News headlines the past calendar year have forced me to think about social justice quite often. The NASW Code of Ethics tells us that social justice is a value of our profession:

Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people…activities seek to promote sensitivity to and knowledge about oppression and cultural and ethnic diversity. Social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people.

As a student and young professional, this value always felt so “big” to me. How can one person make a difference? I often asked myself this question over the years. You see, I’d always put addressing social injustice on a very tall pedestal because it felt like it had to take place on such a large scale, like a movement of some kind. As I’ve grown professionally, this doesn’t feel as insurmountable. I can’t say, however, that I’d ever taken any direct action to “pursue” social change—until recently.

In December 2017, there was a discussion on SWON about a program many of us are involved with—Look Good Feel Better. The discussion centered on a reduction in classes across the country. I want, however, to focus on a different aspect of the program and challenge us to think about opportunities to “promote sensitivity to and knowledge about oppression and cultural and ethnic diversity,” as stated in our Code of Ethics.

Since 2011, I’ve been co-facilitating Look Good Feel Better classes, and since then participating women of color have complained about the names of the kits: “light,” “medium,” “dark” and “extra dark,” especially the latter two, since these are words that are often associated with stigma, stereotypes and even racism. In the past five years, nearly 30 percent of my participants have been African-American. In February 2016, one of them encouraged me to act on my desire to “follow up about it.”  But I had no idea what first step to take.

To start, I reached out to the hospital representative from the American Cancer Society. I was encouraged to start by filing a National Feedback Form, which I did. ACS doesn’t own the program; rather, they are one of three program collaborators. From there I did get a call from an administrator to discuss my feedback further and hit my first roadblock in the form of a question: "Why haven’t we received this kind of complaint before?"

If you’ve ever watched the television show, “The Amazing Race,” you know there are many “roadblocks” where participants are faced with a choice about how to proceed in the game. In that moment, I reflected upon the many conversations where I’d helped women process the stigma of being called “extra dark” while also facing the stigma associated with having a cancer diagnosis. I thought about the nonverbal glances I’d seen women of color exchange during class as an unwanted label hung on their kit, visible to everyone. So many thoughts and one big decision—is this my opportunity to actually put social justice into action? Yes.

I disclosed my own skin color and that patients may have felt more comfortable disclosing their feelings to one of a very small percentage of African-American oncology social workers in this profession. (A 2016 AOSW member survey showed that just over 90 percent of our members who responded (N = 390) were Caucasian.) I explained that since I have been aware of, sensitive to and open to discussion about this issue facing women of color, it was an issue that started to make me very uncomfortable over the years, to the point where I stopped using the names of the kits altogether and stuck with the celebrity examples only.

It’s been two years of follow-up phone calls, e-mails, meetings, suggestions (i.e., to use more generic labels or alternative color names that are less offensive) and some very uncomfortable discussions (i.e., about what it means to have “dark” skin in order to help others understand the scope of the problem).

On January 17, 2018, I finally had the opportunity to address this issue with both the Director of the Look Good Feel Better Foundation, the organization that owns the program, and the manager of kit assembly and procurement. The good news is that they have been following along for the past two years. They shared details about their follow-up with cosmetic companies and the other 25 countries where the program exists. We discussed my suggestions and the result is:

• The celebrity examples continue to be expanded to represent a wider variety of ethnicities and thus skin tones.
• There is agreement that messaging in both the “program finder” on their website and the skin tone scripts should be reviewed and possibly revised.
• There is also agreement that they can assist with more messaging to help in “those moments” when a participant isn’t pleased with the name of her kit.

As for the actual labels that hang on the kits, well, they’ve all been ordered for 2018—as is. They explained that it’s “hard to land on a name for the kits” and pointed out that changing the names now doesn’t exclude the possibility of offense to other participants in the future. Am I disappointed that the labels themselves will remain? Yes. The point they stressed, however, is that “we do care…we don’t want people to be offended.” They further pointed out that changing the messaging is a first step and they’ve invited me into the process to review the messaging and offer suggestions.  

• Did I bring up “social justice” directly in my conversation? Yes.
• Did I get the end result I was seeking? No.
• Do I feel like I wasted my time? Absolutely not. I’ve gotten their attention.
• Is this another road block? At first, I thought so; however, they have invited me to keep an open conversation with them and there is value in that.

I’ve shared some of the details of this process to encourage all of us to think about what it truly means to challenge social injustice. Oncology social workers are dealing with many complex issues as we try to provide quality care to our patients. Social injustice is all around us. What opportunities exist for us—for you—to truly pursue social change? Our 34th Annual Conference theme is about doing this work in pivotal times and influencing the lives of our patients, their families and communities. It is through our work for others that we elevate our profession and what we’re really about. I encourage you to:

• Think about the problems and/or concerns that are consistently present or that keep coming up for patients you serve in vulnerable and/or oppressed communities. Gather more information.
• Remember that opportunities to address social injustice can occur on micro, mezzo and macro levels and don’t always require the kind of process I’ve described above.
• Talk to your colleagues; seek the perspectives of others who have also observed or may have encountered this problem. There may be others willing to partner with you.
• Start small. Who knows where you’ll end up but break your steps into manageable pieces.
• Be patient. Effective change often involves a process. Accept that there will be roadblocks and these are not necessarily stop signs.
• Regroup when needed. You’ll be learning as you go. If one approach isn’t working, revision is permitted and encouraged!

Social injustice, practicing with cultural humility, diversity and inclusion in our workforce, training the next generation of oncology social workers, ethics and professional boundaries—these are some of the issues I care deeply about. They not only relate to who we are professionally and as an organization but also to how we work with our patients.

I am extremely excited and humbled by the opportunity to serve as your 2018 President-Elect. Together we each make AOSW a leader in psychosocial oncology.