What is “Allied Health”
Have you ever wondered why a very diverse group of professions such as physiotherapy, radiography or occupational therapy are so often referred to collectively as “allied health”? We all know the phrase, but what does it really mean? In what way are they “allied” and to whom? Why have they become identified in this way? Most importantly, are their current roles changing in a way which makes the term more or less meaningful?
It is curious that the term “allied health” is so well recognised and acknowledged but so poorly defined. To understand why, we need to look at the early stages of the development of the allied health professions. Their gradual identification as a collective probably began in the UK and was linked to the emergence of the “National Health Service” (NHS) at the end of World War II.
An increased demand for rehabilitation after the war, combined with a need for skilled workers, focused attention on this group. By the mid-twentieth century, each of the constituent professions was trying to secure greater recognition by courting the medical profession, which was the hegemonic force in healthcare and health policy. This meant aligning with medicine as subordinates within the healthcare hierarchy. But the trade-off was that it also allowed the professions to be part of mainstream healthcare.
At the same time, the NHS and its centralised provision of healthcare promised much for those joining the new service. The non-medical professions were able to negotiate directly with the State, rather than the medical profession. As a result, they were treated as a collective rather than as separate, individual professions.
Applying parity across pay scales, terms and conditions of work, and the need to fit within new regional and local structures meant the Government needed to treat them as one entity. As a result, they were managed collectively, and initially legislated as the “Professions Supplementary to Medicine”.
This was the first step in establishing a collective identity and position within healthcare for what was an otherwise disparate group of professions. In Australia, the emergence of the allied health collective was even more complex, being subject to separate state regulations, organisations and funding bodies.
Over the next twenty years, it became evident that these professions were, or had become, more than merely “supplementary to medicine” in the healthcare system. They had developed new, expanded skill sets, and were increasingly autonomous, with clearly separate and identifiable roles. Their contribution to the health and well being of the nation was increasingly acknowledged, and it no longer seemed relevant to refer to them as “supplementary”. Thus, a new term evolved – “professions allied to medicine” (PAMS).
This continued to acknowledge the hegemony of medicine across the health division of labour, yet afforded the PAMs greater independence. Later still, the term “allied health professions” emerged, dropping the overt link to medicine and its connotations of a supportive role.
Olsen (2012) suggested that the term “allied health” emerged in the USA, as a means to identify essential health workers that were not medical doctors, dentists or nurses; a seemingly arbitrary selection of title. Either way, it begged the question, to whom were they now allied, if not medicine?
Rosalie Boyce’s seminal work on the AHPs provides a compelling answer (see Boyce 2006). The collective became an “organisationally sanctioned subculture, grounded within a shared meaning of allied to each other…”. AHPs had become a “profession community” in both Australia and the UK, bonded by shared cultural values as much as by political necessity.
Where does all of this leave “allied health professions” in the current context of healthcare? Is the term still relevant and meaningful, or has it become obsolete?
There are some clear pointers. Demographic changes have led to new challenges, both in terms of increasing demand for healthcare as populations age, and also in workforce shortages as the “baby boomer” generation retires and leaves the workforce. This has been brought into even sharper focus by the advent of the recent Covid 19 pandemic, which has placed unprecedented demands on health services.
In short, the AHPs have had to adapt, and to do so rapidly. It has been a test of their skills and flexibility. Established scopes of practice, rigidly defined and robustly defended in the past, have had to be jettisoned in order to respond to need – and the AHPs appear to have done this with aplomb.
Just look at how AHPs have contributed to the collective efforts to manage the pandemic – working in critical care to address nursing shortages, expanded access to prescribing of medicines in a time of crisis, even managing orthopaedic wards to free up medical doctors.
Our recent book – The Allied Health Professions A Sociological Perspective provides some insights into the conundrum of allied health, offering a limited number of key points that can, at least, be asserted ‘conclusively’ about these professions:
- They all adhere to the medical model in terms of their underpinning science and philosophy (unlike the complementary and alternative professions)
- They all occupy a niche area of practice – often focusing on a discrete part of the body (eyes, feet) or treatment /diagnostic modality (X-rays, PET, MRI, medicines) or philosophy (restoring independence and meaningful occupation).
- They must meet a comparable standard to gain entry to the profession (usually a Bachelor’s degree), and are often (but not always) regulated by the state.
- They emerged in the post-industrial division of labour, in response to social and technological change.
- Diversity remains an issue; ethnic diversity focuses on cultural competence and health literacy, and recruitment of ethnic minorities as a priority.
- Practitioners have become adept at work role flexibility, expanding and shifting scope of practice to accommodate need.
- Allied health professions are highly feminised, with implications for status, and type of role (often identified in a caring as opposed to curing role – but not exclusively so, and currently changing).
Allied health professions are clearly changing. In order to thrive, they must respond to current need. They must become what is asked of them, and not merely pursue what they desire.