I am human by Dawn Renfrew

“I am human: I think nothing human alien to me”


Terence the African

So wrote Terence the African, around 2000 years ago. He was a slave from Roman Africa, a dramatist, and an interpreter. He was quoted recently in the annual BBC Radio 4 Reith lectures, by Professor Kwame Anthony Appiah, professor of philosophy and law at New York University.


Appiah Now

Professor Appiah’s subject, “Mistaken Identities”, is one of the most defining issues of our age. We all have multiple identities which describe who we are. These include those suggested by our gender, age, occupation, political affiliation, nationality, race etc. The possibilities are endless when you think about it: parent, child, sibling, friend, Bake-off fan, or Queen of the South fan are just a few.

In a healthcare setting, we also have many identities, including being part of our own discipline, team, ward or service. Sometimes we are ourselves patients, and some of us are managers. Any health condition, whether physical or mental, can become part of our identity.

Appiah himself embodies many complex aspects of identity. Half-British, half-Ghanaian, he was brought up in Ghana and England, and has now adopted America as his homeland. He is the grandson of the Chancellor of the Exchequer, Sir Stafford Cripps. He is a crime novelist, and a fan of Japanese haiku. In addition, he was one of the first people to take advantage of the new gay marriage laws in New York State. He is probably ideally placed to set about unpicking assumptions which we all have about the “labels” associated with identity.


Growing up in England

Appiah discusses 4 aspects of identity over 4 lectures: creed [religion], country [nationality], colour [race] and culture [Western identity vs non-Western]. These are delivered in 4 different locations: London, Glasgow, Accra [capital of Ghana] and New York. The lectures cover the great sweep of history, and examples from a range of countries across the globe. They argue that identities are more complex and fluid, than are commonly supposed. They are more a “narrative”, than an “essence”, and do not necessarily determine who we are. Everywhere you look, you can find exceptions in identities, which challenge our commonly-held assumptions about them.


Growing up in Ghana

Identity is important for our survival. It helps give meaning to our lives, and helps us feel, and be, part of a community. Evolutionary psychologists would argue that it has been critical to our development as a species. All identities are constructed and evolve over time, but as soon as you construct an identity, you create potentially not only an “us” [those within the group], but also an “other” [those outside it]. When there is competition for resources, things can turn nasty, and the “others” may be persecuted or scapegoated. So it is important that we are relaxed and open about our identities, and that we recognise why that process of “othering” arises so easily within all of us. It’s a trap that is easy to fall into, and we need to resist it.

Appiah doesn’t mention healthcare in particular. But if we apply these ideas to the healthcare setting, we can see that a shared identity can help us pull together to meet our patient’s needs, in what are often increasingly challenging circumstances. Equally, there can be a process of “othering” which operates, whether it is towards our patients, our managers, our employees, or other agencies. Whilst understandable, “othering” can prevent us fully engaging with the “other” in a way that leads to the best outcome for all of us. This is relevant to our aims to provide person-centred care, and to integration with other agencies.

On the question of nationhood, Appiah isn’t against nationalism, so long as it is an “open, civic nationalism”. His favourite idea of nationhood, however, involves 2 concepts. The first is patriotism, defined as concern with the honour of your country [or countries]. This means feeling proud when your country does something good, and ashamed when it does something bad. The second concept is cosmopolitanism, which means being a citizen of the world. These can combine to form a “patriotic cosmopolitanism”. You can, and should, respect both “the local” and “the global”.

Identities connect the small scale, where we live our lives alongside our kith and kin [and healthcare colleagues], with larger movements, causes and concerns. Our lives must make sense at the largest of scales as well as at the smallest. We live in an era where our actions, both ideological and technological, have global effects. When it comes to the compass of our concern and compassion, humanity itself is not too broad a horizon. We live with 7 billion other humans, on a small, warming planet. The concept of cosmopolitanism has become a necessity.


Appiah with Obama

Appiah argues for a tolerant, pluralistic, and diverse society. He says, failure to accept this is not just a failure to understand human identity, it is not in our collective self-interest. We do not need to abandon identities, but we don’t need to be divided by them either. Ultimately, the identity of “being human” ought to transcend all others.

As Scout, the young heroine in the novel about race and mental illness, To Kill a Mocking Bird, concludes: “I think there’s just one kind of folks. Folks”.

The Reith lectures are available to listen to on the Radio 4 website, indefinitely.

Dr Dawn Renfrew is a Consultant Child and Adolescent Psychiatrist for NHS Dumfries and Galloway

Gender Matters by Lynsey Fitzpatrick









image5On 6th September 2016 in Lockerbie Town Hall, NHS Dumfries and Galloway and Dumfries and Galloway Council, supported by the national feminist organisation ‘Engender’, jointly hosted ‘Gender Matters’ – an opportunity, in the form of a workshop, to explore the issues surrounding gender equality.

There were over 40 people from a range of organisations including NHS, Council, South West Rape Crisis and Sexual Abuse Centre, LGBT Plus, LGBT Youth Scotland, DG Mental Health Association, Support in Mind and Glasgow University, and also members of the public along with staff from other Health Board areas.
When I started to write this blog post, I was thinking back as to why the steering group behind the event decided to host this event in the first place. There is a plethora of evidence to back up why we need to support events of this nature, for example:

  • Women are twice as dependant on social security than men
  • In 2015 the gender pay gap in Scotland was 14.8% (comparing men’s full time average hourly earnings with women’s full time average hourly earnings)
  • Also gender pay gap in Scotland when comparing men’s full time average hourly earnings with women’s part time hourly earnings was 33.5%
  • This means, on average, women in Scotland earn £175.30 per week less than men.
  • The objectification and sexualisation of women’s bodies across media platforms is so commonplace and widely accepted that it generally fails to resonate as an equality issue and contributes to the perception that women are somehow inferior to men.
  • Femininity is often sexualised and passive whereas masculinity is defined by dominance and sometimes aggression and violence.
  • At least 85,000 women are raped each year in the UK.
  • 1 billion women in the world will experience physical or sexual violence in their lifetime.
  • In 2014/15, there were 59,882 incidents of domestic abuse recorded by the Police in Scotland. 79% of these incidents involved a female ‘victim’ and male perpetrator.


So there are plenty of reasons as to why we held this event; to challenge social gender norms, to progress thinking around changing perceptions in our homes, at work and how we confront the media (not least our legal duty under the Equality Act 2010).

But what is it that made us so passionate about being part of this work?
image12A huge reason for me personally is that I have an (almost) 5 year old daughter. In my current post as Equality Lead for NHS D&G I have become much more aware of some of the research and facts around gender equality and often reflect on how her future is being shaped as we speak; because of the gender norms all around her, expectations from her family, her peers and her school.
I’m horrified to think that she is more likely in later life to be paid less than a male counterpart for doing the same level of work, or that her relationships and self esteem will be impacted by the stereotyping of her gender in the media.

image29A friend and I had a discussion at one of the film screenings for “16 days of action against Gender Based Violence” which focused on the sexualisation of children from an early age. We talked in particular detail following the film about the impact the internet might have on our daughters as they grow up – the availability of porn, more opportunity to be groomed, shifting expectations of how our bodies should look and what we should be doing with them – and decided that we really wanted to do something about this, to make a difference to our daughter’s lives, and hopefully many more at the same time.
As NHS employee’s we are legally obliged to consider gender issues in everything we do. The often dreaded impact assessment process is designed to help with this. Yet at times it is seems more of a burden than a way of informing services how best to prevent discrimination and advance equality for all.

I came across the following clip at a Close the Gap event which shows how gender mainstreaming is applicable in situations that many of us deal with on a daily basis and how this can impact on efficiency and quality of public services, benefitting not only the people who use our services, but also our key partners:

(Watch from the beginning to 3:18minutes in for a quick demonstration on how indirect gender approaches can change the way people live).
Back to the event in September: the day was split into two halves – the morning session focused on Culture and the afternoon session on Economy. The format for the day was Open Space Workshops, starting with a short presentation on each of the topics. Participants then identified topics that their group wanted to focus their discussions around. Participants were free to move around the room and join in or leave discussions as desired.
Some of the topics covered during the course of the day included:

  • Gender in the Media
    Equal pay for equal work
    Rape Culture
    Part time Work
    ‘Hidden Care’ and the economic ‘value’ of care
    Societal Norms
    Women and Sport
    Cultural Expectations
    Being non-gender specific (e.g. clothes, toys, activities)
    Women’s Only Groups
    Gender Education
    Welfare Reform

Understanding ‘double standards’
There was a real buzz in the room as each of the groups discussed their topics of interest and it was clear that participants appreciated the opportunity to discuss the issues openly, an opportunity we don’t often get.
All of the event feedback was extremely positive, and there was a real interest from participants in taking this work forward, both in the workplace setting, and in their personal lives. Some of the suggestions included the creation of a Gender Equality Network for D&G, avoiding stereotyping, creating safe spaces for women to talk openly, promoting the White Ribbon Campaign, encouraging managers to see the benefits of a work/life balance, challenging the way gender is represented and considered across society, e.g. across social media, within policies and structures. This list is by no means exhaustive of everything that was covered on the day!
I hope that having a quick read of this sh

ort blog (and hopefully a watch of the gender mainstreaming clip) will be enough to convince a few more people that gender equality really does matter.
If you are interested in being part of future discussions on gender inequality and involved in a Women’s Network then please get in touch.

Lynsey Fitzpatrick is Equality and Diversity Lead at NHS Dumfries and Galloway

LGBT History Month by Laura Lennox

Laura L 1Good things to have come out of Dumfries, Scotland:

  • Calvin Harris, superstar DJ
  • LGBT Charter of Rights    
  • Big Burns Supper                                  
  • Please feel free to add more in the comments section at the end…..                      

February is LGBT History Month. LGBT stands for Lesbian, Gay, Bisexual and Transgender. LGBT History Month takes place in Scotland every February. It’s an opportunity to celebrate the lives and culture of LGBT people as well as the chance to raise awareness of the continual need to ensure all LGBT people feel valued, supported and included.

Laura L 2

Our Speech and Language Therapy Adult Service in NHS Dumfries & Galloway are currently undertaking the LGBT Charter of Rights. The LGBT Charter of Rights is a programme created by LGBT Youth Scotland. It developed from the findings of a group of young people in Dumfries (Phoenix LGBT Youth) who began exploring relevant topics to LGBT people and included education, social and health issues. It emerged that people who are LGBT still face discrimination and prejudice due to barriers in these areas. The LGBT Charter of Rights is a way to target these inequalities by providing a means for groups and organisations to change their policies and practice to work towards a fairer and inclusive society for people who are LGBT.

Laura L 3

The training we received from LGBT Youth Scotland focused on health & wellbeing issues in particular, based on the Life in Scotland for LGBT Young People: Health Report (2012). Just over half (56.5%) of LGBT young people (13-25yrs) feel safe and supported by the NHS in terms of their sexual orientation or gender identity. Women within the LGBT population (43.1%) and transgender young people (48.1%) are even less likely to feel supported by the NHS. What really stands out is the fact that 40.1% of LGBT young people consider themselves to have mental ill health. These facts and figures are unfortunately understandable when you consider any person who faces continual discrimination and prejudice for just being who they are.

Our Call to Action: As a National Health Service, we are required to demonstrate our commitment to equality and diversity in accordance with the Equality Act, 2010. Ensuring our legislation and policies meet the needs of the LGBT population is a part of this ongoing process. But it is much more than this. We, as individual staff members within the organisation, have a responsibility to actively take steps to identify and break down these barriers within our own practice and our own services to ensure that people who are LGBT are treated equally and fairly. For more information on how you can begin then please follow this link: https://www.lgbtyouth.org.uk/charter-general    

Thank you.

Laura Lennox is a Speech and Language Therapist at NHS Dumfries and Galloway


Gender Equality is Everyones Business by Luis Pombo

What’s the issue with gender?

Gender can be an elusive concept but since it is so embedded in the fabric of our identities, and day to day life and culture, we perceive its nature to be as natural as the air we breathe. In other words the very nature of gender makes it almost impossible for us to think about it as what it really is; a code.

When we wake up in the morning, we do not usually think about gender, or how we are going to make our behaviour fit within the limits of the gender identities we have grown into, or how others expect this to be the case. Any alteration to the rules, any breaking of the code, will attract other people’s attention and sometimes their censure.

But what is gender?

Is it about what sex we are?…Identifying as a woman or a man? Being male or female? Being masculine or feminine? Behaving masculinely or femininely?…

Luis 3Sex and gender are sometimes used interchangeably despite having different meanings; sex is about biology and gender is cultural.

A very useful gender definition is the one adopted by the World Health Organisation:

Gender refers to the array of socially constructed roles and relationships, personality traits, attitudes, behaviours, values, relative power and influence that society ascribes to the two sexes on a differential basis. […] Gender is an acquired identity that is learned, changes over time, and varies widely within and across cultures. Gender is relational and refers not simply to women or men but to the relationship between them.


Luis 2Gender goes beyond identifying ourselves as men or women or being masculine or feminine; gender is a whole acquired identity and in the process of acquiring that identity we also acquire notions of power, influence, privilege, expectations and restrictions of what we can expect in life. We learn what is acceptable and unacceptable according to our acquired gender role and we also learn to accept these standards and not to challenge them due to their perceived naturalness.  In a way, it is a kind of code that we all generally share and agree to abide by; a code that cannot be challenged or changed straightforwardly and without consequences for the challenger.

To understand this we need to have a look at how we, humans, ‘get’ our gender.

“It’s a girl!”

As soon as we are born, or now with the help of scans even before then, a name is assigned to us, “appropriate” clothes are bought for us and our bedrooms are decorated according to what gender we are expected to grow into; images of footballs, Spiderman or Disney Princesses will feature in our lampshades, duvet covers and curtains, and toys will follow. A trip to any shop selling baby equipment, clothes or toys shows how entrenched such views are and how much is marketed in terms of learned gender norms.

As we grow, we see our parents and other people around us performing gender and the understanding that we get from those performances is reinforced by other similar consistent messages coming from the behaviour of other people, and from popular culture – songs, music videos, games, books, celebrities, films, cartoons, etc. –

After two years of a constant exposure to fairly consistent gender messages, we start internalising them and by the age of 3 we already know whether we are a boy or a girl. Moreover, by the age of 5 our ideas of gender stereotypes are well developed and by the age of 7 they are fully fixed.

So what?!

There would not be anything wrong with all this except that when we internalise our gender identities we also internalise other notions which will expand or limit our opportunities and expectations according to notions of relative power which, by the way, historically have been imbalanced and which informed a way of thinking and acting that resulted in inequalities some of them still happening these days.

For example:

  • 2300 years ago, Aristotle thought that: “The male is by nature superior, and the female inferior, and the one rules and the other is ruled; this principle, of necessity, extends to all mankind.”
  • Women were first allowed to inherit property in the UK only 133 years ago.
  • Women were allowed to vote in the UK only 87 years ago; 39 years ago in Portugal; maybe this year women will be allowed to vote for the first time in the history of Saudi Arabia and there are no prospects of women being allowed to vote in Vatican City in the foreseeable future.  
  • Out of 196 countries in the world today, only 17 have a woman president or prime minister.
  • Out of 650 seats in the House of Commons, 191 are occupied by women. That’s 29%; compared with Rwanda 63.8% and Bolivia 53.1%.
  • Women are portrayed in media and advertising as sexual objects which fit the male gaze; women’s bodies are objectified in everyday life.
  • Children’s toys ………Dolls like Monster High are highly sexualised.
  • It becomes natural for Young men to see pornographic images of women and to objectify them.
  • Men feel pressure to be macho and not be emotional
  • Men learn to direct emotions towards anger / Use of violence and link to masculinity is internalised / Power is constructed as a capacity to dominate and control
  • Many expectations of masculinity are impossible to attain, six-packs, rich, decided, etc. 
  • Men are in general at greater risk of suicide
  • Men are subject to violence from other men if they don’t conform to the stereotype
  • Poweris constructed as a capacity to dominate and control others.
  • At least 85,000 women are raped on average each year in the UK.
  • 72 million children around the world are not in school; girls are the majority.
  • 759 million adults around the world cannot read or write; the majority are women.
  • 25% of girls in relationships in the UK reported physical violence.
  • 60,080 domestic abuse incidents were reported to the Police in Scotland in 2012/13; 45,916 (76%) were women abused by a man.
  • 45% of women in Europe have suffered from men’s violence.
  • In 2013, the gender pay gap in Europe is 2%. Women would need to work an extra 59 days in a year to match the amount earned by men.
  • In the UK, men earn 17.5 % more than women on average per hour.
  • Globally, 603 million women live in countries where domestic abuse is not yet considered a crime.
  • Over 60 million girls worldwide are child brides, married before the age of 18.
  • FGM (Female Genital Mutilation) is most commonly carried out when a girl is 5-8 years old but it can happen from infancy to the age of 15. More than 125 million girls and women alive today have been cut and at least 23,000 girls under 15 could be at riskof FGM in England and Wales.
  • 1 billion women in the world will experience physical or sexual violence in their lifetime.
  • Prostitution is still seen by some as “work” or as a “career” and some men (we are talking about millions here) feel entitled to buy sex.
  • And this list could continue…!

Rewriting the Code

There is hope! … And everyone can make a difference, however ‘small’

We have to bear in mind that gender norms and parameters are not fixed and can be changed.

If we start looking at the ‘taken-for-granted’ reality of our everyday life with more inquisitive eyes and start spotting the gender rules we all follow we will be better prepared to start challenging and rewriting them.

Luis 1

A practical way of challenging these norms is by example; for instance, at home men could take responsibility for or share traditional ‘female’ tasks like doing the laundry, ironing, or cooking. At the same time, traditional ‘masculine’ tasks like mowing the lawn or doing home repairs could also be shared. These behaviours will be seen and adopted by the couple’s children and part of the norms will start being rewritten. 

Parents could buy gender neutral clothes and toys for their children and encourage gender neutral play; parents could also avoid encouraging boys to be strong and girls to be gentle as the stereotypes dictate. Comments like “Don’t kick the ball like a girl”, “Stop being such a wee girl”, “Stop crying, be a man” should be avoided.

We could also choose deliberate challenging behaviours in our professional worlds; e.g. a male colleague may offer to be in charge of the teas and coffees prior to a meeting or tidying up afterwards. What is more, people could deliberately look at what kind of language they use and favour gender neutral language like: ‘chair’ instead of ‘chairman’, ‘humankind’ instead of ‘mankind’, etc.

Developing our understanding of the restrictions imposed by gender norms and challenging the expectations associated with them can be the start of a process to rebalance the position of women and men in society, to develop a more equal and fairer society that can be enjoyed and built by both women and men equally for the benefit of all. 


Luis Pombo – Research and Information Officer, Domestic Abuse and Violence Against Women Partnership


Kerry Herriot – Development Officer, Domestic Abuse and Violence Against Women Partnership

Jo Kopela – Health and Wellbeing Specialist, DG Health and Wellbeing Team

Lynsey Fitzpatrick – Equality and Diversity Lead, NHS Dumfries and Galloway @lynseyfitzy

We would like to take this opportunity to warmly invite any NHS or Dumfries and Galloway Council staff to the second of our joint NHS/Council interactive events exploring the issue of gender equality. Through film, discussion, evidence, the influence of the media and the impact of privilege in society, we will continue to raise awareness and develop a shared understanding of how everyone can contribute towards promoting gender equality. This event is taking place on Monday 9th November 2015 at 2pm at Garroch Training Centre, Dumfries. If you would be interested in coming along, please contact Lynsey Fitzpatrick on 01387 244030 or at lynsey.fitzpatrick@nhs.net