What is the past–and future–of health equity research, theory, practice, and policy? Comments from an oncologist kick off some thinking.
I recently had an interesting conversation with an oncologist about health equity and communication. It got me going back and forth in time. I want to share some of what we talked about, in hopes of inspiring you and maybe challenging you, when it comes to working toward health equity.
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I was speaking with an oncologist about this course, and he kind of opened up with an interesting set of thoughts about health equity and its history and present.
He said, “Every single announcement from NIH offering funding is saying ‘we want to address equity with this funding.’ It’s on everybody’s mind. It’s not like people haven’t thought about this–the challenge is to come up with something novel.” And a little later he said about health equity what I used as this title of this episode, “it’s the important topic of our times.”
I thought this was an interesting set of phrases, and I want to unpack them a little, specifically how health equity relates to communication, and the sense of time that this clinician’s comments suggest.
So many people are working on health equity in so many ways over time, right? There are many pieces of this puzzle, so much work to be done. Many accomplishments as well. This podcast series has highlighted programs and people doing the work, and I’ve offered my own contributions. So, let’s go backwards and forwards in time a little, and get some inspiration on the long road to health equity.
The oncologist said, “It’s not like people haven’t thought about this.”
Nope. Thinking about and working on health equity isn’t new. We did an episode on the meaning of health equity. Even “health equity” as a term and concept has a long history. Authors of one paper that I cited, put it nearly 40 years ago. They said, “Since 1984, the idea of health equity has proliferated throughout Public Health discourse.” I’ll put links to that episode in the notes.
This year is also the 20th anniversary of Unequal treatment. You could say that whole report is about health equity. In another episode, I asked, what did “Unequal Treatment” say about communication 20 years ago? And I go through the report looking at communication. Some of what’s there makes me wonder about the clinician’s comment: “the challenge is to come up with something novel.”
I kind of wonder the opposite: if one of the challenges is also to keep mining what’s there, keep digging in the territory marked out in that report. How much do we know now about the questions and issues raised in “Unequal Treatment,” that we didn’t know 20 years ago? Genuine question. It might be both exciting and frustrating to answer it. I wonder what you think?
Because so much has been accomplished! There’s been so much research, theory, policy, practice that’s come about the last 20 years as a result of sustained efforts over time, often from minoritized and marginalized people. And these accomplishments are a reason for pride and hope.
A related feeling might be the sense “well, we know better, so we should be doing better by now.” I’ve heard from many of our listeners how the old stuff lingers.
For example, I interviewed Hematologist Dr. Lachelle Dawn Weeks who spoke about the tendency for clinicians and physicians to be seen not as full people. She put it, “I think there’s a tendency in medicine and academia to think of physicians as these sort of heroic healers, and academicians as this sort of, you know, machine–that sort of spitting out scholarship as a commodity. And then patients as either bags of medical problems, or research subjects, if they happen to be on a clinical trial. And we sort of compartmentalize people in these different ways.” Her approach is to focus on wholeness.
Because it’s been done doesn’t mean it’s done. There are drums worth beating. Things we need reminding of. Points that deserve to be made, again and again.
One of our guests was Dr. Paul Ranelli, Professor Emeritus of Social Pharmacy at University of Minnesota School of Pharmacy, Duluth Campus. He spent his career centering patients, and teaching his students about patients as holders of valuable information. He shared some phrases he’s used to support that view, again link I’ll put in the notes. Because we’re a long way from patients universally being treated as experts.
Still, there are many people and organizations coming up with something novel.
New understandings. Updated and refreshed concepts. There’s more nuance, I think. More intersectionality. More interdisciplinarity. And there’s VOLUME in the sense of MORE and LOUDER! More people talking more talk openly, writing more research about health equity.
Listeners from all over the health sector told me what a welcome change this was for them. It was the start of 2020, when here at HCP we put equity front and center – it’s always been here, but I started calling it out loudly at that time. I was taking a calculated risk in doing that. It’s not a risk that everyone can take.
But there are organizations coming up with fresh treatments of known concepts, or familiar treatments of newer ideas.
I did a series on freely available resources on health equity that dealt with communication. One was free online course from U.S. Department of Health & Human Services called “Culturally and Linguistically Appropriate Services (CLAS) in Maternal Health Care.” There is some hard-hitting prose there. There are top notch references, most of them links. And they say things difficult to hear. On purpose. They challenge us to think uncomfortable thoughts. And this kind of work from a large federal agency felt to me like a fresh statement.
A free online course that I reviewed from Center for Medicare and Medicaid Services was called “Improving Health Care Quality for LGBTQ People,” again link in the notes. And I said in that episode that I had gotten a little complacent, because I’m in a lot of equity conversations, that somehow just by being in these conversations I would pick up stuff I needed to know about LGBTQ health, like by osmosis. And obviously, that is wrong! So I took the course, and learned many new things. In the episode, I give you four reasons why you should take the course, too. One of our listeners who’s a veterinarian took the course and told me about it. She tagged me on LinkedIn. She took it because she wanted to get better at communicating with pet owners and family who are LGBTQ.
I’ll tell you, I was in my word nerd glory with The New York City Department of Health and their language use guide. It’s, again, freely available. It’s part of the Race to Justice Action Kit. The authors are super smart about language in use. They make some fine-grained distinctions between similar concepts – so we can think about how we’re using words and phrases. And we also have a basis for thinking about how others are using words and phrases. And some of this was new to me, and I do this kind of thing for a living! So yes, something novel!
There’s also all sorts of stuff going on in the digital health world. There’s flags in EMRs to give clinicians time to pause, or a heads up about something. You know I talk about the importance of digital health literacy in the design of digital health tools. It’s one of those drums I will continue to beat, I should do another episode on that, it’s time.
Whether it’s something novel, or something we know but need to be reminded of, my new course on communication has it. Because equity is “the important issue of our times.” This course meets people where they’re at in terms of their willingness to engage with equity as a topic. And it’s for all patient-facing employees. For more information visit HealthCommunicationPartners.com. Find me on linked and twitter. I’m Dr. Anne Marie Liebel and this has been 10 Minutes to Better Patient Communication. Audio engineering and music by Joe Liebel.