It’s been an exciting time for health equity!
As I reported earlier this month, US House Ways and Means Committee released a new document outlining policy pillars and priorities, A Bold Vision for a Legislative Pathway Toward Health and Economic Equity, and a new report, Something Must Change: Inequities in U.S. Policy and Society, with this fiery statement: “Health does not exist in a vacuum, and achieving health equity will require addressing the economic and social inequities that have long persisted within our country.”
Then, on January 20th, the day of his Inauguration, President Biden issued an Executive Order on Advancing Racial Equit yand Support for Underserved Communities Through the Federal Government.
There’s much to look at in this brief document, which, NPR reports, is just the beginning.
Among many other things, this Executive Order contains a request.
I’ll tell you what is it, and then I’ll share my response to that request.
The Request
Here are some excerpts of this Executive Order, from the White House Briefing Room website:
Because advancing equity requires a systematic approach to embedding fairness in decision-making processes, executive departments and agencies (agencies) must recognize and work to redress inequities in their policies and programs that serve as barriers to equal opportunity…
…The Federal Government’s goal in advancing equity is to provide everyone with the opportunity to reach their full potential. Consistent with these aims, each agency must assess whether, and to what extent, its programs and policies perpetuate systemic barriers to opportunities and benefits for people of color and other underserved groups. Such assessments will better equip agencies to develop policies and programs that deliver resources and benefits equitably to all.
The request comes a few lines later, for “study methods for assessing whether agency policies and actions create or exacerbate barriers to full and equal participation by all eligible individuals.”
To be clear, the agencies are being asked to study barriers. Specifically, whether “agency policies and actions create or exacerbate barriers.”
I have a response to that request: Better watch your language.
Some Policy Geeking
You might know that policy and its relationships to practice are things I notice. Policy/practice relationships are part of what I read for when I read. They’re part of what I listen for when someone speaks. So allow me to policy-geek out for a minute.
There are different ways to think about and deal with policy.
Traditionally, policy architects and analysts have tended to downplay the many social, cultural, historical and political processes surrounding policy engagement and action. But some policy researchers over the last 25 years have moved away from decontextualized ideas about policy. Instead, they invite us to think about policy as a set of socially and culturally situated texts and practices.
And many of these policy folks suggest that there can be just and useful social policy. But it takes careful work.
For instance, you can’t just ask questions like, “What are the effects of this policy?” (and make sure it’s something that’s easily measurable!)
We’ve got to ask questions about where these policies came from. Where they’re going into, and what the consequence are (or might be) there. Questions about what’s been going on historically around these policies.
Ask One Question
There’s more questions we could ask, but because this site is about language use, I’m going to suggest Federal Agencies begin by studying the policies themselves, as written texts.
I suggest the agencies read their own policies carefully, and ask one question: what’s built into these policies through the use of specific terms, phrases, and discourses?
Let me back up a bit.
Why analyzing language use is important to Health Equity
People who look at literacy and language the way that I do, approach the language as a structure. As a durable, social structure.
Since we’re talking about structural inequalities, some of these inequalities are created and maintained through language. Conversations are structures. Written texts are structures. Laws are structures. Policies are structures. They can be analyzed for how they’re made, what they hold in and what they keep out, who they allow to matter and who’s not allowed to belong.
I’ll turn to linguist Norman Fairclough in his Language and Power (1989, 2015):
“Linguistic phenomena are social in the sense that whenever people speak or listen or write or read, they do so in ways which are determined socially and have social effects.”
In policies, words matter. Through word choices, policies have social effects. Different word choices = different effects.
Let me be clear: I’m not talking about simply swapping out some terms for others.
I’m talking about studying the assumptions about people, places, resources, and actions underneath specific word choices in these policies. That’s because, through specific word choices, policies position people and their contexts. They define social ‘problems’ and recommended ‘solutions.’ That’s why this kind of analysis of language is important to Health Equity.
What we don’t want in the new policies is the same old set of assumptions that got us here in the first place.
What you can do now
I’ve said before: since language is powerful enough to contribute to health disparities, I suggest it is powerful enough to reduce them.
Wherever you are, I encourage you to question the assumptions beneath the common terminology and discourses around you. even and especially if they’ve been around so long, or are so ubiquitous, that they’re taken-for-granted.
I challenge you to view those assumptions not as natural or neutral, but as politically and historically situated, and revealing a particular viewpoint.
If you would like some support in this, our Addressing Implicit Bias 2nd Edition helps you examine language and its often-hidden connections to biases. It’s an audiobook and e-book with clickable links, PowerPoint shows, and resources. It’s very affordable, and your purchase supports our podcast series. It’s a digital download, it’s immediately available, and if you’re an instructor looking for something that’s handy and digital for your classes, please ask your library. We have institutional copies available.
Contact me for more support. (You too, President & Dr. Biden.)
