Reflections on Ableism

During National Physical Therapy Month, physical therapists are highlighted and recognized as a critical health care provider. The Department of Physical Therapy and Rehabilitation Sciences  at UCSF recognizes the team effort in providing the highest quality of care to our patients and their families. We strive to be allies with our patients with an emphasis on optimizing their quality of life. Physical therapists are movement specialists and provide individualized care to support each and every person’s unique needs.

There are a billion people worldwide and 15 percent of the population are living with disabilities. The health disparities are striking. People with disabilities are three times less likely to access the health care they need, four times more likely to be treated badly, and five times more likely to have a catastrophic health expenditure. If we

have aspirations for health equity for all and if quality health access is a right for all, we have a lot of work to do to achieve these goals. These are not just aspirations for people with disabilities, but for health equity in the health systems that provide care to all.  Designing health systems for people with disabilities improves health services for everyone. The Missing Billion organization is gathering good practices for inclusive health systems. More so, they are involving people with disabilities in the transformation of health systems to ensure that the input of those  in need are considered and integrated into this process. As physical therapists, we work with patients who have disabilities of all kinds, physical, sensory, cognitive, temporary, invisible, etc. We strive to have our spaces accessible to everyone.

October as Disability Awareness month is also a reminder to reflect on ableism. Ableism is discrimination in favor of the able-bodied and against those with disabilities. There are several perspectives on the definition of ableism. One example would be a health care provider trying to “fix” a person with a disability as opposed to having an individual discussion with each person to figure out their individual goals and how they can maximize their function.. Disability is related to the characteristics of the person combined with the barriers in society or environment that hinder them from participating in life. Disability is not just defined by the presence of a physical or mental health impairment - it is determined by the person’s experience in society - their school, home, community and work environments.

We’re working on recognizing ableism in our own behaviors as well as in the health systems in which we provide care. Some of the things we’ve been reflecting on are:

• Viewing disability not as a problem to be fixed, but an integral part of a person’s lived experience.
• Being an active listener, respecting the patient’s story.
• Not associating stereotypes with certain types of physical and mental health impairments.
• Advocating for systems that provide for or care for people with disabilities - without stipulations that limit choices.
• Contributing to a society that doesn’t hinder others - lessening the impact of impairments on participation.
• Committing to continue to learn about how ableism is a part of our own behavior and the systems in society.
•  Are we thinking about the spaces in which we practice, are we asking patients about the barriers they experience to accessing care?
• Are we thinking about DEI work with an accessibility lens?
• How are we approaching our patients and identifying our patients’ needs for equitable access to care? How are we using words (phrases) that may have implicit bias towards able-bodied preference (for example optimizing or maximizing function vs increasing or fitting into a criteria of performance)?
• How are we addressing people with disabilities, are we asking their preferred language style?

We invite you to continue the conversation, engage in self-reflection, and visit resources as we build a more inclusive environment for all.