Stephanie Nixon Challenges Quinte Health to See Both Sides of the Coin

Healthcare is full of people who want to make things better. But what happens when the very system we work in is part of the problem?

That was the bold question Stephanie Nixon, PhD, brought to Quinte Health during a recent presentation. A scholar-activist, Vice Dean of Health Sciences, and Director of the School of Rehabilitation Therapy at Queen’s University, Stephanie introduced Quinte Health staff to her “Coin Model of Privilege and Critical Allyship”—a powerful, thought-provoking framework that helps us understand how social structures shape health inequities, and what we can do about it.

And it starts with a coin.

A Simple Metaphor with Big Impact

At the heart of Stephanie’s theory is a metaphor: imagine a coin. On one side (the top) is privilege—unearned advantages given to people because of things like their race, gender, class, or ability. On the other side (the bottom) is oppression—unearned disadvantages that others face because of those same social structures. We don’t choose which side we’re on; it’s determined by systems that have been built over centuries. None of us invented the coin—but we’ve all inherited it.

“There’s no top without a bottom,” Stephanie said. “And the goal is not to flip the coin or pity those on the bottom. The goal is to get rid of the coin altogether.”

What’s Water?

Stephanie invited the audience to think differently—starting with how we even see inequality. She used the metaphor of two fish, where one asks the other, “How’s the water?” The other fish replies, “What’s water?”

That, she explained, is how privilege works. It’s invisible to those who benefit from it—just like water to a fish. Those of us who sit on the top of the coin (due to whiteness, wealth, straightness, able-bodiedness, etc.) often don’t even notice the systems working in our favour. Meanwhile, those on the bottom are forced to navigate and survive in those systems of oppression every day.

And healthcare is no exception.

A Call to Action in Healthcare

Stephanie made it clear: systems of oppression—racism, sexism, ableism, colonialism, and more—are built into the very foundations of healthcare and other institutions. These are not just abstract ideas. They affect real people, real health outcomes, and real experiences in the health system every day.

Those on the privileged side of the coin must do more than “help” those who are marginalized. We must work in solidarity to dismantle the systems that create and sustain inequity. It’s not about charity—it’s about justice. It’s about unlearning, listening, and changing the way we move through the world.

Collective Liberation

Stephanie’s presentation was more than just a lecture—it was a challenge. She urged staff to reflect, to feel uncomfortable, and to begin the work of “learning in action.” She reminded us that dismantling oppression isn’t about fixing people who are marginalized—it’s about fixing the system that marginalizes.

“We need to act with accountability and care at the same time,” she said.

That means changing policies, shifting cultures, and redistributing power—within ourselves, our teams, and our institutions. It means amplifying voices from the bottom of the coin and crediting their leadership. And it means acknowledging our complicity while staying committed to collective liberation.

Because if we truly want to make things better in healthcare, we can’t just treat the symptoms of inequality. We have to address its root cause—the coin itself.

And now that we can see the coin, we can start the work of dismantling it. Together.

Thank you to Stephanie Nixon and Quinte Health’s DEI Committee for engaging our team in meaningful discussion.

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