make individuals different from each. A term used to describe the relative uniqueness of the individual in the population- including characteristics or factors such as personality, work style, religion, race, ethnicity, gender or sexual orientation, having a disability, socioeconomic level, educational attainment, and general work experience.

this is me
‘This is me’
  • Where do you live?
  • What is your job?
  • What clothes do you wear/
  • What sort of car do you drive?
  • What hair style have you got?
  • What do you do in your spare time?
  • What newspaper do you read?
  • Where do you go on holiday?
  • What sort of food do you eat?
  • What sort of music do you listen to?
part 1

Part 1


a concept
  • Equal opportunities and valuing diversity are not the same thing.
  • Equal ops = law, difference, isolates groups
  • Valuing diversity = maximising strengths, complementing each other, inclusiveness
  • Paradoxically, both are important
a truism
  • We all have prejudices
  • “That which you acknowledge you can control; that which you do not acknowledge controls you”

de Mello, Awareness

some definitions
Some definitions
  • Stereotype
  • Prejudice
  • Discrimination
definition of stereotyping

Definition of ‘stereotyping’

Ascribing a general characteristic of a group to everyone irrespective of the individual’s characteristics

what is prejudice

What is prejudice?

To make a judgement without having the facts

Having a negative attitude towards another based solely on membership of a group



A man and his son were out driving one afternoon and were involved in a serious car crash. The father was killed at the scene, but the son survived and was rushed to hospital and prepared for surgery for his life threatening injuries.

As the son was wheeled from the anaesthetic room the surgeon walked out of the theatre exclaiming “I can’t operate on this man, he is my son”

what is discrimination

What is discrimination?

‘less favourable treatment on the grounds of sex, race, disability, sexual orientation and religion or belief’

the equality act october 2010

The Equality Act (October 2010)

Protected characteristics

Seven types of discrimination


Protected characteristics:-

Disability (including mental health and obesity)


Religion or belief

Sexual orientation

Gender reassignment

Marriage and civil partnership

Pregnancy & maternity


7 types of discrimination

7 Types of discrimination





Harassment by a third party


Discrimination by perception

discrimination r eceiving less favourable treatment

Discrimination –receiving less favourable treatment’

Burden of proof is on employer to prove that discrimination did not occur

1 direct discrimination

1) Direct discrimination

Discrimination because of a protected characteristic

2 associative discrimination

2) Associative discrimination

Direct discrimination against someone because they are associated with another person with a protected characteristic (including carers of disabled people and elderly relatives)

3 indirect discrimination

3) Indirect discrimination

Where a rule or policy applies to everyone, but disadvantages a person with a protected characteristic, and is not justified by the requirements of the job (e.g possession of a UK degree)

4 harassment

4) Harassment

Behaviour deemed offensive by the recipient .

(Employees can claim they find something offensive even when it is not directed at them)



‘engaging in unwanted conduct which has the purpose or effect of violating another person’s dignity, or is creating an intimidating, hostile, degrading, humiliating or offensive environment…… having regard to all the circumstances, including, in particular, the perception of the victim’

5 harassment by a third party

5) Harassment by a third party

Employers are potentially liable for the harassment of staff or customers by people they do not employ



‘ a particular form of harassment involving a misuse of power to criticise, condemn, abuse , humiliate or otherwise undermine a person (or group’s) ability to the extent that they cannot perform their job properly of suffer stress as a result’

(TUC definition)

6 victimisation

6) Victimisation

Discrimination against someone because they made or supported a complaint under Equality Act legislation

7 discrimination by perception

7) Discrimination by perception

When someone thinks a person has a particular protected characteristic, even if they do not. (e.g. rejecting a job application from a women with an African sounding name, whom an employer infers must be black even though she is white).

unwitting or institutional discrimination the mcpherson report into steven lawrence inquiry

‘Unwitting’ or ‘Institutional’ discrimination(The McPherson Report into Steven Lawrence Inquiry)

‘the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin.

equality act 2010 definition of disability

Equality Act 2010 definition of ‘disability’

‘a person who has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities’ (i.e. longer than 12 months)

dda act 1995 part iii october 2004

DDA Act 1995. Part III October 2004

‘Service providers should make reasonable adjustments to remove physical barriers ‘ (e.g steps, stairways, entrances and exits)

dda at least one of the following affected
DDA :-at least one of the following affected


Manual dexterity

Physical co-ordination


Ability to lift, carry or move objects

Speech, hearing or eyesight

Memory, ability to concentrate, learn or understand

Understanding of the risk of physical danger

defining disability
Defining disability

Examples of disabilities:-

Physical impairments (ME)

Sensory impairments (visual/hearing)

Medical conditions (Cancer, HIV/AIDS)

Mental Health conditions (Depression/schizophrenia)

Learning difficulties (Dyslexia)

examples of reasonable adjustments

Examples of ‘reasonable adjustments’





positive discrimination

Positive discrimination

Choosing to hire a candidate from an under-represented group, providing they are as qualified for the role as other candidates.

3 situations of allowable discrimination
3 situations of allowable discrimination

For reasons of modesty

For reasons of authenticity

Genuine occupational requirement (the service being best provided by a person from that group)

human rights act 1998
Human Rights Act 1998

Right to life

Right to a fair trial

No punishment without law

Right to respect for private and family life

Freedom of thought, conscience and religion

Right to marry

Right to education

other relevant laws
Other relevant laws

Rehabilitation of offenders act (1974)

Human Rights Act 1998

EU Part-time work directive 2002

Flexible Working Regulations 2002.


NHS is one organisation

Deliberate discrimination illegal

Accidental organisational discrimination illegal

Onus of proof is on us, not claimant

Therefore keep records

what is new or coming
What is new or coming?

NHS Litigation Authority standards

DH recruitment guidance

Care Quality Commission standard 7e

DH Human Rights in Healthcare

Northeast SHA Single Equality Scheme


Your new GPR turns up for work on their first day, having arrived by bus. “Didn’t you know I have epilepsy, so can’t drive at the moment?” she asks.What are your options?


A patient at your practice is seeking to make an appointment. When offered an consultation with your Irish GPR he comments “No, I don’t want to see no ‘Mick’”. The GPR is within earshot.How would you handle the situation?


Having seen your Nigerian GPR walk through the waiting room, a patient comments to another patient ‘you don’t see many chocolate Niggers round these parts do you?’What should you do?


Your GPR informs you they suffer from migraine which is provoked by sleep deprivation. They request that they not be allocated any night OOH shifts during their attachment. How would you respond?

‘For religious reasons I won’t be free to work on Friday afternoons’ your GPR tells you.Is this an acceptable request?

You are a partner working in a practice with a large Bangladeshi population. You wish to employ a new nurse, primarily to work with the Bangladeshi girls and young women. Both your existing nurses are elderly. You would ideally like a young nurse who is bilingual, and who is not likely to go off on maternity leave.Compose a job advert.


At a practice party one evening you overhear a member of your employed staff making racist remarks about another member of your staff. The other person ignores the remark.What should you do?

part 2

Part 2

Diversity and Culture


The recognition and valuing of difference between people

Creating a working culture and practices that recognise, respect, value and harness difference for the benefit of the organisation and individual patients.

dimensions of diversity
Dimensions of Diversity






Skin colour


Class (wealth, family background, education)

Region(N/S, urban/rural)

Country/region of origin

Country/region of residence

Educational level


Sexual orientation

Political orientation


Culture (beliefs, expectations, behaviours)



Identification with a social group on grounds of culture, common origin, and shared history


Genetic inheritance (‘Race’?)










ethnic population in cumbria
Ethnic Population in Cumbria

Ethnic Population 0.7% (8.7% UK)

Even spread across county (no concentration in one area)

Immigration significant - especially from Poland

Tourist sector in lakes, seafood industry main factor

No stats available on health inequalities in Black and Minority Ethnic Groups - stats too small!

a definition of culture

A definition of ‘culture’

The sum of one’s beliefs, rituals, customs and practices that guide thinking, decisions and actions in a patterned way. They are learned throughout a lifetime, and passed on through generations.


Complex social phenomenon

Shared beliefs, values and attitudes that guide behaviour of members

Dynamic concept - keeps changing

We are all multicultural, but often don’t recognise it

this is me1

This is me

What 10 features would best describe you to someone you had never met?

iceberg model kreps and kunimoto 1994
“Iceberg model” Kreps and Kunimoto (1994)





Skin colour

Sea level

Socio-economic status


Sexual orientation

Political ideology

Disability and health

Cultural beliefs, expectations

your cultural identity
Your cultural identity

Which cultural groups would others say you belong to (top of iceberg)?

Which other cultural groups do you feel you belong to (bottom of iceberg)?

question 1 is it reasonable to take time off work to look after a sick child if so who should do it
Question 1Is it reasonable to take time off work to look after a sick child. If so, who should do it?
Question 2Should families look after their own elderly members, or is it OK to put them in a residential home?

Well meaning blunders




Tendency to stereotype


Cultural acceptance

introducing geert hofstede

Introducing Geert Hofstede

A survey of over 100,000 employees of IBM in forty different countries (1980) looking at different cultural dimensions

Five cultural dimensions which chart the general characteristics of a society (though not necessarily each individual member of that society)

areas in which cultures differ hofstede 1991
Areas in which cultures differ(Hofstede 1991)

Power and distance

Individualism v Collectivism

Masculinity v Femininity

Uncertainty avoidance

Long-term v short-term orientation / Confucian work dynamism

1 power and distance

1) Power and distance

The extent to which less powerful members of a culture expect and accept unequal power distribution

2 collectivism v individualism

2) Collectivism v individualism

People integrated into a cohesive group that provides protection, or everyone looking after themselves?

3 femininity v masculinity

3) Femininity v masculinity

In masculine cultures traditional distinctions between the gender roles are maintained. In Feminine cultures the distinctions are blurred.

4 uncertainty avoidance

4) Uncertainty avoidance

Differences in the avoidance of uncertainty or unknown matters, tolerance of ambiguity.

5 long term v short term time orientation confucian work dynamism

5) Long-term v short-term time orientation / Confucian work dynamism



Observing status distinctions (older people having more authority)

Valuing thrift, frugality

cultural dimensions
Cultural dimensions

Universalist vsparticularist (values vs relationships) (UK/Arab countries)

Individualist vs communitarian (individual vs group) (UK/Germany)

Neutral vs affective (range of expressed emotion) (UK/Italy)

Specific vs diffuse (range of involvement) (UK/Asian countries)

Ascription vs achievement (how status accorded) (Asian countries/UK)

universalist uk particularist arab indian subcontinent e g recruitment
Universalist (UK) / Particularist (Arab, Indian subcontinent) e.g. recruitment


Rules more important than relationships

A deal is a deal

Fairness is treating everyone the same

Consistency is valued


Relationships more important than rules

Relationships evolve

So deals can be modified

Treating cases on special merits is valued

neutral uk affective italy e g communication styles
Neutral (UK) / affective (Italy) e.g. communication styles


Don’t show feelings

Little physical contact, strong facial expressions and gestures

Coolness admired

Subconscious verbal/paraverbal signals important


Reveal thoughts and feelings

Touching and use of large gestures is common

Speak passionately

Heated, animated expression admired

specific uk diffuse eastern countries e g meetings
Specific (UK) / diffuse (Eastern countries) e.g. meetings


Direct and purposeful

Precise and transparent

Do not mix business with pleasure


Indirect, aim of communication not obvious

Tactful, maybe ambiguous or opaque

Personal trust important

Mix business with pleasure

achievement uk ascription asian countries e g respect for teachers and doctors
Achievement (UK) / ascription (Asian countries) e.g. respect for teachers and doctors


Respect for what you do

Use of titles only when relevant

Age and gender (etc) don’t determine level of responsibility

‘What have you studied?’


Respect for position

Extensive use of titles

Older males in positions of responsibility

‘Where did you study?’

what is prejudice1

What is prejudice?

To make a judgement without having the facts

be aware of system1 system 2

Be aware of System1 / System 2

‘Thinking Fast and Slow’

Daniel Kahneman

part 3

Part 3



Which aspects of your identity would you refuse to give up?Which aspects do you feel could not be changed even if you developed impairments?

what do we mean by disability

What do we mean by ‘disability’?

A physical or mental impairment which has a substantial and long term adverse effect on the ability to carry out normal day to day activities

Disability Discrimination Act 1995



  • Learning disability
  • Psychiatric illness
  • Paraplegia

Which do you feel least able to cope with?

Which do you feel best able to cope with?

the individual or medical model of disability
The individual or medical model of disability
  • Sees each disabled person as an individual bound up with their own condition or malfunction
  • Impairments are seem as a problem
  • The individual must strive to ‘overcome the impairment
  • The aim is to be/act as ‘normally’ as possible
  • Assumes every disabled person wishes to be ‘cured’
  • ‘Cures’ lie with doctors or therapists
the social model of disability
The social model of disability
  • Disabled people are disabled by physical, organisational, attitudinal/behavioural barriers in society
  • ‘Disability’ refers to the restrictions society causes, not to the impairments themselves
  • The aim is a world fully accessible to all
  • If everyone is free to participate fully there would be no ‘disabilities’
who classification of impairment disability and handicap 1980
WHO classification of Impairment, Disability and Handicap 1980

Disease (Pathology)

Impairment (Symptoms and signs)

Disability (Activities of daily living)

Handicap (social roles)

an odeon moment
An Odeon moment


ask the elephant
Ask the elephant


Kvalsvig A. 2003:362(9401): 2079-2080