Mac Unit Ii Prezo 26.04.2023 3 Slide Handout-Colour

4/26/23
POWER IN PRACTICE II:

PROGRESSING PAST AWARENESS
TRACY BLAKE, PT, PHD (she|her|hers) McMaster University

tracyablakeptphd@gmail.com PT PRAC, Unit II
@tracyablake 26.04.2023
WHERE I’M AT, GEOGRAPHICALLY SPEAKING

The traditional territory of many nations, through the Dish with One Spoon
Treaty between the Anishinaabe, Haudenosaunee, and Mississaugas of the
Credit that bound them to share the territory and steward the land. It was
expanded to invite the Chippewa and Huron-Wendat peoples, as well as other
Indigenous peoples, settlers, and newcomers in the spirit of peace, friendship,
and respect.
Rexdale, a multi-cultural, multi-ethnic, multi-faith, working class neighbourhood

in Toronto (Canada).
WHERE I’M AT, PROFESSIONALLY SPEAKING

• Research
• Research Lead, SportsX (MLSE Digital Lab Research and Development)
• Clinical Care
• University Health Network-Toronto Western*
• Canada Basketball—Women’s National Team*
• Education
• Adjunct Lecturer, University of Toronto PT program
• Adjunct Assistant Clinical Professor, McMaster University PT program*
• Guest Lecturer: UBC Kin*, UWO SEM Advanced Practice*
• “Leadership”
• Safety Health and Performance Coordinator, Maritime Women’s Basketball Association
• Editorial: BOSEM, JOSPT*
• External Advisory Boards: ENNRICH (University of Manitoba), CHI2PS (University of Bath)
• Other
• Consultant, Learning and Teaching Fellowship Grant, McMaster University PT program*
• Founder & Program Lead, Canada Games Sport Physiotherapy Leadership Program
I have no additional competing interests or financial disclosures. * compensated
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INTENTIONS
• to model a way of knowing and navigating power and privilege that has
helped me evolve as a professional, and align my purpose with the
needs of the communities I serve
• To model learning, unlearning and relearning (information, ideas, and

boundaries) in real time.
• Caveat:
“We can disagree and still love each other unless your disagreement is rooted in
my oppression and denial of my humanity and right to exist.”
--Robert Jones, Jr.
COMMON TERMS: PEOPLE

• Men (cisgender and transgender)
• Women (cisgender and transgender)
• Non-binary (cisgender and transgender)
• Ciswomen/Cismen
• Transwomen/Transmen
• Assigned female at birth (AFAB)
• Assigned male at birth (AMAB)
• People with insemination-based reproductive systems
• People with ovulation-based reproductive systems
• Construct presenting: how people are seen by others (e.g. Megan Markle, Janet Mock)
• Construct passing: how people try to be seen by others [e.g., Robert Reed (Mike Brady, The
Brady Bunch), Rachel Dolezar]
• Across age, ability, cultural, region, language, religion, etc.
UNIT I REMINDERS
Terms and Concepts
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The ability to access, utilize, and leverage resources (goods and services), opportunities,
POWER and voice.
Jones, 2000
the process by which a theory, lesson, or skill is enacted, embodied, or realized, the act
PRAXIS of engaging, applying, exercising, realizing, or practicing ideas
TasieOsegenwuse, International Journal of Integrative Humanism (2018)
“the examination of one’s own beliefs, judgements, and practices during the research
REFLEXIVITY process and how these may have influenced the research. If positionality refers to what we
know and believe, then reflexivity is what we do with this knowledge.”
Hammond and Wellington (2014), Key Concepts, London, Routledge
JUSTICE
A system or
structure ADVANTAGE DISADVANTAGE
predicated on parity
in access, EARNED Merit Demerit
utilization, and
leveraging of UNEARNED Privilege Oppression
resources,
opportunities, and
voice. Increased emphasis
Decreased emphasis
INJUSTICE
A system or
structure ADVANTAGE DISADVANTAGE
predicated on
differential access, EARNED Merit Demerit
utilization, and
leveraging of UNEARNED Privilege Oppression
resources,
opportunities, and
voice. Increased emphasis
Decreased emphasis
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Respecting the
decision-making PRINCIPLES
capacities of
RESPECT FOR autonomous OF
AUTONOMY persons; enabling
individuals to make BIOMEDICAL
reasoned informed
choices.
ETHICS
Beauchamp and Childress, 1979
10
Balancing of benefits
of treatment against PRINCIPLES
the risks and costs;
BENEFICENCE the healthcare
OF
professional should
act in a way that
BIOMEDICAL
benefits the patient. ETHICS
11
Distributing benefits
risks and costs fairly; PRINCIPLES
the notion that
NON- patients in similar
OF
MALEFICENCE positions should be BIOMEDICAL
treated in a similar
manner. ETHICS
12
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Avoid the causation

of harm; While all PRINCIPLES
treatment involves
JUSTICE some harm, harm OF
should not be
disproportionate BIOMEDICAL
to the benefits of
treatment.
ETHICS
13
“I did then
what I knew
how to do.
Now that I
know better,
Maya Angelou
1928-2014 I do better.”
14
PLAN
• AWARENESS
• ACKNOWLEDGEMENT
• ACCOUNTABILITY
• ACTION
15
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PLAN AWARENESS
ACKNOWLEDGEMENT
ACCOUNTABILITY
ACTION
16
UNIVERSAL ARTICLE 1
“All human beings are born free and equal in
DECLARATION dignity and rights. They are endowed with
reason and conscience and should act
OF HUMAN RIGHTS towards one another in a spirit of
brotherhood.”
(1948)
https://www.un.org/en/about-us/universal-declaration-of-human-rights
17
UNIVERSAL ARTICLE 2
“Everyone is entitled to all the rights and
DECLARATION freedoms set forth in this Declaration, without
distinction of any kind, such as race, colour,
OF HUMAN RIGHTS sex, language, religion, political or other
opinion, national or social origin, property,
birth or other status. Furthermore, no
(1948) distinction shall be made on the basis of the
political, jurisdictional or international status
of the country or territory to which a person
belongs, whether it be independent, trust,
non-self-governing or under any other
limitation of sovereignty.”
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UNIVERSAL ARTICLE 25.1

“Everyone has the right to a standard of living
DECLARATION adequate for the health and well-being of
himself and of his family, including food,
OF HUMAN RIGHTS clothing, housing and medical care and
necessary social services, and the right to
security in the event of unemployment,
(1948) sickness, disability, widowhood, old age or
other lack of livelihood in circumstances
beyond his control.”
19
SEE WHAT THE 2019

HAPPENED WCPT Congress
WAS… Edition
20
“WCPT is committed to diversity and inclusion in its activities and recognises

these are areas where further progress is needed more broadly in the
profession, and society as a whole not just in healthcare, to foster greater
equity for all people.(13-16 )WCPT promotes strategies to increase diversity,
inclusion and equity across physical therapy including in policy, education,
professional and employment practices, and research. Further, as an
organisation WCPT is committed to ensuring a diverse and inclusive
workplace for its employees.”
“In a physical therapy context, those developing standards of education

and practice need to actively engage people from underrepresented
communities in order to ensure diversity within the profession, and to
provide a foundation for an inclusive environment. Physical therapists
should be equipped to embrace diversity in any interactions they have with
others. Understanding how social inequality, advantage and disadvantage
operate, their consequences and how to address these issues(17) are
ethical responsibilities(18, 19) of physical therapists and physical therapy
organisations. Lack of inclusive policies can makes [sic] clinical services
inaccessible for some people and the profession.”
21
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“WCPT recognises that contextual variations and significant co-existing

diversity considerations significantly contribute to the complexity of
implementing diversity and inclusion strategies. There is the potential for
unintended consequences with well-meaning implementation of policies
when such complexities are not recognised.(20, 21) Contextual variations
can include, for example, different national legislations that affect legal and
social practices, cultural norms and socio-economic factors. Different groups
of people receive discrimination in different circumstances, and the same
groups can be discriminated against differently. There are considerable
individual variations within particular ‘groups’ and some people are
discriminated against for two or more factors, such as gender, ethnicity and
age. (22) As a result, policies promoting inclusion need to be relevant to the
specific needs of the communities they serve, while being agile enough to
account for individual differences and future changes.”
22
23
GUEST EDITORIAL / COLLABORATION SPÉCIALE
The Search for Justice: Developing a Collaborative

Understanding of Health Justice in Physiotherapy
https://www.utpjournals.press/doi/pdf/10.3138/ptc-74-3-gee - Wednesday, April 26, 2023 5:38:08 AM - McMaster University Library IP Address:130.113.111.210
Jasdeep Dhir, BSc(PT), MClSc(MT);* Tracy Blake, MSc(PT), PhD;*†‡

Shaun Cleaver, BSc (PT), PhD;§ Jenna Smith-Turchyn, MSc(PT), PhD;*
Patricia Miller, Dipl(PT), PhD;* Meredith Smith, MScPT;¶**††
Mari Udarbe Han, BMR(PT), BSc; ‡‡§§¶¶ Katie Gasparelli, BSc(PT), MSc(RS);***
Sarah Wojkowski, MSc(PT), PhD*
Health justice is achieved when systems and
There is a real and present need for the physiother-
apy (PT) profession to confront injustices. This need
requires a clear understanding of health justice.1–3 In this
must cultivate environments that align with the concepts
and practices of health justice. As a profession, we must
work to build capacity in the community of learners and
structures exist to ensure all people have
editorial, we reflect on health justice in PT and propose
an operational definition and next steps for Canadian PT
entry-level programmes, professional associations, and
health care workers to disrupt and dismantle unjust sys-
tems, and build and reinforce just systems.
There are resources that explore concepts and frame-
access to the resources and opportunities they
regulators to consider.
The World Health Organization defines “health” as a
“state of complete physical, mental and social well-being
works for social justice,8 the social determinants of
health/health disparities,9–11 and health equity.4,9,10,12
However, there is a paucity of literature contextualized
need to attain, maintain, and sustain physical,
mental, and emotional well-being, regardless of
and not merely the absence of disease or infirmity.”4 This to PT that explores health justice, and there is a lack of
definition reflects an integrative understanding of health models and frameworks that can guide application to PT
as opposed to the predominant biomedical paradigm, practice. While Borras noted that the pursuit of health
previous or current health status. Health justice

which treats body, mind, and spirit as separate entities. justice require analyses, strategies, and interventions that
Justice can be described as a system or structure predi- integrate the economic, cultural, and political spheres of
cated on parity in access, utilization, and the leveraging of redistribution, recognition, and representation,13 there is
requires the development of strategies and

resources, opportunities, and voice.5,6 Health equity can little direction on how to achieve this goal.
only be achieved when each individual can attain their
full potential for health and well-being.4 Justice and health PURSUING A COLLABORATIVE UNDERSTANDING OF
equity are the crux of an optimally operating society.7
The current systemic and structural barriers that con-
tribute to health inequity are a global crisis and contrib-
HEALTH JUSTICE IN PT
It’s necessary to have an understanding of health jus-
tice through identified themes, frameworks, initiatives,
interventions that integrate and promote parity
ute to health outcome disparities.2,8,9 Health profession
programmes need to invest the time, attention, and
resources to ensure that learners across the health care
and evaluations. It is integral that these interpretations
are responsive and reflective of the myriad contexts to
which they can be applied. To begin this work in PT, we
in the availability, accessibility, affordability, and
sector are taught in inclusive environments, and develop
the cultural humility and competencies needed to deliver
high-quality patient-centred care. Training programmes
propose the following operational definition of “health
justice.” It is based on the available literature that can be
used to ground collaborative discussions.
quality of services/resources. As well, health
From the: *School of Rehabilitation Science, Physiotherapy, McMaster University, Hamilton, Ontario, Canada; †Sport Scientist Canada; ‡Toronto Western Hospital,
justice needs a voice in economic, social,
University Health Network, Toronto, Ontario, Canada; §Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; ¶Department of Physical
Therapy, University of Toronto, Toronto, Ontario, Canada; **Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; ††Black Physiotherapy
Association, Canada; ‡‡519Physio, London, Ontario, Canada; §§London Health Sciences Centre; London, Ontario, Canada; ¶¶Black, Brown, Indigenous, Person of
cultural, and political systems or structures.
Colour (BBIPOC) Physiotherapy Student Collective in collaboration with the National Student Assembly, Canadian Physiotherapy Association, Canada; ***Healthcare
Excellence Canada, Ottawa, Ontario, Canada.
Correspondence to: Jasdeep Dhir, McMaster University, Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON L8S 1C7, Canada; dhirj@
mcmaster.ca.
Contributors: All authors designed the study; or collected, analyzed, or interpreted the data; and drafted or critically revised the article and approved the final draft.
Competing Interests: None declared.
Note from the Authors: We acknowledge power and privilege associated with our identified affiliations and our personal lived experiences, which influence the lens
through which we present this paper.
Physiotherapy Canada 2022; 74(3); 227–229; doi:10.3138/ptc-74-3-gee
227
24
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INDIVIDUAL SYSTEMIC
INTERPERSONAL
INDIVIDUAL The INSTITUTIONAL
interactions Policies and practices at the
LENS OF A person’s beliefs & actions

that serve to perpetuate
oppression
• conscious & unconscious
between
people-–
both within
and across
organization (or ‘sector’) level
that perpetuate oppression.
STRUCTURAL
SYSTEMIC • externalized &internalized difference
How these effects interact and
accumulate across institutions—
and across history
OPPRESSION National Equity Project. https://www.nationalequityproject.org/frameworks/lens-of-systemic-oppression
25
SEVEN-STEP FRAMEWORK
FOR CRITICAL ANALYSIS AND
ITS APPLICATION IN THE
FIELD OF PHYSICAL THERAPY
26
Perspective
Perspective
Seven-Step Framework for Critical
Analysis and Its Application in the
Field of Physical Therapy
Stephanie A. Nixon, Euson Yeung, James A. Shaw, Ayelet Kuper, Barbara E. Gibson
S.A. Nixon, PhD, Department of
Physical
S.A. Therapy,
Nixon, University of
PhD, Department of
Toronto, 160-500
Physical Therapy, University
University Ave,
of
Critical analysis (or the ability to recognize taken-for-granted assumptions and their effects) is Toronto, 160-500
Ontario, University
Canada M5G
Toronto, Ave,
Downloaded from https://academic.oup.com/ptj/article/97/2/249/2996708 by guest on 23 November 2022
a skill that requires teaching and practice. The purpose of this article is to introduce a
A 7-step framework for critical analysis that can

1V7, and Ontario,
Toronto, International CentreM5G
Canada for
framework for critically analyzing assumptions within physical therapy and illustrate its utility Disability
1V7, and and Rehabilitation,
International Centre Uni-
for
through application to 2 examples: a physical therapy clinic logo and an outcome measure for versity of Toronto.
Disability Address all cor-
and Rehabilitation, Uni-
health-related quality of life (HRQOL). This 7-step framework for critical analysis was created respondence
versity to Address
of Toronto. Dr Nixon at:
all cor-
for a pilot project to develop reflexivity among senior physical therapist students and further Stephanie.nixon@utoronto.ca.
respondence to Dr Nixon at:
be used by students, clinicians, and faculty to

developed through an iterative process of reflecting on its utility for advancing the field of Stephanie.nixon@utoronto.ca.
E. Yeung, PhD, Department of
physical therapy. The 7-step framework is an iterative process involving a cascade of 7 steps: Physical
E. Therapy,
Yeung, PhD, University
Department of
of Physical
(1) name the specific aspect of practice being analyzed, (2) identify the intended purposes of Toronto.University of Toronto.
Therapy,
this aspect of practice, (3) uncover the assumptions that support these intended purposes, (4)
reflect on their practices as physical therapists

identify who benefits, (5) identify who is disadvantaged, (6) link these specific ideas to J.A. Shaw,
J.A. Shaw,
PhD,PhD, Institute
Institute for
for Health
Health System
System SolutionsSolutions
and VirtualandCare,
Vir-
society-level patterns, and (7) conceive of alternatives that mitigate actual or potential harms.
tual Care,College
Women’s Women’s College
Hospital, Hos-
Toronto,
It is emphasized that being theoretically critical does not equate to being negative. Rather, the pital, Toronto,
Ontario, Canada. Ontario, Canada.
word “critical” is used in the sense of thinking deeply and carefully about the intended and
and on norms within the profession more

unintended consequences of actions (including common professional practices, ways of A. Kuper,
A. Kuper, MD,
MD, DPhil,
DPhil, Wilson
Wilson Cen-
Cen-
speaking, and visual representations) in order to reflect on and mature the field of physical tre for
tre for Research
Research inin Education,
Education, Uni-
Uni-
therapy. The purpose of critical analysis is to invite and promote dialogue that assists physical versity Health
versity HealthNetwork;
Network; Depart-
Depart ment
ment
of of Medicine,
Medicine, UniversityUniversity of
of Toronto;
therapist clinicians, researchers, and students to arrive at new insights about the impacts of
Toronto; and of Department of
broadly. By focusing on clinicians and describing

and Department Medicine, Sunny-
their day-to-day actions. Medicine,
brook HealthSunnybrook Health
Science Centre, Sci-
Toronto,
ence Centre,
Ontario, Canada. Toronto, Ontario,
Canada.
B.E. Gibson, PhD, Department of
practical activities involved in learning the skills

B.E. Gibson,
Physical PhD,
Therapy, Department
University of Toronto,of
Physical
and Therapy,
Bloorview University
Research of
Institute,
Toronto,Bloorview
Holland and Bloorview Research
Kids Rehabilitation
Institute,Toronto,
Hospital, Holland Bloorview
Ontario, Canada. Kids
of critical analysis, we depart from previous

Rehabilitation Hospital, Toronto,
[Nixon
Ontario, SA,Canada.
Yeung E, Shaw JA, et al.
Seven-step framework for critical
[Nixon and
analysis SA, its
Yeung E, Shaw
application JA,
in the
et al.ofSeven-step
field framework
physical therapy. for
Phys Ther.
critical analysis and its application
frameworks and maximize opportunities for

2017;97:249–257.]
in the field of physical therapy.
© 2017 American Physical Therapy
Phys Ther. 2017;97:xxx–xxx.]
Association
© 2017 American
Published Physical Therapy
Ahead of Print:
Association
application of the framework in physical

September 29, 2016
Accepted: September 14, 2016
Published Ahead of Print:
Submitted: March 29, 2016
September 29, 2016
Post a Rapid Response to

this article at:
ptjournal.apta.org
therapy.
February 2017 Volume 97 Number 2 Physical Therapy f 1
Post a comment for this

article at:
https://academic.oup.com/ptj
February 2017 Volume 97 Number 2 Physical Therapy ! 249
27
9
4/26/23
Perspective
Perspective
Physical
S.A. Therapy,
PhD, Department of
Toronto, 160-500
University Ave,
of
Ontario, University
Canada M5G
Toronto, Ave,

a skill that requires teaching and practice. The purpose of this article is to introduce a 1V7, and Ontario,
Canada for
for
versity to Address
all cor-
E. Therapy,
Department of
of Physical
Therapy,
J.A. Shaw,
PhD,PhD, Institute
Institute for
for Health
Health System
and VirtualandCare,
Vir-
tual Care,College
Hospital, Hos-
Toronto,
A. Kuper, MD,
MD, DPhil,
DPhil, Wilson
Wilson Cen-
Cen-
tre for Research
Education, Uni-
Uni-
Network; Depart-
Depart ment
ment
of of Medicine,
of Toronto;
Toronto;
and Departmentand of Department of
Medicine, Sunny-
Toronto,
ence Centre,
Canada.
B.E. Gibson,
Physical PhD,
Therapy, Department
Physical
and Therapy,
Research of
Institute,
Toronto,Bloorview
Kids Rehabilitation
Institute,Toronto,
[Nixon
Ontario, SA,Canada.
[Nixon and
analysis SA, its
Yeung E, Shaw
application JA,
in the
et al.ofSeven-step
field framework
Phys Ther.
2017;97:249–257.]
Association
© 2017 American
Ahead of Print:
Association
September 29, 2016
September 29, 2016

this article at:
ptjournal.apta.org

article at:
28
SEE WHAT
HAPPENED THE 2020
Edition
WAS…
29
GEORGE
FLOYD
BORN: OCTOBER 14, 1973
DIED: MAY 25, 2020
30
GEORG
10
4/26/23
31
Editorial
In the fight for racial justice, the are predisposed to occur when there is a
Br J Sports Med: first published as 10.1136/bjsports-2020-102894 on 30 July 2020. Downloaded from http://bjsm.bmj.com/ on April 24, 2023 by guest. Protected by copyright.
pattern of bias towards whiteness as the
sidelines are no longer an option default. This is the foundational tenet of

white supremacy. Acknowledging this is
hard. Accepting it, even harder. But until
1,2,3
Tracy Blake we do, we cannot move towards account-
ability and actionable progress towards
racial justice.
Racism is not extraneous to the sport
The British Journal of Sports Medicine the whiteness of those dominating these and exercise medicine community. Its
(BJSM) has worked diligently to position spaces. impact on athlete health, safety and
itself as ‘a multi-media platform that The quality of research is not reflected well-being cannot be denied. Racism
provides original research, reviews and in its neutrality nor in its objectivity; it is will not fade into obscurity and irrele-
debate relating to clinically-relevant reflected in its transparency. Concepts such
vance simply by people not being racist;
aspects of sport and exercise medicine, as the biopsychosocial model, complex
it must be addressed through intention-
including physiotherapy, physical systems approach and the importance of
ally antiracist actions.3 4 Every aspect of
therapy, and rehabilitation’.1 Its global sport in the context of public health are
SEM scholarship-from the scientific para-
community and partnership network amplified across the BJSM platform. Yet
digms we choose to value,5 to the publica-
includes well over 10 000 sport and exer- there is rarely a mention of any social
tion and discourse policies we choose to
cise medicine (SEM) physicians and sport determinants of health, even descriptively.
enact6-must be re-examined and reformed
physiotherapists—each with an ethical The impact of oppression in any itera-
accordingly. Indigenous Australian elder,
obligation to prioritise athlete health, tion (eg, racism, misogyny, homophobia,
artist, educator and activist Lilla Watson
safety and well-being . When the BJSM transphobia, ableism, ageism, classism,
belonged to a collective from which the
chooses to amplify an issue, the sport religious bigotry, etc) on any component
following quote arose: “If you have come
and exercise medicine community listens. of the research process is never discussed.
here to help me you are wasting your time,
When the BJSM chooses to remain silent, The BJSM requires its authors to report
but if you have come because your liber-
as it has on the impact of racism, colo- their ethics approval, informed consent
ation is bound up with mine, then let us
nialism and white supremacy on athlete and completing interests. But no such
work together”.7 Racial justice is more
health, safety and well-being, that silence standards have been implemented around
the use (or lack thereof) of culturally than just a pipe dream. Reform is possible.
speaks volumes.
competent research practices. Methods The time to act is now. The BJSM is not
Racism is a human rights issue and
sections address how study participants exempt.
a public health issue. The murder of
George Floyd has become the catalyst are recruited, assessed, observed, evalu-
Acknowledgements This article was written in
for reflection, reckoning and reform the ated and treated. But discussion regarding Toronto, Ontario, Canada, on the traditional territory of
world over. The BJSM is not exempt. how the disparity between the racial many nations, including the Mississaugas of the Credit,
Much like the Translating Research into demographics of a study population and the Anishnaabe, the Chippewa, the Haudenosaunee,
Injury Prevention Practice model2 would the population of interest could impact a and the Huron-Wendat peoples. This work would not
study’s generalisability, for example, has be what it is without Jennifer Ogilvie and Winta Desta,
suggest, the BJSM must better understand
whose justice-driven vision, critical consideration,
the presentation and burden of racism, been entirely absent. reflective insight and emotional support were always
colonialism and white supremacy, and The BJSM platform extends beyond right on point and right on time.
identify factors that reinforce their pres- peer-reviewed research articles and edito- Contributors The author wrote, revised and edited
ence and impact, be it implicitly, covertly rials to include blogs, podcasts, educa- this manuscript.
or overtly. tional modules, conference accreditations
Funding The authors have not declared a specific
Research and academic publishing and social media. That platform has been grant for this research from any funding agency in the
have an inequity issue. The pervasive and used to amplify issues and disseminate public, commercial or not-for-profit sectors.
persistent dominance of older, White, timely information for the sport and Competing interests Dr Tracy Blake is an Associated
cisgender male voices has received much exercise medicine community. Thirty-two Editor of BJSM.
attention in recent years, including at the offerings, for example, were disseminated Patient consent for publication Not required.
BJSM. The BJSM has both led and ampli- to help clinicians navigate the COVID-19
Provenance and peer review Not commissioned;
fied actionable changes that have focused pandemic between 18 March and 12 internally peer reviewed.
on disrupting and dismantling the bias June 2020. Yet, until now, none of these
© Author(s) (or their employer(s)) 2020. No
towards the older, cisgender maleness of resources have been used to engage with commercial re-use. See rights and permissions.
those dominating these spaces. Yet, the the sport and exercise medicine commu- Published by BMJ.
BJSM has not engaged in any actions to nity about how racism and other systems
disrupt and dismantle the bias towards of oppression can be identified and
dismantled within the US$1 trillion sport-
industrial complex. The apathetic response To cite Blake T. Br J Sports Med Epub ahead of
1
Department of Physical Therapy, University of Toronto, print: [please include Day Month Year]. doi:10.1136/
from the BJSM to the laundry list of exam- bjsports-2020-102894
Toronto, Ontario, Canada ples of institutionalised and interpersonal
2
Volleyball Canda, Ottawa, Ontario, Canada Accepted 15 June 2020
3
University Health Network-Toronto Western Hospital, racism experienced by Black, Indigenous,
and people of colour within sport around Br J Sports Med 2020;0:1–2.
Toronto, Ontario, Canada
doi:10.1136/bjsports-2020-102894
the globe has not gone unnoticed.
Correspondence to Dr Tracy Blake, Department of
Physical Therapy, University of Toronto, Toronto ON These examples of omissions and ORCID iD
M5S, Canada; tracyablakeptphd@gmail.com oversights do not ‘just happen’. They Tracy Blake http://orcid.org/0000-0002-1888-2940
Blake T. Br J Sports Med Month 2020 Vol 0 No 0 1
32
Institutionalized racism is
normative, sometimes
legalized, and often
manifests as inherited
disadvantage. It is
structural, having been
codified in our institutions
of custom, practice, and
law, so there need not be
an identifiable perpetrator.
Indeed, institutionalized
racism is often evident as
Dr. CAMARA PHYLLIS JONES, MD, PhD inaction in the face of need.
AM J PUBLIC HEALTH, 2000
33
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PROJECT: FREE
*
THE
INTERNET * T e rm s a n d c o n d itio n s d e fin ite ly a p p ly
IS FREE
34
RESEARCH
QUESTION
How has the physiotherapy profession in Canada
mobilized to disrupt and dismantle
institutionalized racism?
35
METHODS
1. Search Canadian physiotherapy institutions for reference to the
following:
• COMMON PRESENTATIONS OF RACIAL INJUSTICE
• “racism ”, “white suprem acy”, “colonialism ”
• FACTORS ASSOCIATED WITH RACIAL INJUSTICE
• “power”, “privilege”, “oppression”
• TOOLS TO DISRUPT OR DISMANTLE RACIAL INJUSTICE
• “diversity”, “inclusion”, “equality”, “equity”
• INCLUSION: inform ation had to be publicly available
2. Conduct a thematic content analysis of the findings
3. Categorize findings according to their alignment with internalized,

interpersonal, and institutionalized racism.
36
12
4/26/23
INSTITUTIONS
EDUCATION REGULATION ADVOCACY
37
INSTITUTIONS Course descriptions

University of British Columbia Western University
University of Alberta Université de Montréal*
University of Saskatchewan McGill University
University of Manitoba Université de Sherbrooke
McMaster University Université Laval*
Queen’s University Dalhousie University
Université du Québec à Chicoutimi* University of Toronto
University of Ottawa*
* Translated in Google Translate or Google Chrome
38
INSTITUTIONS
Codes of ethics, standards of practice, and bylaws
Yukon Regulated Health Professions
College of Physical Therapists of British Columbia
Physiotherapy Alberta College+Association
Saskatchewan College of Physical Therapists
College of Physiotherapists of Manitoba
College of Physiotherapists of Ontario
Ordre Professionnel de la Physiothérapie du Québec*
College of Physiotherapists of New Brunswick
Nova Scotia College of Physiotherapists
Prince Edward Islan College of Physiotherapists
Newfoundland and Labrador College of Physiotherapists
39
13
4/26/23
INSTITUTIONS
Canadian Physiotherapy Association

Blogs
General Content
Publications
Branches
Division content
Events
40
INSTITUTIONAL NETWORKS
2009 Entry-to-Practice Physiotherapy
Curriculum: Content Guidelines for
Canadian Council of
Canadian University Programs (CCPUP)
Physiotherapy University
Programs (CCPUP) 2012 Physiotherapy Accreditation
Standards for Entry-Level
Physiotherapy Education
Physiotherapy Education Programs
Accreditation Canada (PEAC) (PEAC)
Canadian Alliance of
Physiotherapy Regulators 2016 Core Code of Ethics for
(CAPR) Physiotherapists in Canada
(CAPR/PTCA*)
National Physiotherapy
Advisory Group (NPAG) 2017 Competency Profile for
Physiotherapists in Canada (NPAG)
2019 Core Standards of Practice for

Physiotherapists in Canada (CAPR)
41
FINDINGS
No mention of common presentations of
EDUCATION racial injustice
Themes: professionalism (diversity),

therapeutic relationships (power)
No implicit or explicit connection to

institutionalized racism
42
14
4/26/23
FINDINGS
No mention of common presentations of racial
injustice or factors associated with racial injustice
REGULATION
Diversity and equity mentioned in code of ethics
only
Themes: professionalism (diversity), care

provision (equity)
No implicit or explicit connection to

institutionalized racism
43
FINDINGS
No mention of white supremacy
ADVOCACY One publication with any content related to
racial justice, everything else under blogs or
general content
CPA Physio Practice Magazine: Diversity Issue (2017)
Themes:
Indigenous health, professional values, power
dynamics, cultural diversity with patients, diversity of
perspective/thought/experience with colleagues
44
FINDINGS
ADVOCACY
Levels of Racism :
Institutional: predominantly
descriptive/declarative,
some instructional, predominantly community
facing, some profession facing.
45
15
4/26/23
FINDINGS
No mention of common presentations of racial
injustice, oppression
NETWORKS
Themes: professionalism, therapeutic
relationship, patient empowerment
Levels of Racism :
Institutional: all descriptive/declarative, predominantly
community facing, some
profession facing.
46
PRELIMINARY ANALYSIS
1-2 iterations of data
Data saturation not achieved
EDUCATION
Based off course descriptions, not syllabi
Université de Montréal not included
Some of this content could have been discussed
within other contexts, such as:
Ethics
Population and public health
Special populations (e.g., ICU, pediatrics, gerontology)
Specialized courses (e.g., legislation, business
practices)
Research capstone projects
REGULATION
Yukon, NWT and Nunavut do not have specific
college resources
ADVOCACY
Did not go into the members section (not free)
Did not go through individual CPA branches and
divisions websites
47
Canadian physiotherapy institutions that educate,

regulate, and advocate for physiotherapists are
TAKE not engaging in physiotherapy-specific antiracism

practices.
There is no formal training or instructive
HOME opportunities for Canadian physiotherapists to

develop the capacity to disrupt and dismantle
institutionalized racism within the context of their
professional roles, despite it’s strong association
with entry level core essential competencies.
MESSAGES Information regarding how racial injustice is

being accounted for within the profession is
entirely absent.
48
16
4/26/23
IMPLICATIONS
Physiotherapists who experience racial injustice within their professional journey have no
formal recourse or remedy within the institutions of physiotherapy itself, despite it being a
self-regulating profession.
Physiotherapists can only engage in anti-racism training and integrate anti-racism practices
independently, with no standard of practice, recommendations, or assessment of
capacity/effectiveness to guide them.
People cannot have any formal expectations regarding anti-racism capacity or practices of
physiotherapists with whom they engage.
Institutionalized racism within physiotherapy will remain largely undisrupted unless

individuals in positions of privilege or choose to address it intentionally and explicitly.
49
THE PEAC Accreditation Standards

Update*
-disclaimer: I was involved in this
MORE McMaster University*
THINGS University of Saskatchewan

University of Manitoba
CHANGE…
*work I was involved in and/or compensated for
50
• Zero people of colour as

authors
• Only one POC in
...THE
advertisement
• 2 men
• Two editorials centred
around COVID, nothing on
the racial injustice protests
MORE
happening at the same time.
• Article talking about PTs
origins during WWI from
nursing, no mention of the
THINGS
segregation and
maltreatment of Canadian
Black and Indigenous
soldiers in that same war,
STAY
nor the fact that nursing
schools in Canada were
segregated until the 1940s.
THE SAME...?
51
17
4/26/23
...THE MORE THINGS STAY THE SAME…?

A new patient tells you that
they stopped seeing their You work as a
previous physiotherapists physiotherapist in a multi-
because the PT made disciplinary clinic. At the end A physiotherapist colleague
comments about their body makes racially insensitive
of your shift, you notice Alex,
and appearance that made one of your colleagues and a jokes while working in an
them uncomfortable. The registered massage open treatment area. You and
patient confirms that the PT your patient are two of
therapist, with a patient. They
made sexual comments but hug and kiss before leaving several people (staff and
did not touch them patients) who overhear.
in separate cars.
inappropriately.
52
...THE MORE THINGS STAY THE SAME…?

A new patient tells you that
they stopped seeing their You work asOF a
previous physiotherapists COLLEGE
physiotherapist in a multi-
NO ONE.
YOU SHOULD “START BY
COLLEGE
because OF
the PT made REGISTERED
disciplinary clinic. At the end A physiotherapist colleague
SPEAKING WITH THE OTHER
PHYSIOTHERAPISTS
comments about their body makes racially insensitive
of your MASSAGE
shift, you notice Alex,
and appearance that made one of your colleagues and a jokesPTwhile
ABOUT THEIRin an
working
OF ONTARIO PROFESSIONAL
them uncomfortable. The THERAPISTS
registered massage OF open treatment area. You and
OBLIGATIONS AND HOW
your patient are two of
patient confirms that the PT therapist,ONTARIO
with a patient. They THEIR people
BEHAVIOUR IS
made sexual several (staff and
DUTY TOcomments
REPORTbut hug and kiss before leaving NEGATIVEIMPACTING
patients) who overhear.
did not touch them in separate cars. EVERYONE IN THE CLINIC,
inappropriately. DUTY TO REPORT INCLUDING PATIENTS.”
53
BREAK
54
18
4/26/23
Perspective
Perspective
Physical
S.A. Therapy,
PhD, Department of
Toronto, 160-500
University Ave,
of
Ontario, University
Canada M5G
Toronto, Ave,

a skill that requires teaching and practice. The purpose of this article is to introduce a 1V7, and Ontario,
Canada for
for
versity to Address
all cor-
E. Therapy,
Department of
of Physical
Therapy,
J.A. Shaw,
PhD,PhD, Institute
Institute for
for Health
Health System
and VirtualandCare,
Vir-
tual Care,College
Hospital, Hos-
Toronto,
A. Kuper, MD,
MD, DPhil,
DPhil, Wilson
Wilson Cen-
Cen-
tre for Research
Education, Uni-
Uni-
Network; Depart-
Depart ment
ment
of of Medicine,
of Toronto;
Toronto;
and Departmentand of Department of
Medicine, Sunny-
Toronto,
ence Centre,
Canada.
B.E. Gibson,
Physical PhD,
Therapy, Department
Physical
and Therapy,
Research of
Institute,
Toronto,Bloorview
Kids Rehabilitation
Institute,Toronto,
[Nixon
Ontario, SA,Canada.
[Nixon and
analysis SA, its
Yeung E, Shaw
application JA,
in the
et al.ofSeven-step
field framework
Phys Ther.
2017;97:249–257.]
Association
© 2017 American
Ahead of Print:
Association
September 29, 2016
September 29, 2016

this article at:
ptjournal.apta.org

article at:
55
56
HISTORY TAKING/INTERVIEW/INTAKE (HII)
QUESTIONS WHAT WE THOUGHT THEN… ...WHAT WE THINK NOW
What is HII ?
Where/how was it seen or found?
57
19
4/26/23
On the surface, what is the point

of HII?
What is it that physical therapists

are trying to do with HII?
Why are the creators or users of

HII using it like this?
58
What assumptions must be

shared for everyone to so easily
see that these are the intended
purposes of HII?
What needs to be widely

understood [or assumed] in order
for these intended purposes to
seem obvious?
59
In general, who benefits from the

common societal assumptions
identified in step 3?
Which groups of people tend to

be supported and empowered or
made to feel good about
themselves because of the
assumptions identified in step 3?
60
20
4/26/23

In general, who gets left out,
marginalized, or harmed by the
assumptions identified in step 3?
Which groups of people may feel

worse about themselves or
looked down upon by others
because of the assumptions
identified in step 3?
How might the disadvantaging of

these groups potentially
disadvantage society as a whole?
61
What societal patterns of privilege

and oppression do the findings in
steps 4 and 5 (respectively) reflect
and reinforce?
e.g., ableism, racism,
sexism, heterosexism
e.g., related to religion,
language, class, education,
immigration status,
indigeneity
62
What might other versions of HII

(defined in step 1) be that avoid
the harmful effects identified in
step 5 and better achieve the
benefits?
How might one imagine altering

HII so that it dismantles (as
opposed to reinforcing) the unfair
power structure identified in step
6?
63
21
4/26/23
SEE WHAT
HAPPENED THE 2023
Edition
WAS…
64
SUMMARY
• We are individuals who part of different communities, but we are also
part of the shared communities of physiotherapy and healthcare
professionals
• Awareness and acknowledgement of the attitudes and actions of

institutions that represent us, govern us, and that we, in turn, represent
is critical if we are to hold them to account.
• Our individual actions towards health justice—for our communities and

in our communities, as individuals do not need to be natural, or organic
or spontaneous. They are learned behaviours that we can develop,
practice, and improve over time. But none of that will happen if we don’t
start, from wherever we are, with whatever we’ve got.
65
“Insight
isn’t insight
if it doesn’t
Dr. CINDY BLACKSTOCK, PhD
lead to
action.”
66
22
4/26/23
THANK YOU
TRACY BLAKE, PT, PHD (she|her|hers) McMaster University
tracyablakeptphd@gmail.com PT PRAC, Unit II
@tracyablake 26.04.2023
67
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4/26/23

POWER IN PRACTICE II:

TRACY BLAKE, PT, PHD (she|her|hers) McMaster University

WHERE I’M AT, GEOGRAPHICALLY SPEAKING

Rexdale, a multi-cultural, multi-ethnic, multi-faith, working class neighbourhood

WHERE I’M AT, PROFESSIONALLY SPEAKING

I have no additional competing interests or financial disclosures. * compensated

• To model learning, unlearning and relearning (information, ideas, and

COMMON TERMS: PEOPLE

Avoid the causation

UNIVERSAL ARTICLE 25.1

SEE WHAT THE 2019

“WCPT is committed to diversity and inclusion in its activities and recognises

“In a physical therapy context, those developing standards of education

“WCPT recognises that contextual variations and significant co-existing

GUEST EDITORIAL / COLLABORATION SPÉCIALE

The Search for Justice: Developing a Collaborative

Jasdeep Dhir, BSc(PT), MClSc(MT);* Tracy Blake, MSc(PT), PhD;*†‡

previous or current health status. Health justice

requires the development of strategies and

LENS OF A person’s beliefs & actions

OPPRESSION National Equity Project. https://www.nationalequityproject.org/frameworks/lens-of-systemic-oppression

A 7-step framework for critical analysis that can

be used by students, clinicians, and faculty to

reflect on their practices as physical therapists

and on norms within the profession more

broadly. By focusing on clinicians and describing

practical activities involved in learning the skills

of critical analysis, we depart from previous

frameworks and maximize opportunities for

application of the framework in physical

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February 2017 Volume 97 Number 2 Physical Therapy ! 249

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February 2017 Volume 97 Number 2 Physical Therapy ! 249

pattern of bias towards whiteness as the

sidelines are no longer an option default. This is the foundational tenet of

Blake T. Br J Sports Med Month 2020 Vol 0 No 0 1

AM J PUBLIC HEALTH, 2000

2. Conduct a thematic content analysis of the findings

3. Categorize findings according to their alignment with internalized,

INSTITUTIONS Course descriptions

Canadian Physiotherapy Association

2019 Core Standards of Practice for

Themes: professionalism (diversity),

No implicit or explicit connection to

Themes: professionalism (diversity), care

No implicit or explicit connection to

Canadian physiotherapy institutions that educate,

TAKE not engaging in physiotherapy-specific antiracism

There is no formal training or instructive

HOME opportunities for Canadian physiotherapists to

MESSAGES Information regarding how racial injustice is

Institutionalized racism within physiotherapy will remain largely undisrupted unless

THE PEAC Accreditation Standards

MORE McMaster University*

THINGS University of Saskatchewan

• Zero people of colour as

...THE MORE THINGS STAY THE SAME…?