Health Care Disparities in Oregon Project
Health Disparity = a disabling condition experienced by a group of people that is caused by the secondary consequences of a larger system’s actions.
As mentioned in Frank Kronenberg’s Plenary Session at the Charlotte, NC AOTA Conference, the Health Care Disparties Project was designed to introduce hands-on interdisciplinary civic education to build community partnerships through provision of occupational therapy. This project is just one of many ways occupational justice can be achieved in practice to alleviate health care disparity. The following is a brief overview of the project from the Pacific University’s School of Occupational Therapy.
The Project Overview
The innovative project, “Health Care Disparities in Oregon”, was funded in part by a grant from the Corporation for National and Community Service and the Oregon Campus Compact to help educate first year students about disparities in health and health care access in the state. This project was created by Tiffany Boggis, Tina McNulty, and John White, occupational therapists and professors at Pacific University School of Occupational Therapy, to increase civic and service education through a multimodal approach, and address a university strategic objective. The project curriculum combined interdisciplinary education with service learning specifically designed to familiarize students with socioeconomic, ethnic, and geographic differences that community member’s experience with health care.
The project curriculum involved several stages including: seminars, research, and interviews with community members, analysis of interviewee stories, a visit to the state legislature, and a presentation to the Pacific University and Forest Grove communities about the project. Classwork began with a rudimentary understanding of health dispartiy terms; occupational deprivation, apartheid, injustice and justice (see Terms section for definitions).
The project began with an Interdisciplinary Health Care Seminar led by Russ Dondero, a 
professor of Political Science, integrating all of Pacific University’s professional programs; occupational therapy, physical therapy, physician assistants, and psychology. The students from all disciplines engaged in discussions about the current state of health care resources in Oregon and how the distribution of resources effects individuals in the state. A range of topics were discussed including access to healthcare, insurance concerns, service delivery, and the subsequent impact on people’s ability to lead healthy and productive lives.
Afterwards, in the School of Occupational Therapy, first year students interviewed a diverse group of community members about their experiences of health and health care disparity who represented socioeconomic, ethnic and geographic populations. The students shared their collected interview stories in class discussions and through analysis and uncovered themes arising from these interviews. The themes identified were; the working poor, immigrants, and people living in rural areas with few resources. The themes the students discovered match and verify literature and statistical findings.
“[Listening to the stories] tugged on my heart strings, that there is something wrong with the healthcare system. I had thought ‘they’ need to do something about it Now I think, I really need to do something about it …I have to and need to.” – MOT 1 Student
The OT students, faculty and 20 women from Adelante Mujeres, an intensive school for low-
income Latinas and their children, together visited the state legislature. In the capitol in Salem, Oregon everyone learned more about the public policy making process and shared concerns about health disparities with legislators and lobbyists. The women from Adelante Mujeres were given the rich opportunity to share their stories, through interpreters, on the senate floor with public policy makers. The School of Occupational Therapy first year students witnessed occupational justice two-fold, by providing opportunity and access to the political process, and by empowering the women to speak for themselves.
As a capstone experience, the first year students presented the Health Care Disparities Forum to the Pacific University and Forest Grove community healthcare stakeholders to discuss the issues of health disparities uncovered through their interdisciplinary education and interviews. The students explored the common themes, shared student-generated strategies to alleviate disparity in Oregon, and led a group discussion about these topics.
The Terms
New concepts are emerging in occupational therapy to help therapists describe and address problems such as disparities in health care that fall under the more encompassing concept of occupational justice. A brief glossary follows to describe these terms and more information on each of them can be found in Occupational therapy without borders: Learning from the Spirit of Survivors (Kronenberg, Simó Algado& Pollard, 2005)..
Occupational deprivation is a lack of engagement in necessary and meaningful occupations due to factors that stand outside of an individual’s personal control usually in reference to captive populations in prisons and institutions (Whiteford, 2000).
Occupational apartheid are political and system wide forces that segregate people for cultural, racial, religious or socioeconomic reasons and restrict access and change meaningful daily occupations. (Kronenberg & Pollard, 2005)
Occupational injustice occurs within a system of occupational apartheid when participation in occupations is segregated, underdeveloped, disrupted, alienated, marginalized, exploited, confined, prohibited or otherwise restricted (Christensen & Townsend, 2004).
Occupational justice refers to the rights, responsibilities and liberties of enablement. Enablement is providing the person with the means to develop and maintain an individually meaningful occupational life trajectory premised on attaining a state of wellbeing (Kronenberg, Simó Algado & Pollard, 2005).
Strategies for the OT Practioner
During the Health Disparities Forum held in Forest Grove, OR, the first year occupational therapy students generated several strategies they felt would alleviate health disparity and increase community health. Among these were: 1) For providing health care services to the working poor advocate for universal health care, or better employer coverage of all employees, and support free clinics, 2) Improve cultural sensitivity in work with immigrants by learning another language, providing signage and literature in multiple languages, and promoting education and hiring of diverse health care workers. 3) To create options for those in rural areas, therapists can develop health promotion resources, volunteer in rural clinics, disseminate information about services through local community networks, and of course ‘think globally and act locally.’
The Health Care Disparties Project increased awareness of occupational justice by building community partnerships through hands-on interdisciplinary civic experience. Students learned that health disparities not only effect people living with socioeconomic, ethnic and geographic differences, but themselves as well. This project is just one of many venues for occupational therapy practioners to put into practice the tenants of the profession to alleviate health care disparity locally and globally.
References
Christiansen, C.H. & Townsend, E.A. (Eds.) (2004) Introduction to occupation: The art and science of living. Upper Saddle River, NJ: Prentice Hall.
Kronenberg, F. & Pollard, N. (2006) The political dimension of occupation and the roles of occupational therapy. AJOT, Nov/Dec. 2006, in press.
Kronenberg, F. & Pollard, N. (2005) Overcoming occupational apartheid: A preliminary exploration of the political nature of occupational therapy. In Kronenberg, F., Simó Algado, S., Pollard, N. (Eds.) Occupational therapy without borders: Learning from the spirit of survivors (p.58-86) New York, NY: Elsevier Churchill Livingstone.
Oregon Housing and Community Services (2004) OHCS: Report on poverty 2004. Retrieved on March 11, 2006 from http://www.ohcs.oregon.gov/OHCS/docs/PovRpt/PR7ProgramsPartners.pdf
Office for Oregon Health Policy and Research (2004) Rising number of uninsured in Oregon. Retrieved on March 12, 2006 from http://www.egov.oregon.gov.DAS/OHPPR/RSCH/docs/OPS-healthinsurance 2004.pdf.
Oregon Department of Human Services (2003) Keeping Oregonians healthy: Preventing chronic diseases by reducing tobacco use, improving diet, and promoting physical activity and preventative screenings. Retrieved on March 12, 2006 from http://oregon.gov/DHS/ph/hpcdp/docs/healthor.pdf
Whiteford, G. (2000) Occupational deprivation: Global challenge in the new millennium. British Journal of Occupational Therapy, 63 (5), 200-204.
Links:
Oregon Campus Compact
http://www.oregoncampuscompact.org/
Frank Kronenberg, BSc, OT, BA(Ed)
http://www.aota.org/nonmembers/area28/links/link09.asp#fri1
World Federation of Occupational Therapy
Oregon State Legislature
Adelante Mujeres
http://www.nwlincs.org/OrEven/Adelante.htm
American Occupational Therapy Association
Occupational Therapy Association of Oregon