Solidarity in Action

Asian American and Pacific Islander Heritage Month - May 2022

Dear UCSF Department of Physical Therapy and Rehabilitation Science Community,

The inauguration of Asian American and Pacific Island Heritage Month in the United States ensued from a conversation that Frank Horton, a representative from New York, had with a Capitol Hill staffer, Jeannie Jew, who brought the idea to him over 15 years before it was authorized by former President Jimmy Carter on March 28th, 1979. It was initially dated for the first week of May due to two historical reasons: 1) It commemorated the first known Japanese immigrant to the U.S. on May 7, 1843, and 2) to honor the completion of the transcontinental railroad on May 10, 1869, wherein 20,000 Chinese workers who participated in this construction[1].  From 1992 onward, Asian American and Pacific Island Heritage Month is remembered and celebrated. This historical precedence shapes our thoughts today as we acknowledge the two specific yet distinct racial groups for their significant contributions to this day.  But we also remember and celebrate with other underrepresented minorities from different racial and ethnic backgrounds who also helped pave the way yet traditionally were assigned as AAPI and not in their unique representation. While there are multiple reasons for the broad classification of AAPI of these subgroups, it poses a unique challenge to recognize the complexity of identifying individuals and cultures accurately represented and reported within the broad category of Asians and Pacific Islanders in their own right. Contributing to this challenge is the lack of consensus in terminology in reporting standards by the Office of Management and Budget (OMB) (ref 3), but also socio-political factors that continue to underpin the discussion between aggregation vs. disaggregation of data.  Not surprisingly, this broad view provides us with data on the larger population of Asians: Chinese, Indian, Filipino, Vietnamese, Korean, then Japanese [2]. What it potentially overlooks are the smaller populations of which there are nearly 50 others (Burmese, Pakistani, Tibet, Kazakhstan, Tajikistan, Azerbaijan, Iran, and Armenia to name a few). This broad view of all Asians is somewhat similar while related cultures, impacted policies, unique forms of celebrations, and recognitions are narrowly focused on these larger groups that demonstrate a paradoxical definition of the term “Asian.” 

There have been many discussions, different perspectives, and rationale for aggregating and for disaggregating the data. Each perspective holds a legitimate case with the thoughtful intention for or against data disaggregation. Those who oppose disaggregation have legitimate concerns for breach of privacy and re-identification of smaller subpopulations of data, especially those with historically underrepresented minorities. Others advocate for data aggregations for the reasons of political strengths and in pursuit of establishing larger clout of solidarity among smaller racial/ethnic groups who share the benefits that derive from overlapping values and cultures within the political sphere. Other concerns for disaggregation are unintended consequences of potentially pitting groups against each other within the AAPI group and perpetuating discriminatory behaviors toward a certain race and ethnicity[3]. While these are only a few challenges mentioned among other potential issues of disaggregation, we must first consider everyone as a representative of a unique identity and socially influenced and constructed being. There is no doubt that all voices, no matter how small or big in numbers need to be acknowledged and heard. Therefore, we need to continue to engage in our local communities that may be misrepresented or “misclassified” from our limited perspective and from the data quality standpoint, especially from the US federal race and ethnicity categories. Not doing so, will perpetuate the cycle of the unknowns of “others” race categories and fail to address those who are critically medically underserved[4]. We must foster appropriate “systems thinking” that takes account of multiple layers of individual systems that evolve from micro (individual level) to meso (group level) to macro (community level) when reflecting on delivering equity healthcare. We must also be culturally mindful about not assuming that certain subgroups all share the same values and come from similar socially constructed places. We know that AAPI is not all the same nor share the same culture and values: for example, there are significant differences between U.S.-born Asian-Americans and second-generation immigrants[5]. 

Appropriate consideration of the various cultures and having the means to assess individuals without glossing over these individuals provide us with a richer story that more appropriately allows us to celebrate the many cultures. We are fortunate that at UCSF, we are already in early discussions with a thoughtful approach to disaggregating data when possible through early groundwork at the education data council. This will help us with identifying overlapping categories of race and ethnicity but also other demographic data that are collected and thoughtfully used to gain further understanding of our learners and to create actionable items. Furthermore, the UCSF Health Equity Council, our admissions committee, and our program assessment committee are considering how data is collected and utilizing this to identify gaps and ultimately provide equitable solutions. Representation matters, and to appropriately represent the unique cultures that exist, we need to reflect on how we think about groups and how we collect information on those groups. 

In solidarity,

Sam Pak, PT, DPT, cert MDT and Alex Dien, PT, DPT

References

[1] About Asian/Pacific Heritage Month [Internet]. [cited 2022 May 22]. Available from: https://asianpacificheritage.gov/about/

[2] Budiman, A, Ruiz, N. Key facts about Asian Americans, a diverse and growing population [Internet]. [cited 2022 May 22]. Available from: https://www.pewresearch.org/fact-tank/2021/04/29/key-facts-about-asian-americans/

[3] Disaggregating Race/Ethnicity Data Categories: Criticisms, Dangers, And Opposing Viewpoints | Health Affairs [Internet]. [cited 2022 May 24]. Available from: https://www.healthaffairs.org/do/10.1377/forefront.20220323.555023

[4] Lee, S., Martinez, G., Ma, G. X., Hsu, C. E., Robinson, E. S., Bawa, J., & Juon, H. S. (2010). Barriers to health care access in 13 Asian American communities. American journal of health behavior, 34(1), 21–30. https://doi.org/10.5993/ajhb.34.1.3

[5] Ye, J., Mack, D., Fry-Johnson, Y., & Parker, K. (2012). Health care access and utilization among US-born and foreign-born Asian Americans. Journal of immigrant and minority health, 14(5), 731–737. https://doi.org/10.1007/s10903-011-9543-9

Resources

Liu, Clifford Z. MS1; Wang, Eileen MD2; Nguyen, Don3; Sun, Mary D.4; Jumreornvong, Oranicha5 The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment, Academic Medicine: February 22, 2022 - Volume - Issue -

doi: 10.1097/ACM.0000000000004639 

 


 

Black History Month - February 2022

Dear UCSF Department of Physical Therapy and Rehabilitation Science Community,

As Black History Month comes to a close, we want to take time to recognize and celebrate the central role Black physical therapists have had in our profession. The contributions of Black physical therapists to the advancement of the profession and rehabilitation services cannot be taken for granted. During this time, we look to individuals such as Bessie Blount Griffin, Thelma Brown Pendleton, PT, and Vilma Evans, PT, EdD who were some of the first few Black physical therapists of the mid-1900’s. These women had to bear the burden of being pioneers within the field and challenging the status quo while facing systemic racism at every turn. The sacrifices made by these individuals and others like them have created avenues for Black physical therapists and other physical therapists of color to become leaders in the field, whether that be as physical therapy directors, program leaders, or APTA officers.

Black History Month is not just about celebrating our past. It is also essential that we look at the current state of physical therapy and work to invest in the future of the profession by cultivating a new generation of leaders. As of 2022, the physical therapy workforce is more racially and ethnically diverse than ever before, however when compared to the diversity in the nation as a whole, racial and ethnic minorities continue to be underrepresented within the profession. This poses a critical problem for quality of care among minority communities, because when compared to white counterparts, minority patients are less likely to receive outpatient physical therapy services, tend to have worse health outcomes, and are less likely to have positive functional outcomes when they do access therapy. We see time and time again that by culturally matching patients and clinicians, there tends to be higher patient involvement in care, higher levels of patient satisfaction, and better health outcomes overall.

To be able to provide the best physical therapy care for our patients, there needs to be greater effort put towards recruiting students of color into physical therapy programs and ensuring retention of those students throughout the program. We believe that increasing the proportion of minority physical therapists through greater enrollment of minority students is an essential step to mitigating health disparities experienced by minority individuals. This belief sparked our research on Factors that Promote Higher Percentages of Under-represented Minority Students in Entry-Level Physical Therapy Programs.

Our research provided evidence which demonstrated that presence of faculty of color and purposeful recruitment and retention strategies are successful in increasing diversity within physical therapy education cohorts. Increased hiring of faculty of color has been shown to increase diversity, as these individuals serve as role models and culturally sensitive advisors for minority students. While implementation of recruitment and retention strategies geared towards minority students increases diversity by properly equipping students with valuable information about the profession and guidance through the application process. These evidence-based strategies can be employed by institutions nationwide to help combat inequality and social exclusion faced by minority individuals who may be interested in pursuing a career within physical therapy.

We hope that physical therapy faculty and program leaders will read this and understand that there are concrete and effective steps that can be taken to increase diversity in physical therapy programs. This problem has been ongoing since the inception of our profession, and positive change will not be made until leaders come together and prioritize a more racially diverse workforce. We cannot continue to wait for others to start the work, it is the responsibility of each of us to engage in this work together.

In solidarity,

Monica Nolte, DPTc and Ashley Omwanghe, DPTc

Resource

 


 

October - 2021

Dear UCSF Department of Physical Therapy and Rehabilitation Science Community, 

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, 15% of the population, 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 (Can we site the WHO for this: https://www.who.int/disabilities/facts/Infographic_en_pdf.pdf). If we have aspirations for health equity for all and if quality health access is a right for all (https://www.ohchr.org/documents/publications/factsheet31.pdf), we have a lot of work to do to achieve these goals. These are not just aspirations for people for 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. 

In solidarity, 

Casey Nesbit, PT, DPT, DSc and Elise Armstrong, PT, DPT 

 


Pride Month - June 2021

Dear UCSF Department of Physical Therapy and Rehabilitation Science Community,

My name is Keanu Andico and I am a recent graduate of the UCSF/SFSU DPT program from the class of 2021. June is Pride Month. This month we celebrate the LGBTQ community. We celebrate our colleagues, our friends, our family, and for many of us, even ourselves. We recognize the invaluable contributions the LGBTQ community have made for society. We also must certainly thank and honor the brave souls who have paved the way for equality and have given the LGBTQ community the opportunity to live life in a way unthinkable not so long before.

The Stone Wall Riots are often regarded as the birth of the Gay Liberation Movement and fight for LGBT rights in the twentieth century. On June 28, 1969, a police raid began at the Stone Wall Inn in Greenwich Village, New York City when members of the LGBTQ community finally fought back and resisted for the first time. Over the next few days, the protests continued for their right to publicly assemble and be open about their sexuality without fear of being arrested. Over the next few months, gay rights activist groups began to form and mobilize. And somewhere during this time, the Gay Liberation Movement was born.
 
The first Gay Pride March took place on June 28, 1970, marking the one-year anniversary of the Stonewall Riots. Today, LGBTQ pride events are held annually in June across America and in other parts of the world. President Bill Clinton first recognized June as “Gay and Lesbian Pride Month” in 1999. And most recently, June was declared “LGBTQ+ Pride Month” by President Joe Biden in 2021.
 
While Pride is just one month of the calendar year, we don’t stop celebrating the LGBTQ community once July comes around. Pride month simply serves as a reminder of what we have accomplished thus far as well as a catalyst for what we still hope to achieve. The fight for equality and equity is still far from over.
 
In healthcare, LGBTQ disparities continue to persist under the guided hand of systemic homophobia within our society and even in our healthcare systems. This was made very apparent while I was conducting my research on Sexual Orientation Disclosure in healthcare, which was recognized at the state level in the 2021 California State University annual research competition. In my research presentation, I emphasized the well-documented LGBTQ health disparities that certain LGBTQ groups have less access to healthcare services, report a lesser quality of care, and experience worse health outcomes than straight and/or cis-gendered people.
 
Sadly, however, far too often do I hear people say “Why do we still have a Pride Month? Aren’t things much better now?” While society has undoubtedly made significant progress, there is significant progress yet to be had. And even when the day comes that LGBTQ people are treated equally and have the same exact opportunities as straight and/or cis-gendered people, I still believe there should be a Pride Month.
 
To me, Pride Month makes me feel visible like I hadn’t felt earlier in my life. It makes me feel connected to a community that I know will be there for me. And above all, it serves as a reminder to commemorate the generations before me who worked tirelessly and courageously to give people like me the privilege to experience life as unapologetically, fearlessly, and passionately than ever before. Love is love.
 
I ask all of you, whether as an ally or a member of the LGBTQ community, to continue fighting the fight in small or big ways in your practice, research, or personal life for the betterment of UCSF and society at large.
 
Sincerely,
 
Keanu Andico PT, DPT
 
 

March 2021

Dear UCSF Department of Physical Therapy and Rehabilitation Science Community,

March is the month of the year when the United States highlights the valuable contributions and accomplishments of determined and persevering women. As we reflect on the past year with hindsight, which the cliché says is 20/20, I challenge us to look at the progress we have made during the struggle. We as women, the progressive people within the US, and those fortunate to be part of the Bay Area Culture, and moreover UCSF can be the continued change.

Fear struck us in March 2020. The pandemic forced us all - men, women, transgender, privileged, underprivileged, our nation - into containment and a way of life many were unaccustomed; limited, restricted, overwhelmed, and in a way, victimized. Forced to cover up who we are, required to shelter, hide away, extend ourselves, ruminate on our fears, sorrows, learn to survive, and eventually persevere. As women, many of these things were already familiar, except now, everyone was forced to feel it, live it.

We must pause, consider, and reflect on ourselves, just as the symbol of a woman represents. 

Our collective struggles in 2020 played a pivotal role and helped unearth deep-rooted systems our nation has capitalized on from the start. Walking a mile in someone else's shoes hit everyone in some form or fashion over the past year. Though some struggles were inclusive, others - depending on your situation - may have brought a re-emergence of Ruth Schwartz Cowan's 1983 book ‘More Work for Mother’.

  • Is it ironic that 4x as many women, as compared to their male colleagues, were forced to leave the workforce during the pandemic? (1)
  • On a national stage, we witnessed the mass exodus of women from the workplace that Covid caused, which brought uncharted territory for us well beyond ‘The Pregnancy Pause’ - how do we bounce back from this?
  • The Marshall Plan for Moms, calling for policies for equal pay, affordable childcare, and stipends for the “unseen” labor that tends to fall on women.
     

Many of us wore multiple hats since last March: provider, partner, mother, daughter, sister, caretaker, teacher, etc. Only with balance and creativity can one prioritize self-care, and we saw during this struggle many women’s health issues were exacerbated. The ramifications of COVID and the burdens associated with it created increased awareness to women’s physical, mental, emotional, and social health, including access to care, surge in gender-based violence, and the deep existing inequalities that disproportionately affect BIPOC women. The innovation of different service models, like telehealth, were implemented to reach more women and provide the care that would have been lost. We are called to continue creative thinking to enable inclusive and equitable care to further close the health disparities gap.

While many could think this past year was “The Year We Lost”, perhaps there is a new narrative we can share. As we begin to physically emerge from isolation, we are welcomed with what metamorphosis naturally brings after deep self-reflection: imagination, creativity, and much needed change. Women deliver new life into this world, and now, with a woman finally represented on the national stage, perhaps will breathe new life into this country. Through empathy, advocacy, and awareness brought forth by the pandemic, we have increased momentum in future financial, physical, mental, emotional, and societal health for women. It is now up to us to continue to solidify the closure of the gap we have been fighting for.

In solidarity,

Jennifer Kinder PT, MS, DPTSc, Associate Professor

* (1) (https://www.npr.org/2020/10/28/928253674/stuck-at-home-moms-the-pandemics-devastating-toll-on-women)


Juneteenth 2020

Dear UCSF Department of Physical Therapy and Rehabilitation Science Community,

Happy Juneteenth! On June 19th, 1865 a community of Americans received a message that “in accordance with a Proclamation from the Executive of the United States, all slaves are free.” In fact, they had been granted this freedom more than two and a half years prior. Because landowners did not want to lose free labor and because the new Executive Order was not enforced, Black Americans in Texas continued to be enslaved after the proclamation. With the end of the Civil War and the eventual arrival of the Union Troops in Galveston, we were finally all free.

Juneteenth is the oldest nationally celebrated commemoration of the freedom of all Americans. Juneteenth, is a day to celebrate freedom, and themes include drawing together as families and communities, offering healing and support, learning and self-development, and to celebrate achievements.

In our Department, Juneteenth represents an opportunity to celebrate our collective commitment to developing anti-racist practices in physical therapy practice, education, and research. Solidarity in Action is the culmination of several ongoing projects in our department. We aim to better understand the experiences of our stakeholders; develop a sustainable strategy for ongoing development toward anti-racist practices; and support healing and learning. In celebration of Juneteenth, we are proud to launch our Solidarity in Action platform!

Today, we launch our UCSF DPTRS Solidarity in Action Employee Climate Survey. We recognize that our department climate is guided by the attitudes, behaviors, and standards of our team. Including the inclusion of, and level of respect for, individual and group needs, abilities, and potential, across the spectrum of backgrounds, identities, and life experiences. We invite all department employees to provide feedback about their experiences in the department to help develop more equitable systems and practices. By taking a community-informed approach, we hope to also foster a welcoming climate for each and every stakeholder in our community.

Today, we offer the UCSF DPTRS Solidarity in Action Anti-Racism Self-Study Guide. This is an organic, crowd-sourced, document compiled by staff, students, and faculty of the Department. It is intended to serve as a place for community members to offer resources to guide anti-racism understanding and action, and to receive guidance for ongoing personal development. The process of crowd-sourcing represents a recommitment, both at the personal level and as a community, to our Department’s mission.

Today, we participate in the UCSF DPTRS Solidarity in Action UnHidden Curriculum. Students and instructors who are meeting remotely are invited to let their freedom flags fly by using the virtual background feature to share a flag that represents emancipation or freedom. Suggestions include the Pan-African flag, the new Pride flag, the flag of your Indigenous Nation or Tribe, or the American flag. Instructors are encouraged to highlight Black scholars, to discuss how systemic racism impacts their field of study, or to incorporate lessons on freedom or movement.

And finally today, we launch our UCSF DPTRS Solidarity in Action Website where you can access resources to better understand our department’s commitments and actions, find resources for your own learning in anti-racism, and find opportunities to connect with this community. Please share resources or tell us what discussion topics or continuing education workshops would be helpful for you and your team by contacting our Vice Chair of Equity, Kai Kennedy.

We hope that you’ll join in solidarity with us as we celebrate Juneteenth as a community – to begin to heal, to continue to learn, to stand together, and to continue our work until everyone is free.

 

Kai Kennedy, PT, DPT, Vice Chair of Equity

Amber Fitzsimmons, PT, MS, DPTSc, Chair