National Collaborating Centre for Determinants of Health (NCCDH)—Population and the Power of Language

The April 22 National Collaborating Centre for Determinants of Health (NCCDH) webinar on Population and the Power of Language was facilitated by Hannah Moffatt and Lesley Dyck, Knowledge Translation Specialists for the NCCDH. The objectives were to:

• Reflect on the values and assumptions underlying our choice of language in public health
• Explore how terminology can support or hinder our efforts to reduce health inequities.

Specialist advisors on hand to support the discussion were:

• Branka Agic, MD, PhD(c), Manager of Health Equity an CAMH and Deputy Director of the Collaborative Program in Addiction Studies, School of Graduate Studies, University of Toronto, who has extensive experience working with diverse populations as a service provider, researcher and program developer. Her research focuses on mental health and substance use in immigrants, refuges and ethno-racial groups and disparities in access to services. She is currently the lead on the four-year Refugee Mental Health Project funded through Citizenship and Immigration.

• Paola Ardiles MHSc is the founder and network lead of Bridge for Health, an emerging local and global health promotion network aimed to promote citizen engagement and collaboration. She is a recipient of the Nancy Hall Public Policy Leadership Award of Distinction for her local, provincial and national work to advance mental health promotion. She is currently co-chair of a newly established public engagement committee of the Public Health Association of BC.

Starting from a premise that “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” (Dahlgren and Whitehead, 2006), the webinar explored the proposals that improving health equity in public health means:

• Aligning our interventions with social justice values
• Working upstream to alter institutions, policies and practices that cause inequities
• Developing policies and programs that level the effects of the social gradient

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Question 1: Does Language Matter?

The facilitators posed three direct questions:

• What words do you use to describe populations in your plans and reports?
• Are the words you use in this context different that the words you use in person?
• What are the implications of the language you use?

The webinar explored terms that are negatively value-loaded:

• Priority
• Marginalized
• Vulnerable
• Hard/difficult to reach
• Targeted
• Disadvantaged
• Under-served
• Who would benefit most from intervention
• Disenfranchised
• Disempowered
• Underprivileged
• At-risk
• High-risk
• Equity seeking

Looking at the principles behind our use of language, the webinar explored how our impression of our own social position colours our understanding of the relationship between advantage and disadvantage, and how use of language reinforces systems and has a tendency towards generalizations, not capturing the diversity within population groups or engaging with the particularity of single characteristics, varying advantage or intersecting disadvantages.

The webinar also explored how language influences power dynamics:

• ‘Us’ versus ‘them’
• Victim blaming
• Labeling and stigmatization
• Use of language that we would not use to describe ourselves

It also explored how use of terminology acts as an indicator of where our personal attention is focused, for example:

• “The homeless” (individuals)
• “Housing” (structures)
• “Racism” (society)

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Question 2: How could you use language to advance your agenda in different settings (e.g. health department, school, municipal office)? 

The webinar proposed that being intentional about the use of language is of use in:

• engaging groups and increasing empowerment
• assisting recognition of and change to discriminatory beliefs
• addressing power imbalances
• supporting the tailoring of programs to local context
• being systems-oriented and maintaining attention ‘upstream’.

Recommended actions include:

• explicitly considering the values of one’s own use of language within one’s practice and research.
• hosting a conversation about language use in one’s own workplace.
• downloading and reading the NCCDH “Let’s Talk” series at NCCDH Let's Talk Series.

One of the recommendations of the Let’s Talk series is for government organizations to “partner with other government and community organizations to identify ways to improve health outcomes for populations that experience marginalization” such as:

• “Work with non-health organizations that are interested in removing barriers to health for identified populations.”
• “Bring community organizations together to set health equity indicators and targets.”
• Working with local community organizations such as schools, “build a health equity team that includes staff, parents, students and community members”.

As an example of this collaboration, Sudbury District Health Unit produced an animated video, “Let’s Start a Conversation about Health… and not talk about health care at all”, and a guide to engage with and support local organizations in their health equity work.

Another example of this collaborative approach to community health is the My Health, My Community Survey by Vancouver Coastal Health, Fraser Health & UBC Faculty of Medicine reported on in the late March 2014 Keeping in Touch newsletter.