By Andrew A. Parsons, Ph.D., biopharma/life science neuroscientist, EMCC accredited coach/mentor and certified professional medical coach
I attended this webinar (Reimagining Wellness) to learn more about ways of addressing healthcare inequities. The three presenters: Anita Mwalui, TQ Davis and Eirasmin Lokpez-Cobo passionately shared different angles on social determinants of health and how the changing demographics and cultural shifts occurring in the U.S. impact wellness practitioners.
The topic of “reimagining wellness” seemed highly appropriate due to current changes in our societies, ongoing challenges of the global pandemic, and the increasing frequency of extreme weather conditions. The presentation summarized some of these challenges, highlighted health inequalities and demonstrated their detrimental impact.
Thus, the timing of the webinar was indeed timely as we are living in a time of transformation. The way we live our lives, work, play, connect and learn are changing quickly. For practitioners, it is time for us to reimagine and transform our approach as we step up to address inequities.
Following the webinar, I wondered, how could I transform my professional approach to support the levelling up of health inequalities?” I could see similarities with other initiatives aiming to transform the way we think and act. For example, the climate coaching alliance has gained support from several professional coaching bodies and those related to coaching psychology (see https://www.climatecoachingalliance.org/statement/). The commitment is clear “to raising awareness and knowledge with our members, and to providing safe and challenging spaces for them to reflect on their role and their practice in the light of global challenges.”
As coaches and educators, we can support transformation through dialogue with our clients. Recently, a third-generation coaching process that advocates for transformative, generative and genuine dialogues has been described (Stelter, 2019). In these exchanges, the coach becomes a co-creative dialogue partner exploring meaning and action around specific themes. This approach provides an individual transformation. My reflections led me to imagine how wellness professionals could come together and create a collaboration and scalable transformation with a focus on creating health equity.
One-on-one and group conversations have contributed to a lot of transformational change. Mezirow first described it more than 40 years ago as “the process by which we transform problematic frames of reference …. To make them more inclusive, discriminating, open, reflective and emotionally able to change.” (Mezirow 2006)
In the early studies of women returning to the workplace or education, he identified 10 phases of a personal transformative experience. The initiation or first phase occurs with an experience that challenges our beliefs, perspectives, or world views. Mezirow summarized the approach into critical self-reflection of our assumptions and the sources, nature, and consequences of our habits as well as a full commitment to critical discussion.
Transformation is a dynamic process that is unlikely to happen overnight as it requires energy and determination to maintain a reflective and critical discourse. I was curious to see what might emerge if I applied what I learned and here are some results:
Expanding My Thinking
I was surprised to learn that multicultural groups account for 100% of the U.S. population growth in the 2020 census (Source US Census Bureau 2020, Brookings Metropolitan Policy Program 2020). These data really underpinned one of the key messages from the webinar that “one size does not fit all.” For example, access to clean air, water, safe housing, and the response to the pandemic all have cultural aspects that need to be considered.
Additionally, reflecting on the Paralympics this summer helps us to understand how our society views difference and disability. The Olympics and Paralympics show what humans can achieve. In a study sponsored by SCOPE in the U.K., findings suggested that the pandemic has slowed efforts to change negative attitudes toward disabilities. For example, approximately 20% of disabled people believe attitudes toward them have worsened in the past few months and 56% believe disabled people are seen as more vulnerable than before the pandemic (https://paralympics.org.uk/articles/paralympicsgb-and-scope-issue-rallying-call-to-fans-to-turn). This reinforced that there is still a considerable stigma associated with disability and an incentive for people to hide anything that is invisible. Disparity is still highly prevalent as exemplified in bonuses for Gold Medalists (https://www.bloomberg.com/news/articles/2021-08-20/prizes-for-paralympic-gold-medalists-reflect-inequality-for-many).
The second approach in transformative reflections is to examine the source of frameworks, which can be daunting when health and well-being operates in multi-level, complex and dynamic systems. However, the multicultural wellness wheel focuses on three pillars: personal & family, community and worksite for optimal life-long well-being. Taking different socio-economic perspectives into account helps challenge our inherent perspectives and provides an opportunity to create new frames of reference. This requires us to continually develop cultural knowledge, self-awareness, empathy, and interpersonal skills to communicate effectively.
Working with highly technical individuals and teams requires checking frames of reference regularly. In my experience, tension in highly technical and cross-functional collaborations occurs when there is a lack of communications or clarity. One of the key learnings from the webinar is the differences between diversity, equality, equity, and justice. Reflecting on the transformational learning processes allowed me to focus on the differences in understanding some of my mental frameworks.
Redefining the Issue or Finding a Better Question
I also found that the visual approach used by the presenters was an effective learning tool. This simple cartoon demonstrates the differences between inequality, equality, equity and justice (https://onlinepublichealth.gwu.edu/resources/equity-vs-equality/). As a practitioner, graphics enable critical dialogue and a transformational shift in perspective.
I find these visualizations useful in redefining the problem. Initially, I focused on “how to create equitable access to the apples from a bent tree.”
One solution is to use different sized ladders as an equitable way to access the apples. However, one side of the tree still has more apples than the other. Thinking differently about this issue provides a completely different approach to finding the solution. If the question is “how to create a uniform crop of apples on both sides of the tree” then a different solution emerges. A more systemic solution engages supports and pulleys to straighten the tree. Readjusting the “bend” allows a more uniform distribution of the crop. This approach requires energy and resources to rectify the structural problem of the tree. However, it provides a longer lasting, equitable opportunity for the characters. As a coach, the very simple question of “what else” can support our clients in finding different ways of seeing issues or problems to develop solutions.
The presenters outlined several opportunities to address inequities through reimagining wellness. I could see an elegant redefinition and focus to create a rebalancing of health inequalities. Some of the approaches that were raised included fair representation in clinical trials; increasing HCPs cultural competency; person-centred campaigns; and education programs to partnering with government, corporations, communities, and other stakeholders.
As wellness professionals, take time to review this webinar and reflect on how you can expand your current knowledge, learn ways to create new understandings, and reimagine ways of incorporating what you learn into your professional and personal practices when one size doesn’t fit all. Eloquently stated by Paula Dressel on the webinar, “The route to achieving equity will not be accomplished through treating everyone equally. It will be achieved by treating everyone justly according to their circumstances.”
References and Recommended Reading
- Mezirow, J. Education for perspective transformation: women’s re-entry programs in community colleges. 1978. Mezirow, J. (1991a). Transformative dimensions of adult learning. San Francisco: Jossey-Bass.
- Mezirow, J. (2006). Transformative learning theory. In Sutherland, P & Crowther, J. (eds) Lifelong learning: Concepts and contexts
- Stelter, R (2019) The art of dialogue in coaching. Routledge, Abingdon,UK