The New York City Department of Health has a language use guide on its site. I preview it, and tell you 5 reasons why you should check it out.
The NYC Department of Health has a language use guide on its site. A language use guide! From major health department! As a researcher and educator in equitable uses of language and literacy I’m telling you 5 reasons this guide is good.
Hi everybody. I’m Dr. Anne Marie Liebel, and this is “10 Minutes to Better Patient Communication” from Health Communication Partners, your partners in health-equity focused education and communication. Visit healthcommunicationpartners.com.
What I’m talking about today is a Language Use Guide.
So first the basics. This is from the NYC Department of Health and Mental Hygiene. And I love some wordplay in a title, I really do. It’s hosted on the nyc.gov page, and the language use guide I’m talking about is a pdf, it’s freely available. Is it part of the Race to Justice Action Kit. Let’s stop for a moment an appreciate that there’s a whole thing called a Race to Justice Action Kit!
You’ll find the whole Race to Justice Action Kit there on this site, so many useful resources. Easiest way to find may be go to nyc.gov and search race to justice in the search box. Race the word to t-o justice, like we’re running fast together in the direction of justice.
I’m going to focus on one resource in this action kit, if there’s time at the end I’ll mention another.
So this Language Use Guide is a “Clarifications of key concepts and recommendations for the use of certain terms.” It’s a use guide; think, “how and when am I using these terms?” It’s about the NYC Health Department and its commitment “to using inclusive language that elevates the voices of those most affected by health inequity.” The guide is explicitly for all NYC health department staff. But if you care about how to communicate about race, racism, racial equity and social justice, I encourage you to check it out.
As someone who’s spent the last 20 years on equitable uses of language and literacy in research, theory, policy and practice, I’m giving 5 reasons this guide is so good.
#1 It starts with this three word sentence: “Word choice matters.” BOOM we can’t escape that truth. Anyone who starts that way I’m already a fan. As you’ll hear they don’t back down from making some hard calls about language. And they acknowledge the fluid nature of language, saying “Language constantly evolves and varies between and within communities.” Which means any hard calls, including the ones they make, will need to be revisited and remade. And they promise they’ll be watchful on this and update the guide over time.
#2: They make some clear-eyed distinctions among similar sounding terms: equity, equality, disparity and inequity, and what they all mean in health. Maybe my favorite single takeaway: they make a distinction between health disparities and health inequities. Definitely check that out. Here’s a preview:, the guide states “Analyzing health inequities does not mean simply collecting data on the differences across groups; it also means identifying and examining the social and structural causes of those differences.” Again, don’t miss this part, I’ve changed how I’m using these terms because of it.
#3 They offer a definition of social justice. Social justice one of those terms that we all use, and it definitely gets thrown around, but very few folks are brave enough to stop and define it, say what it means to them and in their organization. They do. They also of racial equity and health equity, and they see the three as in relationship to each other.
You know I feel strongly we need to be specific about how health equity is defined. I did an episode in which I give you six reasons why we need to be concerned about what is meant by Health Equity, and I’ll drop that link in the notes.
#4 The guide gets into the uncomfortable stuff. For example, ”Use the “r” word: racism, racial equity or racial inequity,” and “Be explicit about racism and other forms of oppression, such as sexism, cissexism, classism, ableism, nativism or heterosexism”
They take aim at problematic terms too that have crept into medical and public health discourse, and look at some of the taken for granted ways of using language in health and they question them. And this can be uncomfortable to do. So check them out.
They invite us in to these uncomfortable spaces, they talk right to us as language users. For example, “Explore what kind of biases or assumptions you may have that could inform the way you communicate about the topic.” I appreciate their willingness to unearth the assumptions we’ve been making and take a good hard look at them, what these assumptions are allowing us to do, as well as what they’re keeping us from doing.
I believe that any equity-oriented approach to the work that we do in health–research, theory, practice, policy– it all necessarily involves using language that is itself grounded in equity and justice. This is part of what it means to me to take what I call a critical health stance. And we can find out if our language has grounding is there by starting to ask some hard, reflective questions as the authors of this guide invite us to do.
Now if you want to go further in this kind of question-asking, our most popular podcast episode of all time is twelve prompts that you can ask yourself when you want to engage in some critical reflection. Questions designed to get at your taken-for-granted beliefs. The things that we don’t typically get down to, and the occasional uncomfortable question. I will drop that link in the notes, as well.
#5 Thinking structurally. The guide thinks structurally and it invites us to think structurally, too. They don’t flinch. The inherent question, “Why should we do this?” they answer like this: “Being explicit about race and racism helps us understand how racist policies, systems and structures cause unequal differences in health outcomes.” We’ve got 20 years of data that structures and systems in health are contributing to health inequalities.
Structures are all around. They hide in plain sight. Standard operating procedures are structures. Professional groups are structures. Informal social groups are also structures. Laws are structures. Policies are structures. Conversations are structures. Written texts are structures. So if you’re serious about thinking and acting structurally about inequalities, there’s plenty of places to look.
Like some conversations I’m hearing lately that imply or sometimes flat out state that a main cause of health inequities is located in individual patients themselves. I did an episode, link in the notes.
The guide challenges this kind of thinking too, the individual, biomedical model, and invites us to think structurally about health, saying: “Use an equity lens. If there is an inequity, consider the social, institutional or structural systems that maintain inequities over time. Provide background information on these systems” and “describe issues from a systemic perspective.”
Oh I got a couple seconds, here! There’s also a glossary available! Key concepts of public health and different systems of oppression in one place. Including racism, cissexism, heterosexism and other systems of oppression. And I like that it’s arranged in a topical format. They do a kind of “here’s a problem, here’s an approach” setup, so you are getting educated on topics rather than just reading a list of terms.
For example, there’s a section called “understanding oppression” another called “What terms help us understand cissexism?” And again it’s gonna be on the nyc.gov website.
If you like the sound of this, If you like the sound of a focus on language, and someone helping you through uncomfortable subjects, stay tuned! We have a big announcement coming soon that you won’t want to miss. 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.