Hosted by CHNET-Works
- Part of the NCCDH “Let’s Talk…” series. A 4-page brochure available here.
- Slide Deck available here.
- Online discussion happening on Health Equity Clicks
- “Health equity exists when all people can reach their full health potential and are not disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socioeconomic status, sexual orientation or other socially determined circumstance.” (source: slide deck for this presentation)
- language has an important role in this social construction
- NCCDH is working on a glossary document for Public Health
Why does language about populations matter?
- can end up defining people based on their disease (e.g., schizophrenic, alcoholic, poor people) – but a disease does not define a person (instead, put the person first – person with schizophrenia, person with mental illness, people living in poverty. “people first language”)
- can prevent people from seeking care (e.g., if they don’t identify with the label; feel discriminated against/stigmatized)
- e.g., Code White changed from “violent behaviour” to “disruptive behaviour” (trying to separate mental health and violence; so responders don’t go in assuming violence. Some talk about changing it to “mental health emergency” – responders go in understanding that the person needs mental health support, not necessary violence occurring
Advantage and disadvantage coexist:
- understand relationship between advantage & disadvantage – people are more complex than just their disease/disadvantage; have thought about intersectionality; are we trying to aggregate or disaggregate groups? We want to know that we are reaching those who we are trying to reach (and not underincluding or overincluding)
- reflect on one’s own social position – where do you come from? how do people perceive you? When you think about how complex you are, makes you realize that other people are also very complex.
- acknowledge structural/systematic advantage and reinforcement
Diversity within population groups:
- often this is not considered – “disadvantaged” groups often thought of as a homogenous group based on the particular disadvantage
- there are varying levels of advantage/disadvantage within a group; also intersecting disadvantages
- e.g., people who are homeless experience health inequities. Some of them also have low literacy/low health literacy/disability/etc., and they experience even more inequities
Language influences power dynamics:
- words like “vulnerable”, “disadvantaged”, “marginalized”, etc:
- can create us vs. them situations
- lead to victim blaming, stigmatization
- e.g., “poor people” vs. “people who live in poverty” – the latter is people-first language, highlights the situation in which they live (i.e., poverty) vs. describing “poorness” as an attribute of the person), and sounds less permanent (poverty is a situation that they are in that can change rather than being an attribute ascribed to the person)
- One participant noted that she grew up in poverty but didn’t think of it as that at the time and wondered if she would have internalized it if she’d heard either of those phrases used to describe her.
The language we use focuses our attention:
- “the homeless” focused on individuals, whereas “housing” focuses us on the structures, and “racism” focuses us on society (an issue underlying the issue, driving the structure of “housing”) – looking at different levels (individual, structures, society)
- “priority populations” is neutral language – but does this ignore the situations/structures/systems that are putting people at a disadvantage? Also, “priorities” are always shifting (and who is setting the priorities? And why?). Also, “priority populations” creates that group as separate from the “general population” (“they” vs. “us”).
- so the language can drive action by what it causes us to focus on
How could you use language to advance your agenda in different settings?
- not everyone has an understanding of health equities, so sometimes describe “differences in health outcomes based on social determinants of health” rather than saying “health inequities”
- insiders (member of the community) vs. outsiders (not members) – e.g., sometimes insiders use words to describe themselves that are not deemed appropriate for outsiders (e.g., in LGBT community)
- language is always changing, so need to keep up
- know your audience (e.g., telling the business community that you need an intervention for mental health probably won’t get them excited, but talking about improving the productivity and creativity of your workforce might be better received; similarly, with education sector, you’d talk about scholarship achievement, high school completion – these also speak to *why* promoting mental well-being is important)
- also, a shift to “mental well-being” – not just focusing on an absence of mental illness (similar to the definition of “health” (often thought of as specifically physical health) as not just being the absence of disease)
- so not just language when it comes to what do we call specific population groups, but how do we use language more broadly
Take Home Message:
- “Being intentional about the use of language can…
- engage and empower groups (focus on strengths)
- recognize and alter discriminatory beliefs
- address unequal power imbalances
- tailor programs to local context
- maintain attention “upstream” and be systems-oriented” (Source: Slide Deck for this presentation)
- No perfect answer to what language to use and not everyone will agree. Be intentional of what language you use, think about who it is serving and what unintentional consequences it might have.