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Speaking Differently to Advance Our Mission

Friday, January 17, 2020   (0 Comments)
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Written By: Jennifer Moon, Communications and Public Relations Associate, Unity Care NW


Recognizing and addressing the “social determinants of health” is at the heart of our mission as community health centers. We walk the talk. We break down barriers to health care, improve access, and strive to build healthy communities through community partnerships, advocacy, and innovation.

But do we talk the talk? Sometimes not so much.

At Unity Care NW, we are turning a critical eye to how we talk about our work with staff, in the community, and with donors, legislators, and funders. A noted philosopher once said, “A talent for speaking differently, rather than for arguing well, is the chief instrument of cultural change.” We are taking that lesson to heart, thinking about how we talk about our work and challenging ourselves to speak differently to advance rather than undermine our mission.

Community health centers have a unique charge in our health care system – to deliver quality care for the whole person while simultaneously advocating on for the health of entire communities. To fulfill that charge, we extend our work beyond the four walls of an exam room. We forge community partnerships, we raise public awareness about the social determinants of health, and we work with legislators and public officials to improve services and reform systems. We seek to create the understanding and public will to improve not only individual health but also community health.

Too often, however, we undermine our message when our language shifts attention from the barriers to improved health that we have erected through systems and public policy and instead focuses on the individual factors that contribute to poor or improved health.

A few examples:

Enabling services are defined by HRSA as “non-clinical services that do not include direct patient services that enable individuals to access health care and improve health outcomes.” They include “case management, referrals, translation/interpretation, transportation, eligibility assistance, health education, environmental health risk reduction, health literacy, and outreach.” In other words, they are those services that help break down systemic barriers to care and facilitate improved health outcomes for individuals and communities.


As health practitioners, we understand what these services are, what the term “enabling services” means, how the term is used in administering our programs, and how important such services are to our patients. But when we go out into the community or speak with policy makers about the value and importance of such services in health promotion, do we do harm by using this phrase?

If our objective is to build political will to address the systemic causes of poor health, “enabling” is probably not the best word to use. “Enabling” has negative connotations in our culture. Rather than directing attention to the systemic barriers to health and how we might mitigate or break down these barriers, “enabling services” evokes the individual factors contributing to poor health. Use the word “enable,” and our cultural defaults may prompt listeners to ask: “What decisions has that person made in their life that puts them in a position where they require ‘enabling’? Why are you ‘enabling’ someone when you should be helping them become more self-sufficient and stand on their own two feet?’” Use the word “enable,” and the focus goes to the individual determinants as opposed to the social determinants of health.

Let’s take another example: “safety net.” We all recognize that we are “safety net” providers. We ensure that those who are unable to receive health care anywhere else get the care they need at our health centers. But is our mission really so small that we publicly describe our role as catching people in a net when they fall? Should someone “fall,” we certainly want to be there to catch them. But our role is far larger than that. It is to work to ensure that the conditions for living a healthy life are so widely present that no one individual “falls” in the first place. When we describe ourselves as “safety net providers,” we diminish the work we do related to building healthier communities.

Another term that we routinely rely upon is “barriers to care.” We use this phrase all the time to describe the factors that stand in the way of access to care and to improved health outcomes. Barriers are typically things that individuals face and hopefully overcome. But maybe a larger question we should be asking is why are they there in the first place? At Unity Care NW, we are reframing this as: “Being healthy shouldn’t be so hard.” We’d suggest this statement points us in the direction of drawing attention to the systems, practices, and policies that impede healthy outcomes. It simply shouldn’t be so hard to be and stay healthy. Changing that reality is central to our work.


Beyond these examples, there are other opportunities to simplify our language to better reach our intended listeners. Perhaps we can change how we talk about sliding fee discounts. Our health center has traditionally said that we offer health care “regardless of insurance status or ability to pay.” How about something like “What you pay is based on what you earn”?

Even the phrase “social determinants of health.” Is there a better way to talk about the conditions and resources needed to build health? The Robert Wood Johnson Foundation believes there is. They suggest, as an example, “Health begins where we live, learn, work and play.”

This is exploratory work on our part. We are just starting down this path, excited at reevaluating our communication practice. We don’t pretend to have all the answers, but our goal is to be intentional about the language we use to talk about our work. As we proceed, we’ll review best communication practices and expert recommendations related to health care. We’ll take a cue from leaders such as the Robert Wood Johnson Foundation and others to reframe our message. We’ll prioritize “plain speak,” language that can be quickly and easily understood and limit acronyms and jargon.

It’s easy to slip into old habits, but in the coming year, as we work with funders, policy makers, and community members, as well as in our internal communications with staff, we intend to challenge ourselves to speak differently, on behalf of our patients and our community.




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