The American Medical Association (AMA) and the Association of American Medical Colleges’ Center for Health Justice (AAMC) recently created Advancing Health Equity: A Guide to Language, Narrative and Concepts. While this health equity solutions guide was created for doctors, hospitals, and other leaders in the healthcare space, its content has many important implications for employers as well.
Here are 5 key takeaways from the AMA and AAMC’s guide to advancing health equity, and what they mean for employers.
1. Health inequities are present and documented throughout the US
What is health equity? To understand what it is and how to promote health equity, it’s important to understand its opposite: health inequity. Health inequities are gaps in healthcare that are “unjust, avoidable, unnecessary, and unfair,” according to the AMA and AAMC’s guide.
Health inequities are in place because of social systems that prevent groups of people from developing their full potential. Sometimes this is intentional, but many times, it is not. Health inequities do not exist in isolation. Instead, they are directly related to other inequities in society, including in the workplace, housing, education, and the criminal justice system.
This is essential for employers to understand because there is a good chance that many employees within your organization may face health inequities. When employers consider the potential health inequities in their employee population, it may be easier to identify possible gaps in healthcare.
2. Questioning the dominant narratives is an important step towards correcting inequities
The AMA and AAMC’s guide to advancing health equity discusses the narratives that are in place in a society. By that, they mean the deeply held values and beliefs, as well as the collection of messages that represent an idea or belief.
Dominant narratives are a part of everyday life, and they are often accepted by a population as natural. They help determine the questions we ask as well as the potential solutions that we suggest. Often the narratives become part of our consciousness from an early age, so it’s not easy to determine the source.
Dominant narratives are deeply rooted and widespread, and they cater to society’s most powerful social groups. It is extremely challenging to change these narratives, but this is why it is important to examine them closely, and see them for what they are according to the AMA and AAMC guide: “tools for creating and reinforcing power.”
Employers should take time to consider what the dominant narratives are within their organizations. What social groups do they benefit, and who were they created to protect? What groups may be left out of these narratives?
3. Race-based and individualistic narratives are dominant in healthcare and society as a whole
To question the dominant narratives that exist, it’s critical to understand what those narratives are. Two dominant narratives that need to shift in order to advance health equity are the race-based narrative and the narrative of individualism.
The race-based narrative infers that a person’s race is a biological category rather than being a purely social construct. This narrative suggests that the health issues people of certain races face are due to biological factors, rather than the societal inequities in place that have prevented them from receiving adequate healthcare.
Some of the largest gaps in the healthcare system, and in many other systems, are present due to racial inequities. Yet conversations about racism are extremely difficult for many people.
Individualism is another narrative that is dominant in healthcare. It is similar to meritocracy, which is the idea that individuals can advance because of their capabilities and merits, and not because of their family, wealth, or social background. In healthcare, this narrative puts the emphasis on changing individual behavior and often ignores the underlying institutional and structural causes of disease.
For employers, it is important to consider whether race-based or individualistic narratives are an underlying part of the company’s culture. How do these narratives shape what kinds of health and well-being benefits and incentives your company offers? How can your company be a leader in promoting dialogue about the negative impacts of racism and individualism on your employee population?
4. Advancing health equity requires working to shift the existing narratives
One of the key points in the AMA and AAMC’s guide is that “it is almost impossible to be or stay healthy in an unhealthy environment.” Therefore, shifting the narrative from a race-based or individualistic narrative and towards a health-equity based narrative puts the focus on creating healthier environments rather than changing individual behaviors.
A health equity-based narrative centers around how to promote health equity, and focuses on systems, social structure, and practices to discover the sources of inequalities and how they are perpetrated. In contrast to the dominant message of individualism, this narrative does not put the blame on individuals for their conditions.
Instead, this narrative promotes conversation about structural racism and oppression and the actions to take to address it. Additionally, a health equity-based narrative strives to strengthen community-driven initiatives.
For an employer, working to shift the existing narrative means looking at the bigger picture of the population and employee social determinants of health. The employees at your company may have a lot in common, but their health needs are varied and depend on many factors, such as where they live, their proximity to healthy food and a doctor, their socioeconomic status, and barriers to healthcare they may have to face due to structural racism.
5. The language we use to discuss healthcare matters
One of the most important takeaways from the AMA and AAMC’s guide to promoting equity in healthcare is that the language used to discuss healthcare makes a difference. Language evolves, and it is always a good idea to consider the context of the language being used. Promoting equity means no longer using words that reinforce discrimination and exclusion.
To do this, aim to use person-first language whenever possible, which means that the focus is on the person rather than on the disease or disability. For example, say “a person living with diabetes” rather than saying “a diabetic,” or “a person experiencing homelessness” rather than “a homeless person.”
The CDC created 5 principles for more inclusive communication in healthcare:
- Avoid the use of adjectives like vulnerable, marginalized, or high-risk, because these adjectives imply that the condition is inherent to the group rather than the factors that cause the marginalization
- Avoid dehumanizing language, and use person-first language instead
- Remember that there are many types of subpopulations; avoid using the term “minorities”
- Do not use “target,” “tackle,” or “combat” when referring to people or communities; these words have a violent connotation which is not a message that is helpful to promote public health
- Avoid unintentional blaming which can promote stereotypes and stigmatization
This focus on language is a takeaway that employers can take significant action to change at their workplace. Look at the language your company uses to communicate healthcare benefits and incentives and examine it against the CDC’s 5 principles. Where can you change to person-first language to be more inclusive?
As the healthcare industry continues to work toward advancing health equity, it is crucial for employers to turn words into actions in the workplace. With relevant takeaways for employers to implement as they promote health equity, the AMA and AAMC’s guide is a great place to start.
