This example is given by Margarita Mondaca, Assistant Professor Reg.OT, MSc., PhD; Deputy Program Director & International Academic Coordinator; Division of Occupational Therapy Department of Neurobiology, Care Sciences and Society| Karolinska Institutet

Title: Health Equity and disparity in occupational therapy

Time required: 3 hours (3 sessions of 40 minutes)

Materials required: The wheel of power/privilege

Intended Learning Outcomes:
By the end of this teaching session, students shall be able to:
• Describe structures of power and privilege at play within occupational therapy
settings
• Discuss how health equity resonates with the SDGs’ overarching principle of leaving no one behind and how it relates to occupational therapy
• Reflect and be critical about own implicit biases
• Use a model to combat and deconstruct implicit bias in self and others
• Engage in a data-driven approach to combat health disparities

Procedure:
Before the teaching session
Reflect on:
1. What are comments, situations, and feelings that trigger you? How will you handle it if they come up during the session that you are leading?
a. What is your style of communication and interaction? Being an extrovert/introvert, silent/verbal processor, confrontational/avoidant, cerebral/emotive, strict/flexible with agenda timing, is important to know so that you can facilitate intentionally.
b. What are you hoping to accomplish during the session? This is not only important for planning but also so you can be aware if you are projecting/forcing your own goals onto the conversation ineffectively. This is just one step in the
process. Furthermore, you cannot teach to the furthest behind.
c. Consider the impact of your own identity. What might white, brown or black facilitators need to be sensitive of? What might female, male or transgender facilitators need to be sensitive of?

Prepare the space. Make sure your technology works in the space you will be in. Make sure the room is set up to facilitate the type of activity and discussion that you are planning (small groups? lecture? movable chairs and tables?). Details such as music, lighting, and resources, can help create a safe and welcoming space.
Pre-course preparation
do take about 15-20 minutes and an interpretation of the results follows. These take several minutes to read. We believe that 1-2 Implicit Tests are best done on an individual basis before coming to the course and then followed by a reflective exercise during the teaching session.
Ask your student to visit the website Project Implicit (https://implicit.harvard.edu/implicit/): Harvard has developed several self-directed tests that provide an individual with feedback for their affinity to one group or another. The tests

During the session

Show the Wheel of Power and Privilege
Discuss the ways that power/privilege presents itself and common defence mechanisms. Some examples are:
a. Dominating the conversation
b. Invalidating/reframing experiences
c. Focusing on action rather than process and listening to the experiences of others
d. Tone policing
e. People of privilege distancing themselves from their group (i.e. a white person
talking about the way other white people behave in an attempt to separate themselves as exceptional)
f. Focusing on ways in which one has been oppressed other than race (i.e. bringing up class or a white woman focusing on her identity as a woman rather than her white privilege)
6. Introduce the concept of intersectionality through the wheel of power/privilege
a. The interconnected nature of social categorisations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage.
b. Make sure you describe that intersectionality is not about who has it worse or
who has it best, but rather that different persons will experience racism, sexism,
homophobia, transphobia in different ways so that a white woman and a black
woman may have radically different lived experiences of sexism, which may not
necessarily look the same.
7. Introduce Health Equity
a. Health equity resonates with the SDGs’ overarching principle of leaving no one behind and the implicit moral imperative of social justice. Health equity, as described by the WHO Commission on Social Determinants of Health (CSDH), is the absence of inequalities in health that are avoidable by reasonable means. Health is universally valued, and health for all is a societal goal justifiable on moral grounds.
b. Show statistics of how racism, sexism, homophobia and transphobia (or other discrimination relevant to your context) impact the quallity of healthcare provision.
c. Discuss the link between occupation therapy and poverty and inequality so as to leave no one behind. Typically occupational therapy is seen as treatment for the high income groups, how can we make it accessible so as to leave no one behind?
8. Introduce Implicit Bias
a. Unconscious attitudes and beliefs – example: white occupational therapist assuming a patient may not carry out a home therapy program because of a lack of intellect based on their race or socioeconomic status.
b. Many health care professionals are not aware of their own biases and are sometimes confused or defensive when they are called on to “own” behaviours which are offensive and viewed as racist, sexist and so on. They may view racism or sexism as a conscious stereotyping or prejudice which often fuels malicious intention.
c. Let students discuss in small groups what they learned about themselves and how they feel after doing the Implicit Tests required as preparation for class.
9. Challenge your stereotypes
a. Recognize and label stereotypic thoughts or stereotypical portrayals. Examples:
Leaders are tall, White men; Asians are good at math; Blacks are good at sports; Hearing someone say: “Blacks are…” or “Muslim women are…” or “you people are ...” about any group
b. Identify precipitating factors. Examples:
i. Were stereotypes reinforced by information, pictures, or media images?
ii. Were you fatigued or under time pressure?
c. Get students to research academic publications that challenge the fairness of tthe portrayal and replace it with data.
10. Debrief for the last 15 minutes of class, together with your students discuss:
a. What will you take away from this experience?
b. How will you use this experience after you leave this space?
c. How will you use this experience in your occupational therapy practice?