“Speaking Clearly: Language as a “changing technology” to help us advance our work on the social determinants of health and health equity” was one of the panel sessions hosted by NCCDH at The Ontario Public Health Convention (TOPHC) 2015.  The panel session was designed to delve into the use of language and context specific understanding of terminology and communicating about the social determinants of health (SDH) and health equity. 

Facilitating this panel discussion was invigorating!  We all have life experiences that frame how we receive and interpret information….. and how we interpret the interpretations!  Even a discussion about the use of language and terminology will itself be filtered through this lens. And regardless of how specific the objective is for the messages we put out there, we need to keep in mind that what is intended is not always what is received.  The real impact of any message is in how it is felt and what it means to those receiving it. 

The session began with an introduction to the new NCCDH Glossary of Essential Health Equity Terms .   The glossary was developed to promote the use of clear and effective language in communicating about the SDH and health equity, and includes plain language definitions for 15 key concepts for the English glossary, and 18 for the French glossary.  Intended as a “living document” the NCCDH is encouraging users of this tool to provide feedback by leaving comments about the terms directly on the website or submitting by e-mail.

The panel began with Melissa Potvin, Bilingual Communications Coordinator at Health Nexus, who reviewed some of the terms she loves around equity & equality.  She also discussed some of the challenges around the use of language to communicate these concepts, including the assumptions people make, not being able to please everyone, and involving the audience in the crafting of messages.  Caroline Wai, a Health Equity Lead at Toronto Public health, added “social justice” to the terms she loves and explored challenges around other terms such as “upstream/downstream” and “social inclusion”.  She also discussed the importance of considering how the definition of terms can change based on the social context of a person’s thoughts, feelings, and behaviours.  Kim Ouellette, a Public Health Dietitian at Niagara Region Public Health, opened up the conversation to include the use of images and the emotions that they can elicit used in combination with language.  She stressed the importance of avoiding alienation and polarization with messages about health equity.

The panelists stimulated a very animated audience discussion!  The idea of appealing to political ideologies became a focus, with discussion related to starting on “the right” to appeal to an audience who may align more with individual responsibility for health choices instead of broader socio-environmental factors.  The point was made that an approach appealing to one audience may have the opposite effect on a different audience, driving them further away from an understanding of social factors that contribute to health equity, and therefore further from the social responsibility conversation we want to engage them in.  The strong emotional response to images was also mentioned, especially when interpreted through a political and philosophical lens.  If it is a strong emotional response that is desired, then communicators need to be ready to respond carefully to it. But if this is a type of reaction that is not desired, then the use of images that could be polarizing may need to be reconsidered.

Edgy messaging does not have to create shock value, but it is helpful to challenge conventional thinking on a contentious issue.  Shock messages work well when the audience is open to exploring the issue – but can also polarize those on the far end of both the “left” and “right” extremes. Careful and skilled communications are part of supporting that transition in a way that will bring more people along than are left behind.  It is about “starting where the audience is” and shifting their thinking from there.  Images and language around SDH may be mobilizing for some and polarizing for others, depending on the target.

We have had some good follow up conversations since this event, so let’s keep the conversation going!  What have been your experiences using various terms and concepts when communicating about the SDH and health equity?  How can public health professionals make their communications on these issues clearer?  Is building a common understanding of concepts a way for public health to move forward?  Please send your ideas and feedback to Dianne Oickle, Knowledge Translation Specialist.