Conference on implementation of anti-oppressive practice into primary care: Activity report

Abstract

When practicing care based on the social determinants of health (SDH), healthcare professionals must remain aware of how their own implicit biases can inadvertently harm patients, particularly those who are socially marginalized. Anti-oppressive practice (AOP) provides a framework that challenges structural inequities and illuminates the lives of both patients and professionals as well as the historical and sociopolitical contexts in which power imbalances and oppression have developed.¹ Drawing on Freire's concept of critical consciousness,² AOP encourages professionals to reflect on their own authority and how these dynamics may unintentionally perpetuate oppression.³ Expanding the understanding of AOP could significantly enhance health professions education,¹ as evidenced by the Interprofessional Education Collaborative's Core Competencies for Collaborative Practice.⁴ Despite this potential, AOP remains underrepresented in healthcare research and education.⁵ Given the critical role that primary care professionals play in advancing health equity and addressing the bio-psycho-social dimensions of diverse patient populations, we advocate for the integration of AOP into primary care practice.

At the 15th Japan Primary Care Association (JPCA) Annual Meeting in June 2024, the JPCA SDH Committee hosted a symposium on AOP, followed by a workshop with approximately 40 participants with different professional backgrounds at the 21st JPCA Fall Education Seminar in September 2024. The goal of the online workshop was to foster dialogue about integrating AOP into daily practice. In the workshop, we began by outlining the concept of oppression and the structures that perpetuate it. Our main messages are listed in Table 1. Participants then shared their personal encounters with oppression in clinical settings.

Subsequently, two cases were reported, including one from a marginalized region in Japan, where a staff member made a meaningful connection with a resistant patient by listening attentively to his/her narrative, moving beyond the conventional dynamic of charity-based care, or the structure of the staff giving charity and the patient receiving it. Another case examined health care for foreign residents. One of the workshop facilitators reflected on her experience living in various cultures abroad, where she had recognized both her privileged identity as a “Japanese-native, wealthy doctor in Japan or in lower-middle income countries” and her status as an oppressed minority: “non-English-native, non-wealthy Asian female student in an English-speaking country.” Discussions that followed, after clarifying that the dialogue was specific to this occasion, highlighted the importance of recognizing invisible oppression and avoiding reinforcing stigma: a fundamental cause of health inequity.

The workshop was well received, with participants affirming the value of AOP in primary care practice in Japan. Throughout the session, we carefully maintained psychological safety and ensured that the workshop itself did not replicate oppressive structures. In the future, the committee will continue to deepen its engagement with AOP and create more opportunities to share its findings with primary care professionals.

The authors declare no conflict of interest.