- (2013) Volume 10, Issue 4
Editor, Diversity and Equality in Health and Care; Professor of Diversity in Health and Social Care, Mary Seacole Research Centre, De Montfort University, Leicester, UK
Editor, Diversity and Equality in Health and Care; Professor of Nursing, Faculty of Health, Birmingham City University, Birmingham, UK
In September 2013 the largest public library in Europe was opened in Birmingham, the second largest city in the UK. The opening speech was given by one of that city’s newest residents, Malala Yousafzai, the victim of a Taliban-inspired attack for having the temerity, as a girl, to go to school. A leading member of the Taliban is alleged to have later written to her saying that the attack was also about her running a campaign saying how nasty they were (Waraich, 2013b).
Malala Yousafzai was shot in the head and could have died. However, she was rapidly transported from Pakistan to the Queen Elizabeth Hospital in Birmingham, where she received timely treatment and care which saved her life. On leaving the hospital she began to attend the school across the road from one of our offices, and has since become a global champion of education for all children. At the Birmingham library, Malala Yousafzai gave an inspiring speech (Yousafzai, 2013a). She explained that in Swat (Province, Pakistan) ‘I was considered to be a good and obedient student and I also used to get top marks in my class. Apart from my school textbooks I read nine books from the library. Two of them were The Alchemist and Sophie’s World. I thought I did a great job in my whole 15 years of my life.’ In Birmingham she discovered a culture in which people of all ages read hundreds of books. ‘Books’, she reminded us, ‘are very precious’, and indeed they are. Books open the mind to new possibilities, they entertain, record, instruct, comfort, explore and form a bridge, across time, by which we can touch the thoughts of those who lived long before us. Books are powerful, which is why of course totalitarian regimes of all hues, including the Taliban, see them as a threat, and either destroy them or deny access to them for those who might get ideas above their allotted stations. Even in apparently developed and liberal societies, libraries are at risk (see, for example, Voices for the Library, www.voicesforthe library.org.uk). In her speech to the United Nations earlier this year, Malala Yousafzai explained that ‘The power of education frightens the Taliban and others like them. They are afraid of women. The power of the voice of women frightens them’ (www.aworldatschool. org). In a way they are right to feel threatened because, as she has pointed out, books are their nemesis: ‘the weapons that will defeat terrorism’, and ‘one child, one teacher, one pen and one book can change the world’ (Yousafzai, 2013a). Books and education are thus keys to change, enabling children and adults to develop and make constructive contributions to their families and societies. At a time when so many young people in developed countries seem to be discouraged by and disillusioned with education systems that seem to be more about games of political football than the provision of services, the determination and persistence of other children and young people, throughout the world, to secure an education for themselves shames their elders. Education is a right, and it is a right for every individual.
However, Malala Yousafzai’s experience also exemplifies another issue, namely the positive contribution of diversity to daily life. Birmingham is one of the most diverse cities in the UK, and it is this diversity that has created such a vibrant culture in which members of different traditions live together.Nearly half the population is in the younger age groups, and in most school classrooms English is an additional rather than a first or even second language. Cities such as this offer hope of a brighter future, and Birmingham is not the only example. Toronto was once the northern terminus of the Underground Railroad for those escaping slavery in the USA, and an estimated 40 000 people reached freedom (Black History Canada, www.blackhistory canada.ca). Many settled in the city or surrounding area and contributed to the increasing diversity of the population. Nowadays, everyone arriving at Lester Pearson Airport receives a free magazine about the city, which extols its touristic and commercial offerings, and significantly draws attention to the diversity that enables such a wide spectrum of offerings. A local four-time Olympic Gold medallist, Johann Koss, states that ‘Multiculturalism is the classic answer to what’s unique about Toronto ... it brings a lot of talent (and) drives creativity and opportunity’ for everyone. Among the sections of the population who are currently celebrating relatively new-found freedom are those whose sexuality and sexual preferences differ from those of heterosexuals. Toronto will host World Pride 2014, with a brief that is both more inclusive and also more diverse than ever: lesbian, gay, bisexual, transexual, transgender, intersex, queer, questioning, 2-spirited and allies (LGBTTIQQ2A) (www.pride toronto.com/about/mission). The aim is to honour the past, and to recognise, respect and value very different sexual perspectives; diverse sexuality and preferences are no longer grouped together as simply ‘lesbian or gay.’ There is now embodied evidence that sexuality is far more complex than was previously realised, and it is a cause for celebration that, in at least some areas of the world, people have more opportunities to be themselves, regain their suppressed past and look forward to the future.
Such opportunities and equality, including education, access to books, and being able to live openly without dissemblance, are all the more valuable for having been hard won. They must never be taken for granted. The threat of losing them is ever present from those who use violence and aggression to impose their narrow, invariably miserable view of how they want theworld to be, but also from the insidious, poisonous rhetoric of those who find it convenient to use the less powerful as scapegoats. This creeping erosion of equality is particularly dangerous because it so easily becomes one of the taken-for-granted aspects of everyday life that people do not bother to question. It is essential to remain alert to this and to challenge its effects in every way possible.
Readers will be aware that we take a very broad view of diversity because this gives us a platform from which to address the interconnectedness of diversity and equality issues. These rarely occur as single factors. For example, inequalities in education usually link to those arising from poverty and gender disparities, and may also link to cultural and political issues. In this issue we present papers that reflect the multifaceted nature of diversity and equality. In our first paper, Kristal O’Neill et al (2013) presents her study of lesbian women becoming parents. Most heterosexual parents find this a challenging experience, but services are, at least in theory, geared to meet their needs. Negative attitudes, myths and prejudices can mean that lesbian women are excluded from much of this support. O’Neill does not shrink from the desperation that some women may experience, or the sensitive design that is required to conduct the interviews for this study. Although O’Neill describes some appalling instances of poor treatment and insensitivity, she balances these with reports of good practice. We hope that this paper will prove illuminating for healthcare professionals in other settings.
Liz Tilly (2013) moves the focus to the possibility of people with learning difficulties, or disabilities, living autonomous lives and receiving the help they need to manage their own health.Many of them are non-users of services. Even when they do access healthcare, communication failures may lead to wrong treatment or under-diagnosis, which exacerbate their problems. The lessons learned here should open the eyes of all front-line care staff, and the paper ends with some clear and simple recommendations.
Our third research paper takes us to a communitybased project in South Africa, where the survivors of sexual and gender-based violence are at high risk not only of HIV-related illness, but also of psychological ill health. Prince Nare (2013) introduces the Thohoyandou Victim Empowerment Programme, which facilitates the provision of medical, psychological and legal help for rape victims of both genders and all ages. The model of post-exposure prophylaxis described here, embedded in community structures, including the Chief ’s kraal, demonstrates both multiple inequalities, including poverty, lack of transport, and police attitudes, and the diverse strategies required to meet victims’ needs. This holistic approach to inequality reduction carries overtones of studies in many sectors around the world. In support of this paper,we include a CPD feature that we hope will help concerned professionals to inform themselves better about rape and related issues that have featured several times in our editorials and which remain a major public health scandal (McGee, 2013).
Steve Sizmur and Katherine Ko¨rner (2013) provide a counterweight to our usual diet of qualitative research, by giving us access to and insight into the statistical evidence of the NHS patient survey programme. This major rolling study now asks questions about all of the characteristics protected by the Equality Act 2010, and the survey demonstrates the similarities between the experiences of different categories of minority status, as well as their interactions or the effects of ‘intersectionality.’ Qualitative studies repeatedly report a demand for respect and dignity among disadvantaged groups. This paper shows how hard it can be to feel dignified and respected as a service user if one belongs to one or more at-risk categories.
Our final paper, from Sandro Cattacin and colleagues (2013), proposes a way forward for healthcare systems, based on a major European project to devise universally acceptable equity standards. Among other vexed questions, it addresses the definition of the term ‘intersectionality’ (as used above). It is gratifying to find that the perspectives offered here are not confined to a single jurisdiction or national welfare system, and that we can indeed find common ground to move processes, policies and practices forward. We commend these tools to our readers and those that they hopefully influence, as a means to promote action in achieving those elusive ‘millennium goals’ (now, itmust be said, reframed largely as ‘2020 Goals’; ec.europa.eu/eahc/ news/news231.html). Let us hope that we get there before then.
Last, but by no means least, we have our other regular features. Sarah Cruddas reviews a research paper about early intervention in psychosis in Did You See? This provides a sideways look at routes into psychiatric care and the direction of untreated psychosis among Bangladeshi, Pakistani and Indian participants. It is interesting to note that the way that the reviewed study combined these three groups to form a general South Asian ethnic group would not be considered acceptable practice in this journal, and is increasingly being recognised as creating artefactual bias. In the Practitioner’s Blog, Sarah Brown and Mary Dawood reflect on an unsuccessful resuscitation, and issues of diversity when managing family witnesses to these efforts. We hope that this might be helpful for future training of Accident and Emergency staff. The present edition of Knowledgeshare will be the last to be edited by Lorraine Culley. We thank her for her steady and inclusive hand in guiding it through our history to date, and we now welcome Dr Nicky Hudson to the role, with great expectations for the impact of a new broom! Our thanks also go to our reviewers for Volume 10. We could not produce the journal to its current standard without them. Nearly all of our authors comment on the detailed and helpful suggestions they receive after peer review. Our reviewers have great knowledge and patience, and seem to be inexhaustible in their passion to develop the quality of evidence and debate in the field. We extend an invitation to anyone else who would like to gain experience in writing for publication, or who has a burning desire to share their insights by contributing to any of our regular features, and we are happy to provide gentle and constructive support when required. We would especially welcome contributions that could enhance professional vocational education, and reviews of less commonly seen publications or media.
We learned recently that the well-known publishers Sage are preparing an Encyclopedia of Human Services and Diversity for the library reference market. They remark in their advice to authors that ‘Encyclopedias have been prepared on human services, social work, or mental health, in general, but none specifically come from the perspective of diversity’, and they observe that, as human services professionals face an increasingly diverse service, they require new focus, training, and up-to-date, cutting-edge references to evidence. How could we have put it better? And isn’t that just why this journal has been in existence now for 10 years, in order to meet that need? Following on from this, maybe we can bestow congratulations and perhaps a small pat on our own backs as a community, to celebrate the fact that the diversity field is growing and gaining more recognition. We also learn from the publishers that our younger cousin publication, the International Journal for Equity in Health, has received an increased impact factor of 1.84. They note that since they launched the journal in 2010 it has seen a consistent growth in both impact factor and quality of research submitted to and published in the journal. We also feel that, since our launch in 2004, there has been a marked increase in the quality of research in the field, in terms of both theoretical sophistication and research design. For our readers and authors, we are pleased to report that Diversity and Equality in Health and Care has now been accepted for listing inSCOPUS (SciVerse), which will raise our visibility and ease of accessing our papers. However, if we are to achieve a substantial impact factor, it is important that you all cite the papers you read here in other journals when you write for them, too! It is a case of ‘Use us or lose us.’
Twitter: If anyone wants to Tweet, we now have an @DiversityJnl identity which provides an alternative to contacting us using the email address (dhc@ radcliffepublishing.com). We intend to use the Twitter feed to ensure the widest possible coverage of the journal, and shall be using it to highlight other issues or matters of concern to our readership. We welcome feedback and hope that this might make it easier for some of our readers to respond to what they have read in the journal, as well as to ReTweet and spread the word about us. Please also ‘follow’ us!
