1 INTRODUCTION

There are longstanding health inequities being experienced by individuals from historically marginalized populations who self-identify as one or more of the following: Black and African Americans, Latinx, Indigenous; Lesbians, Gays, Bisexuals, Transexuals, Queer/Questioning, Intersex, and Asexual (LGBTQIA+); people from low socio-economic status; individuals with physical and intellectual disabilities; and individuals with various immigrant statuses. Women also experience health inequities disproportionately and these are compounded if their identities include any of the ones above. In the wake of the countless events of violence against the aforementioned individuals, our collective conscience has been shocked and sensitized to the stark systemic inequities in the United States (US) and many other countries where Research in Nursing and Health (RINAH) readers live and work. There is much angst and motivation among the nursing and midwifery professional communities to effect change and reduce these inequities as much as possible. With that momentum building, now is the time for action to achieve health equity.

Health equity is defined as the: “Attainment of the highest level of health for all people. This achievement requires valuing every individual equally with focused societal efforts to avoid inequalities, contemporary injustices, and the elimination of health and healthcare disparities” (United States Department of Health and Human Services, 2010). Achieving health equity is critical not just for population health, but for the removal of systemic barriers to improve health outcomes for people who have been marginalized based on their identities.

We have created this editorial series around “Learning the Language of Health Equity” that will be published in RINAH over the next seven issues. The inspiration for this series came from an early part of Ijeoma Oluo's book “So You Want to Talk About Race” (Oluo, 2019). One important message in Oluo's book was: Mistakes are inevitable when talking about race, equity, inequality, and related issues of discrimination, especially if you belong to a historically dominant group; for example, being White in the US. Whether you are a White person attempting to discuss race with someone who self-identifies as Black, or a cisgender individual discussing gender identity with an individual who self-identifies as a transgender person, then similar principles apply.

Our goal with this editorial series is to deepen our understanding of the importance of learning the language of health equity in its many forms so that the evidence published by RINAH, and other nursing and midwifery journals are less likely to reflect bias, unconscious or otherwise. We further acknowledge the global readership of RINAH who live and work in various political, economic, geographic, and sociocultural contexts and may face similar challenges in their own countries. By initiating these discussions through this editorial series, our goal is to help nursing and midwifery researchers, administrators, practicing professionals, and students learn the fundamentals of the language of health equity. Together, as we learn the basic language of health equity, we improve our chances of having more productive dialogs around racism, discrimination, sexism, and related topics that will advance the professions and make them more inclusive. In turn, more equitable health outcomes may result for those with whom we work.

2 WHY LEARN THE LANGUAGE OF HEALTH EQUITY?

Unless an individual has had sustained training or is involved in programs of research focused on addressing health inequities, most of us are novices learning the language of health equity in its many forms. To address the perpetuation of systemic discrimination of individuals from historically marginalized groups, as health professionals we have a moral, ethical, and sometimes legal responsibility to interrupt these inequities through engaging in culturally humble communication. It is clear, however, that many in our professional communities feel unprepared or stuck, without direction to begin tackling the challenges associated with not being fluent in the language of health equity.

Learning a language requires being conscious of biases, how words are used, and what words comprise respectful communication with others; yet we know that most biases are unconscious (Marcelin et al., 2019). As healthcare professionals, we must acknowledge the uncomfortable truth that through our language and use of words, we have unconsciously—and at times consciously—perpetuated harm to individuals from historically marginalized groups. This phenomenon of actors within health systems consciously or unconsciously harming individuals from historically marginalized populations—especially African Americans and Black people—was carried from chattel slavery through the Jim Crow era to the present day (Washington, 2006). It is not new. Furthermore, much of the harm perpetuated by the health systems on historically marginalized populations have also occurred because of centuries of government, institutional, and health policies that resulted in negative outcomes for people belonging to historically marginalized populations. The result of these policies is a creation of structural barriers resulting in health disparities associated with the delivery of health care. Importantly, causing harm to others through our professional work is antithetical to the ethical principles of the nursing and midwifery professions. Learning the language of health equity reduces the likelihood that harm will be perpetuated on those we work with during healthcare encounters.

3 LEARNING HEALTH EQUITY'S LANGUAGE: WE ARE ALL BEGINNERS, ONE WAY OR ANOTHER

Language educators teach their students to master a new language with the goal of achieving four dimensions of language proficiency: speaking, reading, writing, and listening. When learning a new language, there are concrete steps to take to begin developing basic communication skills. First, it is imperative to know why you are studying the language itself. The second step is to begin learning the core words and why they are important, and then integrate them into spoken language practice. From there, fluency grows.

Like any language that feels “unfamiliar” on your tongue, when initially speaking it mistakes will be made. Fluent language speakers may automatically correct your words, consciously or unconsciously. That is OK; they understand you are learning. Anyone who has learned to speak another language knows that native speakers genuinely appreciate it when have you are learning another language voluntarily and will tolerate mistakes (to a point). Through practicing and making mistakes, the language learner will develop fluency over time. Spending time interacting, observing, and communicating with native speakers further increases fluency. Importantly, learning a language takes deliberate practice and time; and everyone will learn at a rate that reflects how often they interact with native speakers. Fluency may be achieved, but perfection is rare. It demonstrates cultural humility to recognize that fact. Effective allies who are not from racial and ethnic minority groups, or historically marginalized populations are those who make a concerted effort to collaborate with individuals from historically marginalized populations to develop health equity language fluency and cultural humility.

By contrast, individuals who are not from historically marginalized groups are sometimes recalcitrant or not cognizant of how language can be used to further harm individuals who face discrimination. What is troubling about that perspective is that it shuts down critical conversations we all need to have right now. In many societal contexts, individuals from historically marginalized groups usually have the responsibility of adapting to the norms, values, mores, and folkways of the dominant group (Agunwa & Obi, 2018). It is critical to remember that individuals from historically marginalized groups usually acculturate to mainstream social norms, values, mores, and folkways through learning the culturally dominant language to: (1) survive, (2) appear non-threatening, and (3) fit in to avoid discrimination or minimize the daily microaggressions they experience in relation to some aspect of their identities.

Learning to speak the language of health equity demonstrates respect for someone's culture, lived experience and holistic identity. It recognizes the inherent dignity and value in and of everyone as a human being. Importantly, learning health equity's language should not be considered being “politically correct”—a trope often used by individuals who have not been historically marginalized because of their identities. Developing basic discourse competence in the language of health equity allows nurses and midwives to communicate and more effectively engage with individuals who belong to groups and communities that have a deep mistrust for health systems.

It is also important to remember that language is not static; it is always evolving over time. Thus, the language of health equity is constantly evolving. As empirical evidence emerges on how best to support people historically marginalized because of (but not limited to) racism, transphobia, homonegativity (Lefevor et al., 2020), ableism, xenophobia, classism, and anti-immigrant sentiments (Butz & Kehrberg, 2019), our use of language will come to consciously reflect respectful patterns instead of unconscious and disrespectful ones. The language we have used to date has produced the current state of the nation and world, so we need to do things differently to address current problems and build a better future that can achieve the aspirations of health equity.

4 THE ART OF TEACHING THE LANGUAGE

On the other side of learning a language is how native speakers interact with novice ones or those continuing to learn the language. Native speakers develop language expertise naturally. At times, breaking down the steps to learning the language of health equity can be difficult and tiresome for native speakers—especially when it feels like the people around them should know the language and vocabulary already. As any educator knows, students who are constantly berated, chastised, denigrated, or shamed for their mistakes are unlikely to learn. They will lose interest in the subject and never perform well. The same dynamic is observed among newly minted nurses who experience bullying in the workplace, which drives them from their jobs and, maybe, the profession altogether. Constructive feedback, on all counts, will make more headway with creating change and developing allies in the movement toward health equity. And as any educator knows, it can be tiring to feel like you are teaching students repeatedly and the lesson is not being received. Patience among all stakeholders is essential for moving us all forward to achieve the goals of health equity.

Unfortunately, some individuals refuse or are simply unable to learn another language. Their comfort rests in the language of the majority and for them, learning a language is merely pandering to individuals from marginalized groups. Those who have already developed expertise or formed allyships to learn the language of health equity will have to consider the difficult decision of how to best address situations where professionals within nursing and midwifery choose not to make the effort to learn the language of health equity.

5 BENEFITS OF LEARNING THE LANGUAGE OF HEALTH EQUITY

The benefits of professionals within nursing and midwifery communities learning the language of health equity are immediately apparent, because it increases the chances of having culturally humble and meaningful engagement with individuals from historically marginalized communities. For example, researchers seeking to expand their work with individuals from immigrant communities will find if they use the term “illegals” when referring to individuals lacking legal status to live and work in a country, they will not be allowed access to that population by the community leaders and/or allies. Referring to human beings as “illegals” is pejorative and demonstrates a lack cultural humility and respect for their personhood and basic human rights. It also shows that the researcher has done no background work on the history of how the community came to be and why there might be undocumented individuals in it. Therefore, failing to learn how to use respectful language can mean a study is a non-starter or an educator alienates students. So learning the language of health equity is crucial in removing walls of mistrust and building bridges of trust as a step towards achieving health equity.

6 CONCLUSION

Health systems globally are embedded within different cultural, geographic, political, economic, religious, and social contexts. Therefore, nurses and midwives globally are poised to rise to the occasion to form coalitions to promote learning the language of health equity as appropriate to their various practice contexts. In addition, the nursing and midwifery communities do have a moral, ethical, and, sometimes, legal responsibility for using more inclusive language to build coalitions with individuals who have a deep mistrust of health systems. Dismantling this mistrust has the potential to reduce health inequities. We further recognize that the language of health equity is rapidly changing. Such rapid change requires ongoing efforts by every health professional to become and remain competent and comfortable with the language of health equity. Such efforts will ensure that individuals from historically marginalized communities have culturally humble providers and researchers working with them who can communicate in ways that promote high quality and person-centered care along with improving the evidence guiding practice.

Learning a culturally mindful language is a critical step toward achieving health equity. Over the next year in this editorial series, we will explore the basic language specifics to more effectively work with a wide range of marginalized populations. These will include individuals belonging to immigrant populations, LGBTQIA+ individuals, individuals from racial and ethnic minority groups, justice-involved individuals in carceral systems, persons suffering from substance use disorder, veterans, and persons with intellectuals and physical disabilities. Because we as authors are still learning the language of health equity in relation to many of these populations, we will collaborate with fluent speakers as we compose the series so that we can learn from them as well. We invite you to join us on this language learning journey and hope it will benefit those with whom you conduct research, teach and administer care.

AUTHOR CONTRIBUTIONS

Allison Squires and Roy Thompson participated equally in the writing and conceptualization of this work.

Data are available from the corresponding author upon reasonable request.

REFERENCES

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