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A Sociological Perspective

The allied health professions have gained legitimacy through the pursuit of research evidence and the standardisation of practice. Yet there remains very little analysis or understanding of these professions.

Adopting theory from the sociology of health professions, this unique text explores the sociological, economic, political and philosophical pressures that have shaped the professions. Drawing on case studies and examples from occupations including optometrists, occupational therapists and physiotherapists to emerging vocations, including pedorthists and allied health assistants, this book offers an innovative comparison of allied health professions in Australia and Britain.

By telling the story of their past, this original book prepares the allied health professions for a new and different future.

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The Invisible Providers of Health Care

Health care support workers (HSWs) play a fundamental role in international health care systems, and yet they remain largely invisible. Despite this, the number of HSWs is growing fast as governments strive to combat illness and address social care issues in a world of finite resources.

This original collection analyses the global experience of HSWs in the UK, Japan, Australia, Brazil, Canada, Portugal, Sweden and The Netherlands. Leading academics examine issues including the interface of HSWs with the health professions, regulatory practice risks, employment challenges and the dilemmas of an ageing population. Crucial future policy recommendations are also made for a world becoming increasingly dependent on HSWs.

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care organisations), hospitals and community-based health services. The allied health disciplines involved were occupational therapy, physiotherapy, speech language pathology, dietetics and nutrition, podiatry, social work, and allied health assistants. The project involved staff from all professions across all of the participating services, who undertook a process of task codification and disaggregation using a structured workforce planning tool called the Calderdale Framework (Smith and Duffy, 2010 ). The Calderdale Framework is a tool developed by allied

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an allied health assistant who is advised or supported by a more remote ‘expert’, for example, the speech pathologist who advises a remote allied health assistant about the preparation of fluids for swallowing tests (Wales et al, 2017 ). These relationships are being tested further as artificial intelligence/machine learning improves diagnostic approaches, meaning that the relationship between the assessor and the patient will change – perhaps removing the assessor from the diagnostic relationship, or removing them from the clinical interaction altogether (Diprose

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health professionals to allied health assistants (State of Victoria Department of Health and Human Services, 2016 ; Somerville et al, 2018 ). Other recent innovations that support the codification of work practices are the growth of microcredentialing and micro-specialisms. Micro-specialisms are high-volume and generally low-risk tasks that have normally developed from the division of labour of an established role. They tend to involve a short training time to learn a particular task to meet a specific, focused need. Examples that could be classified as micro

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support workforce, such as allied health assistants. These roles are becoming increasingly standardised in terms of training, titles, recognition and regulation. These occupations are often seen as transitional roles rather than aspiring professions in their own right, and may occupy an interdisciplinary space; however, there is evidence of growth and extended scope within these disciplines, such as the expansion of occupational therapy assistant (OTA) roles into assistant practitioners. Chapter 5 draws on the examples of OTAs and podiatry assistants to examine the

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This chapter examines the concept of allied health as a collective comprised of constituent professional groupings. Here, we describe the development of the allied health professions over the past century from the perspective of both the development of individual professions and the emergence of allied health under medical hegemony. Concepts that will be explored include considerations around a heterogeneous group of occupations attempting to work together to achieve a single professional project. We also examine the international health and social care organisational and policy contexts and the importance of the various regulatory frameworks.

The allied health professions are distinct from the medical and nursing professions in numerous ways. Collectively, allied health professions comprise approximately one third of the total health workforce. Due to large jurisdictional variations in inclusion in the allied health collective, as well as challenges in capturing allied health workforce data, the exact numbers and scale of the allied health professions vary widely and are difficult to determine accurately (Olson, 2012; Nancarrow et al, 2017).

Unlike medicine and nursing, which have strong brand recognition, large individual professional size, internal hierarchies, recognised specialisms and, importantly, a strong political voice, the allied health professions are a confederation of independent disciplines, each of varying size and focusing on a niche area of practice. Allied health professions face the dual challenge of negotiating their discrete professional territory within the boundaries of the allied health collective, while attempting to achieve recognition and a voice alongside their larger medical and nursing counterparts.

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The allied health professions, and indeed all contemporary Western professions, have been shaped by a set of distinct social forces and contexts that were a product of their formative era. The Industrial Revolution saw the rapid organisation of labour at a time when social class, British colonialism and paternalism were dominant themes in much of the Western world. For the professions, the consequences have included a highly organised, hierarchical and strongly gender-differentiated workforce. Social policies have evolved over the past half-century to try to explicitly reduce gender and racial inequalities in education, the workplace and health service delivery, with varying levels of success in allied health.

This context is important for understanding both the evolution of the professions through a sociological lens, and also their contemporary context. In many ways, the world has moved on but the professions (particularly the highly structured and gendered health professions) are relics of their post-industrial era formation. At the start of the 21st century, the stereotypical allied health profession is still predominantly female, middle-class and white. The narrow analysis of any areas of diversity from an allied health perspective means that this is a limited field; however, there are dominant paradigms in the literature on the sociology of the professions that are important for diversity. Gender is the obvious position; however, ethnicity and socio-economic status are also important considerations.

Intersectionality recognises that social differences and divisions do not operate separately, but rather intersect. Examining diversity from an intersectional perspective enables us to consider that several classification systems coexist and interact – such as gender, ethnicity/race, sexuality, socio-economic status and even professional status – without reducing them to singular positions (Styhre and Eriksson-Zetterquist, 2008).

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The largest recognised group of allied health professionals is comprised of the established state- and self-regulated professions. These professions have claimed clear philosophies and sometimes anatomical domains and scopes of practice that differentiate them from each other, and other emerging disciplines. This chapter draws on the examples of optometry and radiography, one of which was established prior to the advent of the era of medical dominance, and the other during it. It thus illustrates the way allied health professions responded to the challenge posed by medicine in defining the new health division of labour that took hold in the early 20th century. It also illustrates the different ways in which these professions later identified with other allied health professions: one as part of the broader collective; the other remaining separate from it (Larkin, 1983; Boyce, 2001, 2006). As was explained in Chapter 2, and should be borne in mind when considering the context of the account that follows, they also serve as useful exemplars of the contrasting gender divide within the allied health professions. Radiography became a primarily female profession, and optometry remained a mainly male profession (though, interestingly, the former remains stable but the latter is becoming more feminised) (Register, 2010; Healy et al, 2015).

Those allied health professions with a long pre-modern history – that is, the groups that emerged prior to the period in which medical dominance became firmly established – experienced medical opposition and resistance in their bid for recognition and state registration during the early to mid-20th century (Larkin, 1981, 1983, 2002).

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The health professions are in a constant state of growth and evolution, with new professions continuing to emerge, many in response to new techniques and technologies, and being included under the umbrella of allied health. This chapter explores the emergent allied health occupations, that is, those groups that have recently achieved a level of consistency of title and organisation to then pursue professionalism.

Examples of occupations that have professionalised since the middle of the 20th century include exercise physiologists, rehabilitation counsellors, ODPs, DEs, genetic counsellors, perfusionists and sonographers. In 2020, AHPA introduced affiliate membership for a range of professions, including some emerging ones, for example, lymphoedema therapists, counsellors, diabetes educators, hand therapists, dermal clinicians, hearing aid audiologists, myotherapists, pedorthists, psychotherapists and spiritual counsellors. Not all these professions are recognised allied health professions in all jurisdictions.

A notable exception to the recognition of new allied health professions is the NHS. When the Professions Supplementary to Medicine Act 1960 was introduced, 12 professions were recognised. At the start of 2020, the NHS formally recognised 14 allied health professions: arts therapy, chiropody (now podiatry), dietetics, dramatherapy, medical laboratory sciences, music therapy, occupational therapy, orthoptics, physiotherapy, radiography, prosthetics and orthotics, speech and language therapy, clinical sciences, and paramedics (Larkin, ). Since 2005, just after the formation of the HPC, the recognised allied health professions in the UK have remained relatively stable. An important contribution of this chapter is the way that regulatory frameworks and funding structures influence the development of new professions.

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