In 2019, the AMA established the Center for Health Equity to embed and advance equity across all aspects of health care, including within the AMA itself. Foundational to the work of the Center, the AMA developed, in partnership with the Association of American Medical Colleges (AAMC) Center for Health Justice, one of the most comprehensive health equity communication guides to support physicians’ conversations with patients. Designed for physicians and other health care professionals, the Advancing Health Equity: A Guide to Language, Narrative and Concepts provides guidance and promotes a deeper understanding of equity-focused, person-first language and why it matters.
Like science, language and understanding evolve over time, and this guide is not intended to be a definitive and all-encompassing instruction manual. Instead, it was created to give a fresh perspective about the language we commonly use, and to recognize the harmful effects of dominant narratives in medicine.
Better understanding about language and dominant narratives can help ensure that we are indeed centering care around the lived experience of patients and communities without reinforcing labels, objectification, stigmatization and marginalization. The guide comprises three key components to guide physicians and health care professionals. They include:
Part 1: Health equity language
This section of the guide sets out to help the reader recognize the limitations and harmful consequences of some commonly used words and phrases. In their place, we offer equity-centered alternatives.
Part 2: Why narratives matter
Dominant narratives (also called malignant narratives), particularly those about “race,” individualism and meritocracy, as well as narratives surrounding medicine itself, limit our understanding of the root causes of health inequities. Dominant narratives create harm, undermining public health and the advancement of health equity; they must be named, disrupted and corrected.
Part 3: Glossary of key terms
The glossary provides an overview of key terms and concepts that are frequently used in health equity discussions. It is by no means exhaustive, nor is it a definitive list of correct/incorrect answers. Rather, it is intended to serve as a starting point for reflection. It is a guide on current usage of important terms and will be updated over time. Whenever possible, we cite authoritative sources and introduce ongoing debates over definitions.
Prioritizing Equity: Narratives and Language
This segment of the Prioritizing Equity series focuses on the power of narratives and language in health care. It explores how dominant narratives perpetuate harm, and offers examples of how these narratives can be challenged and disrupted, moving towards equity-focused and person-first alternatives. Watch here: https://www.youtube.com/watch?v=1GSDQqOUF_M
- Panel: Philip M. Alberti, PhD
- Malika Fair, MD, MPH
- David A. Ansell, MD, MPH
- Renée Canady, PhD
- MPA Moderator: Fernando De Maio, PhD
1:30 Panel Introduction
2:24 How dominant narratives perpetuate harm - an example
12:05 Why dominant narratives are detrimental to patients
17:54 Transferring patients from private to public hospitals because they lacked insurance (“patient dumping”)
20:45 Language and the power of naming historic injustices and root causes
22:29 Negative descriptors of people of color in the EHR
23:54 Challenging dominant narratives in the public health setting
30:59 Advancing Health Equity: A Guide to Language, Narrative and Concepts
35:54 Understanding the critical response to the AMA and AAMC’s guide
36:51 How should physicians and institutions understand and implement this guide?
45:44 What the pushback against the guide represents