Recent research has shown how public health, medical care, and human service providers can unintentionally contribute to racial and ethnic health disparities.
This is distressing, and almost unbelievable, considering that most health professionals genuinely seek to give good care to all patients and clients.
Yet, there are documented links between health care professionals’ unconscious bias, and disparities in receipt of health care, and in multiple clinical outcomes.
Can ordinary language undermine equity?
Disparities in care along racial and/or ethnic lines have been documented–even when the patient is a newborn, as described in this paper. In terms of health research, unconscious bias has been identified as a cause for underrepresentation of particular groups in public health and epidemiological studies, as well as clinical trials.
This 2015 AJPH study summarizes some different forms that unconscious actions and attitudes can emerge in the care setting:
“Subtle biases may be expressed in several ways: approaching patients with a dominant and condescending tone that decreases the likelihood that patients will feel heard and valued by their providers, failing to provide interpreters when needed, doing more or less thorough diagnostic work, recommending different treatment options for patients based on assumptions about their treatment adherence capabilities, and granting special privileges, such as allowing some families to visit patients after hours while limiting visitation for other families.”
Numerous studies have also indicated how bias exists within health professions. Foreign-trained doctors are treated unfairly in examinations. Gender inequality persists in specialist medical colleges.
And these biases are revealed partly through spoken language.
Examples of such microaggressions might include questioning where the practitioners received their degree, what country they were born in, or whether they are being supervised. Presumably there are innumerable permutations of microaggressions in health care delivery, experienced within all health care professions.”
Addressing health disparities can seem overwhelming, especially at a time when health professionals are already under immense demands and pressures to be almost superhuman. Yet often, the providers I talk to espouse values of equity and justice.
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I wish to be supportive in this process, so I’m not giving you another impossible standard to live up to. I am taking an approach that won’t surprise you if you’ve read this site or heard my podcast series. I’m going to talk about language.
Language as a most powerful tool
As you may know, I’m particularly interested in what language, literacy and education have to do with each other in (and beyond) the health sector.
Our everyday words and actions (and silences and inactions) can and do contribute to discrimination, even unwittingly. This is, in part, because language is social. It’s also one of the most powerful tools in our human tool kit.
What does that mean? 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.“
(p. 23, emphasis mine)
For the remainder of this piece, I’m going to do my best to unpack some of these ideas.
Helping your words flow from your values
Our language reflects our values…sometimes.
We can all tend to think of the ways we use language as normal, natural, value-free, or neutral. No big deal.
I’ve written before about how linguists demonstrate that our words reflect what we think is normal. Our language reveals our perspective on what Gee calls “being ‘normal,’ ‘acceptable,’ ‘right,’ ‘real,’ ‘the way things are,’ ‘the ways things ought to be,’ or ‘what people like us do’.” (p.2)
This includes ways of talking about other people.
And we get these ideas and terms over time, through the many communities we’re part of. These are reinforced through media we consume, for example, or casual talk at dinner, or sharing stories in online groups.
We are often unaware of these sophisticated workings of language in our everyday lives, as they are habitual.
There are several forms of critical research used to show what is taken for granted in everyday speech, action and writing. This is an important endeavor in part because much of what we do with language escapes our conscious awareness. We rely on assumptions, and ways of talking, acting, and being, that we use almost automatically.
Consider the fish!
It’s not easy being intentional with your words.
There is an allegory in anthropology and ethnography, that my former professor Brian Street retold several times. It’s used to caution researchers about the ethnographic bias:
The fish would be the last creature to discover water.
Among other things, this means it’s hard for us to notice our own language. But it’s necessary, if we don’t want our words working against us.
One way to catch ourselves in the act of implying negative messages we do not intend is by paying attention to phrases or statements–small pieces of language. And if you’re interested in this, here’s an earlier piece I’ve written, and a workshop.
Being mindful of ordinary, everyday language
I’m going to go out on a limb here:
Since language is powerful enough to contribute to health disparities, I suggest it is powerful enough to reduce them.
I’ve focused here (and earlier) on verbal communication. Of course, there’s more. Policies and laws are written, interpreted, and reinterpreted. Written materials are shared, physically and digitally. Images and multimodal texts are nearly inescapable. And these all are loaded with meaning that gets taken up and negotiated differently, by different people, in different situations.
I am continually inspired by the work of health providers and public health professionals in addressing–through concentrated and sustained effort–some of the most pernicious and difficult issues facing society. I’m not suggesting the clinical encounter is a level playing field. Nor that disparities will somehow fall away if we all just watch our language.
Yet I do wish to support the efforts of providers who are committed to reducing health disparities. I agree with those who recognize that examining our own language is one possible starting point.