“I want to help these moms talk to their babies,” the physician told me.
“Who? What do you mean?” I asked.
She gave me a quick overview of a study she’d learned about: “There was a recorder that transcribed the number of words and type of words that they used – more educated people—[there was] the word gap of 30 million…”
I recalled the study she referenced and I started to catch on to her meaning. She and I would continue to talk about this ‘word gap’ for weeks. It turned out she had tried to broach this topic with some moms, but was unsuccessful.
This conversation happened about 15 months ago, but I went and found my notes on it this week, after seeing the ‘word gap’ hit the news again.
I’ll share with you what the physician and I talked about, give you some pointers for the next time you’re thinking about language and your patients, and end with four things you can do to improve the education of all your patients.
Caring for the whole person
The so-called ‘word gap’ hit the news lately, in the form of two different podcasts and a flurry of social media activity.
On July 1, “Vocal Fries” released an episode called “Don’t Mind the Gap” with an interview from Dr. Nelson Flores at the University of Pennsylvania. Ten days later, NPR’s “Code Switch” also tackled the so-called word gap in their episode, “Word Up.” They’re both interesting and informative so please check them out.
The physician and I continued to talk about this study. As she put it, this study portrayed the experience of the low-SES babies and toddlers as, “My mom does not talk to me other than to say stand up, sit down, shut up.” This was truly a terrible image for her to take away from the study, and I understood her concern to help address the situation any way she could.
You want to do your best to help your patients and their families. This physician was genuinely concerned with helping parents do the best they can for their babies.
The controversial 1995 study that started this ’30 million word gap’ trend has gained tremendous attention over the years, positive and negative. The two podcasts (Vocal Fry and Code Switch) do a great job of filling in details and breaking it down, so again please check them both out.
Here, I’m going to talk about this study as a way of connecting to health disparities.
And I’m going focus on the deficit perspective.
Gazing at the gap
I’ve written about deficit perspectives before. Deficit perspectives relate to:
- A focus on what a patient doesn’t understand, or doesn’t do; what a patient’s situation lacks; what his or her community can’t provide.
- Seeing patients as empty ‘containers’ to be ‘filled.’ Passive recipients. Not people with lives, thoughts, histories, or resources.
- A focus that’s limited to negative results, effects, examples, depictions, or instances.
I’ve also warned against educational programming based on deficit assumptions.
As damaging as they are, they also can be tricky to catch, even for the most equity-minded people.
It’s particularly important to call out deficit perspectives now. This is because recent research has shown how public health, medical care, and human service providers can unintentionally contribute to racial/ethnic health disparities. And some of this manifests itself through language that can slip into our use unconsciously.
This brings us to that so-called ’30 million word gap.’
The NPR Codeswitch podcast calls the 30 million an “incredibly catchy number.” Indeed. That number 30 million is big, splashy, and memorable. 30 million of anything seems imposing. Like trade deficits or national debts, large numbers evoke images of currency, capital, value.
I can’t imagine anything that stresses the differences between you and your patient is going to bring you together and make your relationship stronger. Including claims of differences in quality and quantity of language.
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Speaking from our positions
Language is a social construct, and use of language a social act. At the most basic level, we use language to be understood and to understand each other.
We are all speaking from a particular social positions. If it helps, imagine you’re standing on a large map. Whatever we say is said from a viewpoint within the cultures of which we are members. (I’m writing from my perspective right now; you’re reading from yours.)
The cultural background and world view of the provider and the patient come into play in the patient encounter.
We want to be careful that we’re not tacitly accepting an argument – as the “Don’t Mind the Gap” podcast points out – “that a particular cultural background is higher than another. We all have rich cultural and linguistic practices that we engage in.”
Those people and the way they speak
You know, because you are alive in America today, that people who speak English with an accent, or even certain dialects of English, are often seen as inferior.
This is nothing new. Dr. Flores points out how “The language practices of racialized and low income communities – all the way back to European colonialism – have been seen through a deficit lens.”
“The language practices of racialized and low income communities – all the way back to European colonialism – have been seen through a deficit lens.”
Speaking a different dialect or language should not prejudice our attitudes towards others. But too often, it does. Speakers of nonstandard dialects are well aware of the differences between their dialect and mainstream dialects, and of the cultural inequalities they imply.
This means that the so-called 30 million word gap can be memorable—even seductive–because there are ideas multiple generations deep, that might escape our conscious awareness, about those people and the way they speak.
Something small and doable
Here are 4 things you can do to help shift from a deficit perspective to a resource perspective – with any patient:
- Start with the assumption that your patients are already doing the thing you want them to do.
Your job is to expand or extend that action. Rather than assume they’re not having meaningful interactions with their kids, assume they are having meaningful interactions with their kids. That’s a very different starting place.
- Create some language routines that build on what patients are already doing.
You might even include their background knowledge and the words they actually use. As Dr. Flores suggests, “if there are people who speak languages other than English, ask them how to say a few words in that language.”
- Beware any study or theory that implies that those kinds of people just can’t learn, won’t listen, are just not motivated.
Remember, between provider and patient are not issues of ‘correct’ and ‘incorrect’ language, but of worldview, sociocultural influences, assumptions and negotiations.
- Don’t take your eye off the ball in terms of root causes.
Reach out to colleagues who are also addressing issues of poverty, food insecurity, income inequality, and discrimination. Because you’re helping the patients in front of you, and keeping in mind the generations behind them.