Structural inequality

Racism, harassment and microaggressions are part of society and the institutions we work in.

This is true in healthcare, universities, and other institutions where there are structural inequalities.

Structural inequalities are “inequalities deeply woven into the very fabric of a society. They can be observed across institutions such as legal, educational, business, government and health care systems. Inequalities occur because of an imbalance in the distribution of political and economic power. While one group has historically set the rules and writes the law of the land, access of others to wealth and resources have been limited” (Assari, 2023).

What is an ally?

So what is an ally, and what does an ally do in relation to structural inequality? 

“An ally recognizes systemic inequalities and the impact of microaggressions, discrimination, oppression, and racism. Allies recognize their own power and privilege and use it to support the rights of marginalized people. An ally regularly listens, supports, self-reflects, and does their own research to learn more about the history of the struggle in which they are participating. Allies acknowledge their own participation in oppressive systems”.

“An ally will lift others by advocating and sharing growth opportunities and by using their privilege regularly to support others. Allies will work together to attempt to dismantle the oppressive and inequitable systems and, most important, will listen and accept criticism with grace, even if it’s uncomfortable.”

Types of Ally

Hughes (2023) explains different types of ally that exist based on Karen Catlin’s “Better Allies” book:

1. The Sponsor – A sponsor is an ally that vocally supports a person from a minority group and their work with the aim of helping boost the credibility and reputation of the person, especially in situations where the sponsor notices that the contributions of the underrepresented colleague are being dismissed or ignored.

2. The Champion – A champion is an ally who champions for the inclusion of underrepresented groups in public avenues – such as conferences and industry-wide events, traditional media events, social media, etc.– with the aim of giving them greater visibility and sending a message to large audiences about the need for equity and inclusivity.

3. The Amplifier – When an ally takes on the role of the Amplifier, that ally works to ensure that marginalized voices are both heard and respected. This type of allyship can take many forms, but is focused on representation within communication.

4. The Advocate – When an ally takes on the role of the Advocate, that ally uses their power and influence to bring peers from underrepresented groups into highly exclusive circles. The Advocate recognizes and addresses unjust omissions, holding their peers accountable for including qualified colleagues of all genders, races and ethnicities, abilities, ages, body shapes or sizes, religions, and sexual orientations.

5. The Scholar When an ally takes on the role of the Scholar, that ally seeks to learn as much as possible about the challenges and prejudices faced by colleagues from marginalized groups. It’s important to note that Scholars never insert their own opinions, experiences, or ideas, but instead simply listen and learn. They also don’t expect marginalized people to provide links to research proving that bias exists or summaries of best practices. Scholars do their own research to seek out the relevant information.

6. The Upstander – An upstander is an ally who chooses not to sit back and watch as someone from a marginalized group gets harassed or disrespected.  When they see action that they deem to be wrong, they take action against the wrongdoing. When someone makes jokes or comments that are offensive to people from a minority group, an upstander will speak out against such comments.  When they see someone from a marginalized group being treated unfairly, upstanders are not afraid to speak up and fight for the rights of this person.

7. The Confidant – A confidant is an ally who creates an environment that makes people from minority groups comfortable enough to express their needs, frustrations, fears, and challenges.  Confidants provide a listening ear without being judgmental, believing that the people from minority groups are being truthful with their stories. To be a confidant, you need to be ready to believe the experiences of others. Avoid the temptation to assume that such things do not happen simply because they have not happened to you, and avoid the temptation to be judgmental about the experiences of these people.

At St Georges', University of London

The university seeks to adhere to the following principles:

• Student-centredness: Adopt a student-centred approach, harness their ideas, and use their knowledge in the classroom and learning environment (many students are experts).
• Power imbalance: Allyship importantly needs to look at power imbalance.
• Discipline-specific: Allyship needs to be discipline specific i.e., tailored to the discipline.
• Embedded curriculum (not a one-off) embedding allyship across all the curriculum rather than a one-off session 
• Flexible model: A robust and flexible model that works in different modes is needed (e.g., large group size, small groups, face-to-face, online)
• Lifelong learning: Allyship can be a pathway for LIFELONG LEARNING as well as day-to-day acts in real life. 

Exploring Allyship in the curriculum

Exploring allyship in the curriculum involves creating space and openness to discuss power and privilege function in the subject, university, workplaces, and society. Consider what are the issues of privilege and inequality that surround your discipline in terms of

• knowledge creation - where has the knowledge been created?
• exclusionary practices - whose stories have been excluded?
• culture of openess - do students feel they can report issues or provide feedback in a culture of openness. 

Useful resources

• The Guide to Allyship

Bibliography

(2023) NHS choices. Available at: https://www.england.nhs.uk/blog/allied-health-professional-workforce-diversity (Accessed: 24 September 2023).

(2023) Unlocking the power of allyship: Giving health care ... - nejm catalyst. Available at: https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0358 (Accessed: 24 September 2023).

The 7 types of allies - which one are you? (2022) Inclusive Leaders Group LLC. Available at: https://inclusiveleadersgroup.com/the-7-types-of-allies-which-one-are-you/#:~:text=The%207%20Types%20of%20Allies%20%E2%80%93%20Which%20Are%20You%3F,Scholar%2C%20Upstander%2C%20and%20Confidant (Accessed: 24 September 2023).

A. Gkiouleka a et al. (2022) Allied Health Professionals: A promising ally in the work against Health Inequalities- A Rapid Review, Public Health in Practice. Available at: https://www.sciencedirect.com/science/article/pii/S2666535222000453 (Accessed: 24 September 2023).

How to be an anti-racist and White Ally (2023) How to be an anti-racist and white ally. Available at: https://www.bath.ac.uk/guides/how-to-be-an-anti-racist-and-white-ally (Accessed: 24 September 2023).

What are structural inequalities? (2023) Giving Compass. Available at: https://givingcompass.org/article/what-are-structural-inequalities#:~:text=They%20are%20inequalities%20deeply%20woven,of%20political%20and%20economic%20power (Accessed: 24 September 2023).