Ableism in health care

You’d think health care workers would know about disability, but apparently, disabilities are not discussed or taught in a health care context. Questions over quality of life, ability to decide and choose are all issues that affect people with disability when interacting with the health profession.

An article written by two nurses calls out ableism in health care. Ableism occurs when a person with disability experiences discrimination or prejudice from a health care provider.

A man in a turquoise hospital gown, cap and mask is holding a thumbs up sign. He looks like a nurse or a doctor.

They can underestimate the person’s quality of life or competence which affects their level of care. Patients need to feel safe and not to be fearful of being judged or not being heard.

Case study

The article uses a case study of a 60 year old women with Down syndrome to illustrate the issues during the COVID pandemic. This case is not about the care provider being ableist, but being an advocate for the woman. The doctor was pressured by family members to activate the do not resuscitate (DNR) code when the woman entered ICU. The doctor persisted in advocating for the patient and she eventually recovered.

Communication with patients is key. Patients with cognitive disabilities may face attention, memory and comprehension challenges. Nurses must therefore adapt their communication style, learn about the disability and avoid negative language that insults or demeans.

The authors encourage nurses to advocate for people with disability within health care services and in the design of environments.

Entrance to the emergency section of a hospital.. Co-design and ableism in health care.

Ableism isn’t just about patients – it includes family members, and other health care workers. Knowledge can help overcome stereotypes and stigma and improve health and wellbeing for all. Knowledge also helps nurses and other health professionals to feel confident when engaging with people with disability.

This short summary of Ableism in Health Care is open access, and you can access the full paper in the American Journal of Nursing.

Checklists don’t make inclusive culture

Whether it’s digital technology, the built environment, or a tourist destination, checklists don’t make an inclusive culture. When it comes to digital accessibility checklists Sheri Byrne-Haber says, “Just say no”. That’s because general accessibility checklists do more harm than good in establishing a good accessibility program. It doesn’t lead to an inclusive culture.

“… requiring accessibility or guilting or punishing people for failing to provide accessibility is at the bottom half of the accessibility motivation hierarchy.”

Hierarchy pyramid for motivating accessibility change. Starting at the bottom with guilt, then punish, require, reward, enlighten, and at the top, inspire.

According to the Hierarchy, Guilt is about not caring enough. The threat of Punishment is based on, “Do this or you will get sued”. Require focuses on technical requirements – the minimum required by law. Rewards, such as certification statements, awards, and badges can bring about change. However, they are often for the benefit of the maker or designer rather than the user.

Enlightenment comes when people see that accessibility is not just the smart thing to do, or the right thing. When people are motivated for good, that’s enlightenment. This is when they can see the powerful benefits end users gain. A better product emerges and business improves so not being accessible doesn’t make sense.

“Inspiration occurs when you see and experience the distinct impact the accessibility (or lack thereof) of your product can have on the lives of an individual with disabilities.”

A blackboard has the words, It's time to inspire written in white chalk.

Byrne-Haber discusses the issues of checklists from the perspective of digital technology, but her arguments apply across the built environment as well. Indeed, you could also add businesses that are claiming Diversity, Equity and Inclusion (DEI) credentials. WebAIM’s effectiveness pyramid, Hierarchy for Motivating Accessibility Change, puts it into perspective.

When are checklists OK?

Once an inclusive culture is established, targeted checklists are appropriate for guiding new people to make sure they don’t “break the system”. In the website world, Byrne-Haber says that people adding material to a website need some do’s and don’ts. But this could also apply in other areas too. Maintaining the inclusive design intent of a building requires all stakeholders to keep to the theme. So, for example, a checklist for interior designers might be appropriate in these circumstances.

Architectural education and gender equality

The Rethinking the Future blog site has an article on architectural education and gender equality. First, it asks if architecture is gender driven both as a profession and in academia. Second, it asks if the diverse experience of students is really fostering and representing diversity. The third point is, how can a more inclusive learning environment be created. The article concludes with a plea for change.

“Analysing the traditional architectural education system, one can observe the persistence of a masculine Paradigm.”

Three men in hard hats stand on a building site looking at architectural design plans.

The word “architect” conjures up an image of a man so that if a woman is an architect she is referred to as a female architect, not just “architect”. However, moves to address this gender imbalance is being addressed as more women are accepted into architectural institutions. But how many female star architects are there?

Fostering student diversity

Analysing enrolment data for gender ratios helps identify any significant disparities amongst different countries. The visibility and experience of LGBTIQ students in architecture schools can be carried out through surveys or interviews. Social, political and psychological aspects can be revealed by identifying unique challenges students with multiple marginalised identities face. These can be race, ethnicity, religion, and gender diversity.

Faculty and curriculum

Faculty members should move beyond traditional teaching methods by adopting methods to cater for diverse learning styles. Creating an equitable education experience will bring more diversity within learner enrollments and future teaching staff. With a diversity of ideas and mentors there is a better chance of including the LGBTI community and women.

The title of the blog article is Architectural education and gender equality: A comparative study.

In praise of pocket parks

Pocket parks are often an afterthought by developers, architects and councils. Typically, they are bits of left over space that can’t be used for a building or a road. With increased population density, this public space needs to be planned. And it needs to be accessible and inclusive.

“These pocket parks are a terrific opportunity to answer that problem and to provide public space for the local community where previously there may not have been any.” Mike Harris, UNSW.

A shady area with seating in a residential setting.

Pocket parks are being created in spaces not previously considered for green space in Sydney. Large parks such as Centennial Park in Sydney are planned, but master plans need to plan smaller parks in subdivisions as well.

Pocket parks are not all the same. A town centre might have more seating whereas a residential one could feature play equipment. They can also be part of mitigating heat effects. In existing developments, creating a pocket park might mean reclaiming portions of the street.

“We must consider public spaces as social infrastructure and value them in terms of their wellbeing benefits,” Ela Glogowska, UNSW.

A neat paved area with a seat, hedging, shrubs and trees. Two storey homes are in the background.

Larger parks are still a must, but smaller places within easy walking distance are also essential. It is worth applying the three basic principles of the Everyone Can Play guide. Can I get there, Can I play, Can I stay. Connection to Country is another factor often forgotten.

The title of the article Architecture & Design is Pocket parks: Small in size, huge in benefits.

Luminance contrast: a slippery concept

The Technical Insights section of the Autumn 2023 edition of Access Insights is about luminance contrast. This is a hot topic of discussion because it is a slippery concept. What is it and how do you measure it are the starter questions, followed by why do we need it.

This image, courtesy the Egress Group, shows discrete silver tactiles against a dark red carpet. The light grey stair nosings are also contrasted against a black carpet.

Silver discrete tactile indicators on a red carpet on a stair landing showing good luminance contrast.

Howard Moutrie explains that luminance is the amount of light reflected from a surface. The contrast is the amount of light reflected from abutting surfaces. For example the wall and the floor. This is not the same as colour contrast. Red and green are stark contrasts but will often provide the same amount of luminance. Therefore there is not luminance contrast.

So how do you determine luminance contrast? This is where it becomes slippery. Are you measuring this in a laboratory under controlled conditions? Are you measuring it on the street on a rainy day? Or are you measuring it a nighttime? An appendix to the Australian Standard (AS 1428.4.1) is part of the standard with the most up to date calculation.

Moutrie goes on to explain how testing on tactile indicators is not the same as testing on other surfaces. Then there is the issue of how different instruments provide different measurements for the same thing.

The original requirement for a 30% contrast was based on an integrated tactile where the whole surface provided the contrast. Individual tactiles, such as individual stainless steel ones, are supposed to have 45% contrast. Moutrie is critical of the way luminance is measured but the industry has geared up to meet these measurements. He says more research is still needed.

Why do we need it?

People with low vision need the contrast to navigate the environment, including at home. It helps distinguish a door from a wall, and the wall from the floor. It’s also good for people with impaired visual perception. For example not being able to see a white toilet pan in an all white bathroom.

There is more on this topic in, Luminance contrast: how do you measure it? With the cost of measuring apparatus, much is left to doing by eye. Or relying on manufacturers claims.

The title of Moutrie’s article on page 22 is Luminance Contrast – is what you see, what you get?

Cohousing a natural for universal design

Cohousing is about community. It’s about creating a collection of homes in a way that emphasises community interaction. It aims to recapture the positive aspects of village life in a modern context. Matt Daly and Myfan Jordan say that cohousing is a natural for universal design. That’s because it offers an alternative to the inaccessible mass market housing currently available.

Cohousing originated in Denmark in the 1960s. The idea has spread to other countries, but has been slow to take off in Australia.

Graphic of cohousing showing houses, community garden, playground, pool, parking and the common house.

Cohousing groups begin by committing to land purchase and designing and building their homes. When established, members share in the running of the small community. For example, Women in Cohousing is a group of women aged 50 to 80 years. They purchased land in rural Victoria and will design a village of 30 units, a common house, workshop and gardens. Collaboration, sustainability, accessibility are key elements of their community.

The more established communities now have residents who are ageing. Consequently, more thought is being given to designing with accessibility in mind. Recent studies show that social isolation is an issue for all ages. Social interaction across the ages is a cornerstone of the cohousing model.

You can read more detail in Daly and Jordan’s short article, Cohousing: a ‘natural’ for universal design. There is also a reference to UTS research for cohousing for older people. A separate paper discusses three models of cohousing for older people.

In the video below, residents of two cohousing communities provide a personal view of cohousing. They explain how they work and the importance of having people of all ages living together. 8 minutes.

A neurodiverse perspective

Mollie Pittaway gives a neurodiverse perspective on the world in a Medium magazine article. She describes 10 ways autistic people are different to neurotypical people. She makes it clear in the beginning that she doesn’t speak for all autistic people. Pittaway just wants to emphasise cultural differences. Understanding these differences are useful in the workplace for managing and interacting with staff who might be autistic.

Understanding how autistic or neurodiverse people see the world and process information is key to being inclusive in any situation. They don’t need to be the odd one out.

A pack of 12 eggs. 11 are brown and one is white. It represents a neurodiverse perspective of the odd one out.

We all have different ways of experiencing the world and interacting with one another. However, sometimes it is difficult to empathise with each other when our experiences are quite different. Pittaway presents ten differences to neurotypical people are briefly outlined below. See the article in Medium for a more detailed explanation.

10 ways autistic people are different

Small talk: This can feel fake or unimportant, because autistic people want to talk about deeper, meaningful things. Consequently, they don’t join in conversations about pop culture, TV shows or sports games. This means they appear shy or aloof.

Eye contact: Eye contact is considered “normal” and courteous to neurotypical people. Pittaway says she loses her train of thought when looking at someone. This makes it look like they are bored or indifferent.

Directness and empathy

Directness: Neurotypical people can deal with ambiguity in communication rather than saying exactly what they are looking for. Pittaway says she needs as much clarification as possible and finds it difficult not to be direct. This can be perceived as being blunt or rude.

Empathy: When someone is upset many neurotypical people listen and talk things through. Pittaway, however, says her way is to talk about her similar experiences as a way to show she understands. Finding the right words is difficult. However, this can be viewed as moving attention to themselves and therefore being selfish.

Social situations

Social connection: Pittaway says that in comparison to neurotypical people she has a low “social battery”. This means she doesn’t seek frequent social connection such as going to the pub or a party. Recharging her social battery might mean refusing invitations to events.

Interests: Differences are less obvious when it comes to talking about interests. Some autistic people can remember a wide range of facts, but these facts can be boring to others. Everyone has the ability to bore people with their special interests.

Spontaneity: Last minute plans or sudden changes in plan can be challenging for autistic people. Changing routines is difficult and can take extra energy when recharging is required.

Sensory overload: Background noise, traffic, nightclubs and crowding make it a struggle for autistic people to concentrate. They can’t filter the information in the same way as others and just try to hide their distress.

Morals and conforming

Hypermoralism: Autistic people see things in black and white whereas neurotypical people see nuance in things. Pittaway says holding the high moral ground is one of the best traits because they want the best for others. However, they might be seen as the “goody two-shoes” and their concerns are ignored.

Conforming: Going along with the status quo is difficult because autistic people need to understand why things need to be done a certain way. That can make for a lot of questions. This makes it inconvenient for those at the top because it feels like their authority is being questioned.

Pittaway concludes by saying there isn’t any right or better way to communicated. But it is important to respect differences.

The title of the article is 10 Significant ways autistic people are different to neurotypical people. As stated above, this is one person’s experience of being autistic. However, the autism spectrum captures many types of neurodiversity. This is one view.

Neurodiversity is an identity not a disorder

Psychologist John Elder Robison provides a personal view of neurodiversity in his writings. A review of his book in the Psychology Today blog outlines his experience. A key point is that if one in seven children in the US are now identified as neurodiverse, is this really an exception to “normal”? The title of the book is Look me in the Eye: My Life With Asperger’s.

It’s not the bus that’s inaccessible

Imagine you could travel to only 1% of the city where you live – areas that were easily accessible to other residents. The main problem is it’s not the bus system itself that’s inaccessible. It’s all the infrastructure around it such as footpaths and kerb ramps. That’s the claim by researchers in Columbus, Ohio.

“People with mobility disabilities need to get to and from bus stops to use public transportation, and that isn’t easy in many parts of the city.”

The roadway is marked with the words "bus stop" in yellow lettering.

The study of wheelchair users who rely on public transport, found that powered wheelchair users were a little better off than manual users. The researchers used high-resolution, real-time data on the usage of buses by people with and without disabilities.

In one analysis, the researchers found how many of the bus stops could get users to various places in the city within 30 minutes. Manual wheelchair users had 75% fewer bus stops they could use compared with non-disabled users. For powered wheelchair users, they experienced 59% fewer stops. Even when they gave them more time to complete the journey, it was little better. That means wheelchair users are confined to self-segregated parts of the city.

Public transit is not a business, it is not just a social service.  It is crucial urban infrastructure and footpaths are part of that.

Ohio Theatre facade showing a level footpath and kerb ramp for the crossing. It isn't the bus that's inaccessible.

The title of the article is, Why buses can’t get wheelchair users to most areas of cities. It was published on the website.

The research paper is titled, Disparities in public transit accessibility and usage by people with mobility disabilities. You will need institutional access for a free read.


Many people with mobility disabilities (PwMD) rely on public transit to access crucial resources and maintain social interactions. However, they face higher barriers to accessing and using public transit, leading to disparities between people with and without mobility disabilities.

In this paper, we use high-resolution public transit real-time vehicle data, passenger count data, and paratransit usage data from 2018 to 2021 to estimate and compare transit accessibility and usage of people with and without mobility disabilities. We find large disparities in powered and manual wheelchair users’ accessibility relative to people without disabilities.

The city center has the highest accessibility and ridership, as well as the highest disparities in accessibility. Our scenario analysis illustrates the impacts of sidewalks on accessibility disparities among the different groups. We also find that PwMD using fixed-route service are more sensitive to weather conditions and tend to ride transit in the middle of the day rather than during peak hours.

Further, the spatial pattern of bus stop usage by PwMD is different than people without disabilities, suggesting their destination choices can be driven by access concerns. During the COVID-19 pandemic, accessibility disparities increased in 2020, and PwMD disproportionately avoided public transit during 2020, but used it disproportionately more during 2021 compared to riders without disabilities.

This paper is the first to examine PwMD’s transit experience with large high-resolution datasets and holistic analysis incorporating both accessibility and usage. The results fill in these imperative scientific gaps and provide valuable insights for future transit planning.

Home renovations American style

Home renovations and modifications for ageing in place is big business in the United States. The latest issue of Designs 4 Living is focused on home modifications and the “forever” home. Four contributors provide their design ideas on home renovations American style.

Architect Aaron D Murphy asks, Do you have “Stay at Home” Insurance? He means “can you ensure you can stay longer in your own home?” Fearing loss of independence is no reason to do nothing until it’s too late. Murphy emphasises that universal design is good for everyone and not about “hospital parts”.

Designs for Living front cover showing the Fairmont Hotel in Quebec, Canada covered in a dusting of snow.

The title of Karen Koch’s article is “ADA is HOOEY”. Similarly to the Australian standard for public bathrooms, the ADA is not suited to residential settings. Occupational therapist Koch provides good tips, and uses photos to explain the importance of colour contrast for ageing eyes. However, these photos have lots of grab rails and “hospital parts”. A key tip is not to mount grab bars diagonally because that requires grip strength rather than arm and shoulder strength.

Robert May talks about indoor air quality and how he learned the value of clean air. The pandemic caused him to reconsider his scepticism and learn more about it. He says, “What I learned is that if you are not filtering your air then you yourself are the filter”. May goes on to talk about different products.

Jennifer Rossetti and Todd Brickhouse look at robots and the role they can play in our lives. Some already perform everyday tasks, but the interest is in companion robots. The focus of companion robots is on older people, although there is no reason they should be age specific. However, developers are looking for replacement caregivers in residential aged care.

Read Designs 4 Living on Flipsnack.

Year of Accessible Tourism

With the 2032 Olympic and Paralympic Games in their sights, the Queensland Government has declared 2023 the Year of Accessible Tourism. And it comes with funding. The fund will support small to medium sized tourism and events businesses to enhance their access for people with disability. The fund includes:

  • $10m Accessible Tourism Queensland Fund.
  • $1m Awareness and Capability Program.
  • $1m Visitor Experience Development Initiative.
A man in a wheelchair makes his way along a paved pathway amongst palm trees. The text says, Year of Accessible Tourism.

The Awareness and Capability Program is about raising awareness of the access requirements of visitors, workers and the community. The fund is also about building the capability of the tourism sector to support workers with disability. That includes making sure operators have the skills to employ people with disability.

The aim of the Visitor Experience Development stream is to promote the accessible tourism experience for everyone. This will include capturing images, videos and stories for marketing campaigns.

The Queensland Government wants to change the perception of what it means to be an accessible business. The aim is to support businesses to develop a wider range of accessible tourism itineraries and promote accessible tourism experiences.

While this is a great initiative, the media release makes it sound as if accessible experiences are separate from other “normal” experiences for everyone. The Queensland Government has links to resources for anyone interested in these projects.

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