The Search for Justice: Developing a Collaborative Understanding of Health Justice in Physiotherapy

There is a real and present need for the physiotherapy (PT) profession to confront injustices. This need requires a clear understanding of health justice.^1–3 In this 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 regulators to consider.

The World Health Organization defines “health” as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”⁴ This definition reflects an integrative understanding of health as opposed to the predominant biomedical paradigm, which treats body, mind, and spirit as separate entities. Justice can be described as a system or structure predicated on parity in access, utilization, and the leveraging of resources, opportunities, and voice.^5,6 Health equity can only be achieved when each individual can attain their full potential for health and well-being.⁴ Justice and health equity are the crux of an optimally operating society.⁷

The current systemic and structural barriers that contribute to health inequity are a global crisis and contribute 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 sector are taught in inclusive environments, and develop the cultural humility and competencies needed to deliver high-quality patient-centred care. Training programmes 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 health care workers to disrupt and dismantle unjust systems, and build and reinforce just systems.

There are resources that explore concepts and frameworks 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 to PT that explores health justice, and there is a lack of models and frameworks that can guide application to PT practice. While Borras noted that the pursuit of health justice require analyses, strategies, and interventions that integrate the economic, cultural, and political spheres of redistribution, recognition, and representation,¹³ there is little direction on how to achieve this goal.

Pursuing a Collaborative Understanding of Health Justice in PT

It’s necessary to have an understanding of health justice through identified themes, frameworks, initiatives, 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 propose the following operational definition of “health justice.” It is based on the available literature that can be used to ground collaborative discussions.

Health justice is achieved when systems and structures exist to ensure all people have access to the resources and opportunities they need to attain, maintain, and sustain physical, mental, and emotional well-being, regardless of previous or current health status. Health justice requires the development of strategies and interventions that integrate and promote parity in the availability, accessibility, affordability, and quality of services/resources. As well, health justice needs a voice in economic, social, cultural, and political systems or structures.^{4,5,8,13–15}

It is critical to understand and apply the tenets of health justice in the context of the PT profession.^{1–3,16–19} Many of the articles included in the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP),²⁰ and the Truth and Reconciliation Commission (TRC) of Canada Calls to Action²¹ are relevant to the PT profession and include a mandate to act. The TRC specifically calls for health care profession education to include skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.²¹

In 2020, Physiotherapy Education Accreditation Canada (PEAC) revised the accreditation standards for Canadian PT education programmes. The revised standards mandate that Canadian entry-level PT programmes embed concepts, topics, and tools related to anti-oppression, decolonization, and justice throughout their organizations (e.g., admissions, faculty recruitment, development opportunities, curriculum).¹⁴ These competencies will equip PT students and practising physiotherapists to intentionally act to dismantle and disrupt the current systems that hinder and limit equity-deserving groups and will promote systems predicated on parity.

Proposed Direction

To actively address the UNDRIP and the TRC Calls to Action, and to meet PEAC standards, Canadian PT programmes need to integrate health justice tenets in their educational structures and systems to support learners, faculty, staff and affiliated health care workers.

To begin developing a collaborative understanding of health justice in PT, we invite members of PT entry-level programmes, researchers, regulatory bodies, and professional associations to delegate participants for a national consensus exercise that builds on the proposed operational definition. A process is needed to identify the major concepts and themes related to health justice that can inform the development of justice-driven curricular reviews, policies, procedures, and practices by stakeholders in Canadian PT education and practice. To solidify the next steps in this project, we have secured funding from the McMaster Education Research, Innovation and Theory/Physician Services Incorporated Foundation through a network starter grant and acknowledge the Canadian Physiotherapy Association for its commitment of “in kind” support.

Summary

Entry-level PT programmes and practising physiotherapists must be intentional about integrating concepts related to justice, particularly health justice, into curriculum and practice. Without a consensus-derived understanding, measuring and determining progress toward addressing health justice will be difficult to coordinate and consolidate. The co-creation of an understanding of health justice has the potential to influence the evolution of the PT profession in Canada and beyond. The time for our profession to act is now.