Health inequities persist globally, with political, economic, and social determinants exerting greater influence than biological or behavioural factors alone (1). It is often argued that improving access to physiotherapy could significantly impact health inequities and physiotherapists are called upon to address this (2). However, barriers to access to physiotherapy such as geographical, socio‑economic, educational, political and digital constraints are frequently framed as external to physiotherapists’ control. This framing risks rendering the profession powerless. At the same time, limited attention has been given to physiotherapy agency and the role of implicit bias in either hindering or enabling equitable action (3). In attempts to remain professionally neutral, politically challenging issues such as sexual abuse, trafficking, torture and conflict have become untouchable or taboo, despite their relevance to understanding inequitable access.

This focused symposium introduces familiar concepts such as access and health inequities but applies broader theoretical perspectives (1, 4) to problematise common assumptions. It interrogates how decisions about access may create an impression of rationality and fairness within physiotherapy, while potentially favouring those who need services least. The symposium will also explore whether access decisions inadvertently foster dependency and contribute to a syndemic of patient problems affecting both underserved and overserved populations. Rather than serving as a platform for professional self‑promotion, the symposium invites honest reflection and learning from successes and failures in addressing access and equity. Using an equity lens (5, 6), speakers will critically examine access issues across diverse physiotherapy contexts, acknowledging the broader health, social, political, and environmental systems that shape them. The symposium will propose collaborative strategies for addressing global health inequities alongside communities and other agencies.

Mike Ukoha will discuss access issues in musculoskeletal services in the USA context and analyse how subconscious biases influence decision‑making and long‑term patient outcomes. He will also discuss societal trends in implicit attitudes related to race, weight, disability, and other factors, offering strategies for recognising and mitigating bias at both macro and micro levels (7) and how implicit bias training can reproduce biases, but also enable reflection to enact more equitably.

Mfonobong EdoAbasi Udoh will address equity in physiotherapy service delivery by comparing remote and urban communities access in Nigeria (8). Her discussion will focus on measuring access, identifying barriers, and emphasising the need for physiotherapists to engage politically and collaborate with governments to reduce inequities. She will outline practical strategies for improving equity in Nigeria and the global south, highlighting the structural conditions required for providing physiotherapy.

Tobba Sudmann will explore population ageing and ageism in the context of growth in older populations including low and middle-income countries. She will examine ageing as a biological, cultural, social, and structural phenomenon that provides a structural and judicial way of organising people. She will discuss how ageing intersects with other identities, often provoking micro‑aggressions, biased assumptions and unfair access. She will contrast deficit‑based framings of older adults with positive perspectives of ageing as a meaningful life stage that enables a reframing of access to healthcare (9).

1. Bærøe K & Bringedal B (2022) Social inequalities in health: The need for a new concept of health. Tidsskrift for Forskning i Sygdom og Samfund 19(36):27-38 10.7146/tfss.v19i36.133048

2. McCarty D & Shanahan M (2021) Theory-Informed Clinical Practice: How Physical Therapists Can Use Fundamental Interventions to Address Social Determinants of Health, Physical Therapy 101(10) pzab158, https://doi.org/10.1093/ptj/pzab158

3. Charlesworth TES & Banaji MR (2022). Patterns of Implicit and Explicit Attitudes: IV. Change and Stability From 2007 to 2020. Psychological Science, 33(9), 1347-1371. https://doi.org/10.1177/09567976221084257

4. Levesque, JF, Harris, MF & Russell G (2013) Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 12, 18 https://doi.org/10.1186/1475-9276-12-18

5. O’Neill J et al. (2014) Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health, Journal of Clinical Epidemiology 67(1), pp56-64, https://doi.org/10.1016/j.jclinepi.2013.08.005.

6. Hammond, J., Davies, N., Morrow, E. Ross, F., Vandrevala, T. and Harris, R. (2022) “Raising the curtain on the equality theatre”: a study of recruitment to first healthcare job post-qualification in the UK National Health Service. Human Resources for Health 20, 57 https://doi.org/10.1186/s12960-022-00754-9

7. Kurdi, B., Charlesworth, T. E. S., & Mair, P. (2025). International stability and change in explicit and implicit attitudes: An investigation spanning 33 countries, five social groups, and 11 years (2009–2019). Journal of Experimental Psychology: General, 154(6), 1643–1666. https://doi.org/10.1037/xge0001746

8. Igwesi-Chidobe C (2012) Obstacles to Obtaining Optimal Physiotherapy Services in a Rural Community in Southeastern Nigeria. Rehabilitation Research and Practice (11):909675 https://doi:10.1155/2012/909675

9. Spijker, J., & MacInnes, J. (2013). Population ageing: the timebomb that isn’t. BMJ, 347(nov12-1), f6598-f6598. https://doi.org/10.1136/bmj.f6598