How do you make sense of the range and variation in the way health equity is written about? In this episode, I share one way I help myself make sense of the complexity of health equity in articles I read. Hear the episode here and read the transcript below.
A recent JAMA article brought attention to what’s been called the quintuple aim in healthcare. As a result people are talking about and sharing other articles on healthcare and health equity. Clearly, this is an important conversation that’s been happening for a long time, and now with renewed force. Which mean there’s plenty to read. How do you make sense of the many, many documents out there about health equity? Well, I’ll tell you one way I try to manage the complexity when I’m reading about health equity.
Hi everybody. I’m Dr. Anne Marie Liebel. This is “10 Minutes to Better Patient Communication” from Health Communication Partners, an independent health-equity focused education and communication consultancy. If your organization needs expert help with any topic in this series, visit healthcommunicationpartners.com.
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As I mentioned, there was a JAMA Viewpoint published not long ago called “The Quintuple Aim for Health Care Improvement: A New Imperative to Advance Health Equity.”
In it, the authors say: “The COVID-19 pandemic has brought long-overdue and much-needed attention to the lack of health equity in the US and around the world.” They add that, “The challenge now is translating this heightened social consciousness into action, particularly in communities, clinics, and health systems.” They talk about the importance of centering health equity in healthcare reform, what’s been called the quintuple aim. I’ll link to the article, I think it’s behind a paywall. It’s gotten some social media attention and this has the effect of other people sharing and bringing attention to other articles they like about health equity. I’ll link to a couple open access ones, including one that does a quick flyover of the triple aim and how it became the quadruple aim and now quintuple aim.
I thought I’d use this as an opportunity to share some ways of reading texts about equity or health equity. You know me. I’m all about the relationships between lagnauge and equity. Not only spoken language, written language too. And that includes the ways we write and read about equity and health equity.
Because whatever your focus is on health equity and its relationships to healthcare, there’s no shortage of documents. PubMed says more than 8700 articules on health equity were published in 2021. And that’s up from more than 6200 in 2020. all using the term health equity. So making sense of the range and variation of the ways this term is used, defined, and understood it’s difficult but it’s necessary if we’re going to make meaningful progress together toward health equity.
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I get to see a lot of different ways people understand and work toward, or plan to work toward, health equity. Organizations tend to come to me for capacity building, and it’s usually so they can grow, or have some other organizational change, while they are advancing equity. HCP we put health equity front and center in 2021. Everything on the HCP site and this podcast series, back from when we started in 2017 has always been grounded in equity and justice. As you know, we focus on the role communication plays in equity.
I think health equity relates to communication, and health literacy and patient education in some pretty complicated ways. So I’ve done podcast episodes lately, on it. One is how to reflect on your understanding of health equity. Another on supporting more equitable interprofessional communication. And I also shared some encouraging actions I’ve seen lately at the intersection of communication and health equity. So of course links to those in the notes.
It’s all part of what it means to me to take what I call a critical health stance. I believe that any equity-oriented approach to the work that we do, whether it’s health communication, health literacy, and patient education or beyond, whether it’s research, theory, practice, policy– it all necessarily involves our using terminology, our using words and discourses, and our engaging in practices that are all themselves grounded in equity and justice. And these practices include our reading and writing about health equity.
This is part of why I am so concerned about the meaning of the term ‘health equity’ I know you know this, we did a prior episode on the definition of health equity and I’ll put that link in the notes, too. Spoiler alert: I don’t advocate for any particular definition!
These are complex concepts. and the articles, reports, research, policies written about them are also complex. There’s a lot of ways you could read these documents and many elements you could focus on. What I’m going to share is one way in to this complexity if you’re working with a text –any kind of document. One way to go about it. I’ll give you four steps, might help you to sort out some things as you read, and do some of your own analysis as you evolve your own understanding of health equity.
First: look for how health equity is literally defined. You know in a journal article, there’s always that definition that gets dropped somewhere in the first couple paragraphs. But whatever your document is, locate the actual definition. I’m going to ask you to pay attention to that. What definition do the authors use? Do they modify it? How does it compare to other definitions that you’ve run across?
Second: authors will define health equity explicitly, like I just said. through the rest of the paper, or whatever document it is, health equity will also be defined implicitly. You find out more about the author’s thinking about health equity from how else they write about it. The examples they use, the metaphors they use. And very importantly what they don’t write about. So, you found how they defined it, and now I’m asking you to focus on how they’re running with it, how they’re talking about it, what’s between the lines. What are the authors trying to say it means. How does this implied definition or meaning compare to other texts you’ve read? How does it compare to your own current understanding of health equity?
Third: here’s where it gets a little trickier. I’m asking you to locate what authors are saying health equity looks like in real life. Another way of putting this: How does health equity get operationalized. How is this done? Are we getting any real life examples of health equity? Are we getting real life examples of health inequalities? What are we supposed to understand as the relationships between health equity and health inequalities? Because in addition to health equity being an important construct, a concept, health inequalities are real! They are real things in the world! There are health differences that are unnecessary and avoidable and unfair and unjust when we compare them to what is going on in the larger society, as Margaret Whitehead said. What’s being taken as a stand-in for health equity in the text you’re looking at? Where are the people? How do these examples of real life health equity or health inequalities compare to those you’re witnessing in your context? Because at some point health equity gets operationalized. So pay attention to that.
Fourth, look them all together. All three. The explicit definition, the implicit definition, the operationalization. What a word that is! How do they look to you? How far of a leap is it from one to the next to the next? What are you being asked to assume or expect, in order for that leap to work? What are you being expected to ignore, or kind of forget about or sideline, in order for those to work? For that basic logic line that they’re offering you to hold up?
I’m grateful to my mentor Susan Lytle and her longtime collaborator Marilyn Cochran-Smith who taught me how to read education research, policy and other documents like this. But why? Why do this, why ask these questions?
Well for one, there’s usually many reasons we want to be able to do some comparison. So asking questions like this can give you a way to see patterns, trends, similarities/differences, also gaps. Like I said earlier, help you do your own analysis. Another is that we want to align our work with folks who have similar or at least complementary notions of Health Equity. We also want to be able to spot when the term Health Equity is maybe glossing over things that are inequitable or that merely maintain inequality. Because this is about meaningful action, research, policy, and practice.
So I’m arguing we’re gonna need to be uptight sticklers about the meaning of health equity in anything we’re involved with, and any research that we lean on. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music by Joe Liebel. I’m Dr. Anne Marie Liebel.