What does health equity mean to you in your professional and personal lives? In this episode, you’ll learn 14 ways to help you find out.
Health equity is still on people’s minds, and I am here for it! Maybe you can define health equity. But what does it mean to you? In this episode, you’ll learn 14 ways to help you find out.
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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This episode, like every episode, is about a problem or a question that’s emerging in the health sector that relates to health communication, or patient education or health literacy. I’m in a lot of conversations right now, people like you are writing to me, and a common thread continues to be health equity. I was just at another virtual health equity conference this week. And I think health equity relates to health communication, and health literacy and patient education in some pretty complicated ways. I also am concerned about the meaning of the term ‘health equity’ because when a term becomes so popular, it risks becoming meaningless or co=opted. I know you know this, we did a prior episode on the definition of health equity and I’ll put the link in the notes. so I thought the time was right to offer some reflective questions about health equity.
Because we are, as professionals, still asking hard questions of ourselves about what we’re doing, how we’re doing it, why we’re doing it, who we are to do this work. It is this kind of critical reflection and action that Health Communication Partners was built on, and built for.
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Now, reflective practice is a broad umbrella term, I want to get that out of the way right up front. There’s many different understandings of and approaches to reflection and to practice, right?
I have been engaging in reflective practice for about 17 years, specifically a form of reflective practice created by my mentor Susan Lytle and her longtime collaborator and friend Marilyn Cochran-Smith. I believe reflective practice invites you to look at what you’re already doing, to get at your taken-for-granted beliefs and assumptions beneath your words and actions. We don’t often get a chance to think about our assumptions or articulate them to ourselves, let alone to other people. But when we do, we can begin to see places where we’re not living up to our own standards–as well as some opportunities to do better.
I’m serious about the action part. This isn’t only about sitting and thinking and discussing, although it is about that. I want to share one of my favorite quotes from Donald Schön, whose highly-influential books The Reflective Practitioner and Educating the Reflective Practitioner describe and analyze what he calls reflection-in-action . This quote’s from Educating the Reflective Practitioner, and he explains why reflection-in-action is important:
[T]he problems of real-world practice do not present themselves to practitioners as well-formed structures. Indeed, they tend not to present themselves as problems at all but as messy, indeterminate situations…. Often, situations are problematic in several ways at once…. These indeterminate zones of practice—uncertainty, uniqueness, and value conflict—escape the canons of technical rationality. It is just these indeterminate zones of practice, however, that practitioners and critical observers of the professions have come to see with increasing clarity over the past two decades as central to professional practice. (p. 4)
So I’m wondering, what’s the situation with health equity? It’s an indeterminate, messy situation right now! What I want to share here is a key tool in reflective practice: questioning or problem-posing as a way to begin to investigate and address the ‘problems of real-world practice.’
Why ask hard questions? It’s because this kind of interrogation is part of the traditions that I come from. It’s 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, to health communication, health literacy, and patient education–research, theory, practice, policy– it all necessarily involves our using terminology, our using discourses, and our engaging in practices that are themselves grounded in equity and justice. And we can find out if that grounding is there by starting to ask some hard, reflective questions.
I’m going to give you fourteen prompts that you can ask yourself when you want to engage in some critical reflection. These questions are designed to get at your taken-for-granted beliefs. The things that we don’t typically get down to.
And then, we turn explicitly to action. Because after each, there always is a follow-up question: what implications does your answer have for your practice? In other words, why might this matter to you and your work with patients, clients, students, or the public?
- How do I define the term health equity? What does it mean to me now?
- When did I first hear about health equity, and in what context? Where do I see/hear the term most often now?
- Who do I know that historically has written/talked about health equity? Who around me talks about health equity now? What have I noticed about how other people or groups use the term health equity? What is health equity typically mentioned in relation to?
- What counts as health equity work? How would I know it when I saw it? What does it mean to do health equity related work?
- Who does health equity related work? Who doesn’t? Have I ever seen anyone take action on health equity or on something health equity related? What was it? Have I ever taken action on health equity?
- Who seems to be the subject, or target, of health equity efforts? Who is not often the subject or target of health equity efforts?
- How might I be able tell if some policy or practice is advancing health equity, or not?
- What do I see as the relationships between health equity and racism? Between health equity and discrimination?
- When is it difficult for me to talk about health equity related issues? How confident do I feel talking about health equity with my friends? On a scale 1-5, how willing am I to talk with my colleagues about health equity? Where, with whom, or on what health equity topics do I feel uncomfortable, shaky, uneasy, unqualified?
- What do I think is missing in conversations about health equity? Who is missing in conversations about health equity that I’m in?
- What do I think health equity has to do with me in a practical way, if anything? What does health equity have to do with my personal life, if anything?
- What parts of my everyday practice first come to mind when I think about health equity? What parts of my practice don’t have much or anything to do with health equity?
- How much do I consider health equity to be an individual concern, and how much a structural concern?
- What questions do I have about health equity, now?
Again, the important question at the end of each of these is always: what implications does this have for my practice?
Reflection, the way I practice it, is designed to press in to the stress and messiness of practice—not deny it. Ideally, reflective practice isn’t something that you do just once in a while. It’s a practice, it’s constant. So I encourage you: don’t do this alone.
Whether you reflect with others, or alone in your thoughts, intentional and systematic reflection is a powerful tool. It invites us as professionals to imagine other possible practices, roles, and relationships. Which means it’s ideal for those of us deeply committed to health equity, and entirely uninterested in going back to normal.
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.