Deana Kanagasingam’s PhD Thesis Proposal

Title: “Social justice in the clinic: Caring for larger patients”

Thesis Supervisors: Dr. Moss Norman and Dr. Laura Hurd
Committee Members: Dr. Robert Woollard (Department of Family Practice)

Chair: Dr Patricia Vertinsky

Abstract: Even though social justice has often been described as “the historic dream of public health” (Gostin & Powers, 2006, p. 1053), the potential of healthcare to live up to its noble ideals remains uncertain. From a social justice perspective, healthcare environments should be safe spaces that uphold principles of compassion and respect for patient welfare, allowing patients of all shapes and sizes to feel comfortable seeking support for a variety of health concerns, including weight (Puhl, 2010). However, a review of the existing literature reveals the presence of oppressive attitudes and behaviours directed at larger patients by a range of healthcare practitioners in healthcare settings (Bombak, McPhail, & Ward, 2016; Phelan et al., 2014).

Despite the increased attention on such injustice, to-date there have been no empirical studies on 1) healthcare practitioners who practice social justice in treating larger patients for weight-related issues or 2) larger patients’ experiences of receiving social justice-informed care. I refer to social justice in practice as addressing intersecting macro-level inequities such as racism, sexism, and sizeism through micro-level interactions between practitioners and patients (Mishler, 2005). My study seeks to fill a research gap by presenting an alternative to the dominant paradigm of obesity treatment and examining how social justice is understood, enacted, and experienced in clinical interventions related to weight. In order to achieve this goal, I seek to showcase exemplary social justice-oriented healthcare practitioners. At the same time, I will feature the voices of larger patients to provide a balanced account of the clinical encounter. Patients’ narratives will allow me to explore the impact of social justice practices on patients’ quality of care.

Drawing on the theoretical frameworks of critical realism (Sayer, 2012) and intersectionality (Gunnarsson, 2017), I will conduct in-depth one-on-one interviews with 15 healthcare practitioners from different disciplines and 15 patients who are served by such practitioners. I will address five main questions: 1) What does social justice mean to practitioners who identify as social justice advocates? 2) How do practitioners translate principles of social justice into concrete practices and behaviours when interacting with larger patients? 3) What are the challenges of practicing social justice that practitioners encounter when working with larger patients? 4) What does social justice mean to larger patients? 5) How does social justice-informed care shape larger patients’ experience in healthcare? Using critical thematic analysis (Lawless & Chen, 2019), I will distill key research findings to contribute to transdisciplinary dialogue within the healthcare field and enhance both practitioners’ and patients’ understandings and lived experiences of the complexities of weight and health.

This research will make theoretical contributions to a number of disciplinary areas including the sociology of health and illness, critical obesity studies, critical realism, intersectionality, and interpersonal health communication. Additionally, the research findings will guide capacity-building efforts targeted at healthcare trainees to equip them with clinical skills consistent with a social justice paradigm, and subsequently enrich patients’ quality of care.