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Inclusivity in healthcare and the concept of ‘safe space’: opportunities and challenges
  1. Véronique Lugrin
  1. Enmouvement Sports & Performance Centre, Lausanne, Switzerland
  1. Correspondence to Véronique Lugrin, Enmouvement Sports & Performance Centre, Lausanne 1003, Switzerland; veronique{at}

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Seventy two per cent of transgender individuals, 52% of bisexual or lesbian women and 44% of bisexual or gay men have felt uncomfortable using healthcare services.1 In addition, 40% of LGBTQI+ people avoid discussing their gender identity or sexual orientation.1 Gender identity and biological sex are factors that influence health, participation in sports and the healthcare routes one accesses. When these factors are not taken into account, and when they come with prejudice, biased treatment and healthcare services may result.2–4

A programme dedicated to inclusivity

Enmouvement is a multidisciplinary clinic with programmes dedicated to physical activity and artistic performances located in the heart of Lausanne, Switzerland. A collective of experts passionate about health, sport and performance who collaborate daily to promote sustainable health and performance, the Enmouvement team motto is ‘exercise is your best therapy’ (figure 1). The clinic has been promoting a holistic and environmental biopsychosocial approach to health for the past 8 years.

Enmouvement programmes have become renowned for their work with artists and sports people of all levels. The concept of ‘safe space’ is integral to the vision and values of Enmouvement, as a clinic where movement is seen as a key to the health of everybody, no matter their gender identity, ethnic origin or socioeconomic status.

According to Harris5 and Arao and Clemens,6 a safe space can be defined as ‘an environment where everybody can feel comfortable to express themselves and fully contribute, without being afraid of being attacked, humiliated or seeing their experience being belittled’. Enmouvement services are safe and accessible to minoritised communities, and we aim to make our programmes open to communities who have experienced, or still experience, discrimination.

Training is essential in the development of inclusive programmes

To better understand the experience of transgender individuals, including the discrimination and erasure they experience, we have undergone specific training, provided by the charity Agnodice, on gender identities. Enmouvement provides healthcare services embedded in a non-binary understanding of gender that respects identity self-determination and people’s own gender identify and expression. We are aware that people who are discriminated against may have had traumatic experiences, and we aim to avoid, at all costs, the reproduction of traumatic experiences in our clinic.

Enmouvement aims to be a caring and open-to-all space, where everybody can feel welcomed, comfortable and valued and to provide the means for people to take care of their body, mind and soul safely so that sustainable health or performance can become accessible to all.7 Education, collaboration and attention are key elements to such an approach, as well as the ability for therapists to question their own beliefs and therapeutic processes.

As our understanding of the world around us is built on the way we are brought up, including our culture, gender and experience,8 we are aware that we may project our interpretations of the world onto our patients. This awareness is a necessary step toward better, less biased and sustainable healthcare services.

Integrating the principles of equity, diversity and inclusivity

As recommended by Coe et al,9 Enmouvement has implemented the three pillars of equity, diversity and inclusion (EDI) in our healthcare services, recruitment and training of staff according to the EDI principles, where the objectives are to:

  • Foster awareness, understanding and tolerance

  • Celebrate diversity in cultures, beliefs and ideas.

  • reat people with respect and dignity.

  • Value differences in individuals.

  • Recognise what everyone has to contribute and support one another.

This results in feelings of security and trust for both patients and clinicians, an improved therapeutic collaboration, a better understanding of one’s patients,and enhanced healthcare services overall.1

Practical steps to develop inclusive programs that serve your community

  • Train and educate staff to adopt an inclusive and reflective attitude

  • Have a code of conduct in which EDI is embedded

  • Use inclusive language in forms and workshops

  • Ask clients which name and pronouns they prefer to be used

  • Have toilets and changing rooms that do not distinguish by gender

  • Have inclusive posters, stickers and reading materials.

Ethics statements

Patient consent for publication

Ethics approval

Not applicable.



  • Contributors Mario Bizzini (SSPA) revised and proofread the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.