Building the Shared Language of Health Equity
In May, the American Medical Association (AMA) made waves by announcing a new commitment to racial equity in healthcare, guided by a three-year, five-point strategic plan whose initial steps involve reckoning with and apologizing for the role the association played in the perpetuation of those inequities.
The AMA’s plan emphasizes the need to embed equity into the organization’s culture and practices; build alliances with marginalized groups; encourage innovation towards equity; push back against the causes of inequity; and work towards truth and reconciliation about healthcare’s past.
But to achieve those goals, healthcare organizations must understand how to talk about a topic that has long been overlooked. Aletha Maybank, MD, MPH, is the AMA’s first-ever chief health equity officer, and she played a major role in the creation of the new plan. When she spoke to co-hosts Abner Mason and Vik Bakhru on Health Equity Now, she illustrated why language is central to all five points of AMA’s transformative strategy.
Many of the plan’s 80 pages are devoted to defining a shared language around health equity—the document even includes an appendix of terms related to racism and structural inequity. As co-host Abner Mason noted, the fight for health equity depends on collaboration, which is impossible without a shared language.
“I really appreciate the emphasis in the strategic plan about getting the language right,” he said. “The language is so important, and if we don’t get the language right, it’s really hard for us to level-set and engage in ways where both sides understand what’s being said.”
Maybank agreed. “We want to get the narrative right, and the words that you use shape the narrative, which then shapes the actions and shapes the solution,” she said. “You have to have an inside-outside strategy. We can’t do health equity work outside the organization if we don’t even understand what the terms mean.”
Making the Terms Match the Issues
Language can affect how people think about problems and their solutions, and what may seem like simple or irrelevant distinctions can mean the difference between progress and stasis.
Take the term “disparities,” for example. When Maybank began working in public health about 15 years ago, she said that “disparities” was the predominant term that public health entities and the federal government used to describe differences in health outcomes among different populations in the US.
Those disparities are easy to see in the data. But to Maybank and the AMA, that terminology just isn’t descriptive enough—the gaps in the data aren’t the problem, they’re just a symptom.
“There was something that needed to change in the narrative so that folks didn’t think disparities just happened. [We need to convey] that there’s some root to it, and not only that there’s a root, but there is injustice to that root, and that these are avoidable,” she said.
Maybank also explained that the term “equity” is different from “equality.” Equality would imply providing the same resources to everyone, ignorant of the reality that different people have different needs and different starting points. Achieving health equity, instead, means taking people’s diverse needs into account, and working towards a future where everyone can expect the best outcomes, with treatment paths molded to their personal and cultural needs.
Speaking Intentionally and Avoiding Jargonization
After terms are defined, it’s important to maintain their meanings and avoid rendering them toothless through inaccurate or excessive use.
Maybank emphasized the importance of treating those concepts carefully and using them intentionally when discussing the third point of the AMA’s plan, “push upstream to address all determinants of health & root causes of inequities.”
“The language that’s used out there, ‘social determinants of health,’ I think is tricky language as well. Because people overuse it and it becomes jargon, and it isn’t really clear [what they’re referring to],” she said. She finds that people in healthcare often use the phrase to talk about people’s unique needs, rather than the local factors that create those unique needs.
That’s an important distinction, according to Maybank: One reading of the phrase speaks to patient care, while the other speaks to systemic issues and the need to address them to improve health at scale.
“I think the terms are getting conflated. Again, it’s about the narrative: If you’re focusing on social determinants of health, you’re really focusing on the policies and structures that drive those conditions,” she said. “That’s a different kind of work, and we don’t want to lose that while addressing social needs.”
Bracing for Continual Change
Healthcare is in the midst of a narrative evolution that touches all aspects of modern life, as industries learn to embrace pronouns, non-paternalistic language, and the constant evolution of terminology. That may be a difficult adjustment for veteran health leaders and providers, but it’s one they should grow accustomed to. Language changes to reflect current needs, and change is constant in healthcare.
Maybank said that younger members of the AMA, medical students, and newly-graduated physicians contribute much of the inspiration and guidance for the organization’s evolving racial equity mission.
But the same terms they are helping to elevate today may someday be inadequate, too. Today’s terms won’t retain their descriptive power forever—even the AMA’s guidance notes that language will continue to evolve. Healthcare professionals must ensure that their conversations about health equity remain fruitful and fair if they want to prevent existing inequities from growing worse and push toward meaningful change.
“If we don’t understand what the terms mean, we can’t assess how our decisions may exacerbate inequities, or even remedy inequities,” Maybank said. “So there’s a lot of internal work to do around building a shared analysis and changing culture. “