The Power of Plain Language

Over the last few months, I have become a thesaurus. If the US government says I can’t say ‘equity’ in a scientific publication, what can I say instead? I have to admit I have rather enjoyed the challenge. As I have ranted in the past, I’m not sure that people are clear what inequities are. So, it’s been quite satisfying using phrases like ‘differences in health outcomes that can be traced back to unfair or unjust sociopolitical arrangements’. 

I’ve been doing this word-somersaulting as part of my Furthering the Narrative project in collaboration with Tony Iton and the California Endowment. The aim of the project is to write high-quality scientific articles about the link between power and health, although the bulk of the work has involved helping thought leaders and innovators in population health make sense of their work (which is a big part of what good medical editing is about). 

I’ve also been making sense of my own work. Bothered by the lack of community-oriented innovation at TEDMED, where I was the Physician Editor between 2012 and 2014, in 2013 I went in search of it. As you know from my last post, my sense-making is influenced by the work of S. Leonard Syme, the father of social epidemiology. While my observation in 2013 was that most innovations in health seemed to lack any appreciation of people’s social and cultural contexts, his was that control over destiny is fundamental to health. Bringing them together, then, how do you innovate in health if enhancing control is an important outcome to pursue? 

My search for community-oriented innovation always had a dirty secret. I was looking for an underlying set of principles that might stand up a new field of practice. I was motivated to do this having been tasked with publishing the second version of the CONSORT statement, basically a description of what is needed to do randomized trials. I remember being slightly appalled by the fact that this fundamental scaffolding of scientific research had basically been put together by a bunch of researchers and editors chatting about what they think is needed. 

It seemed to me that if they could stand up a whole field of practice so could I. 

I failed, of course. Not because the set of principles I put together was wrong (they’re as right an anything else out there, even now) but because there is a massive difference between knowing something and influencing how things are done. Ideas for how to conduct research change practice through the massive ecosystem of publications, universities, and other research organizations (think biotech and pharma). There really isn’t anything equivalent in health innovation – and, when you think about it, what even is the health innovation field?

Even if there was such a field, ‘control’ is not an easy idea to get behind. What does it mean in practice? Recent work has explored that but for me it comes down to agency and power. Over the years, I have used those terms synonymously but I now think of agency as something individuals have and power as something communities have. And when it comes down to it, there is only so much individuals can do with agency. If you live in a place devoid of resources and opportunities, your agency will only get you so far. 

So, for ‘control over destiny’ to be meaningful it has to be about innovations in community power. Thankfully, there is a field in that, and it’s started to penetrate health. The core practice, community organizing, has reached the dizzy heights of a rapid review in a peer-reviewed journal. And, from the coal face of the work, comes a report on what is needed for public health to work with community power building organizations (CPBOs). 

So, the field is maturing, taking shape, gathering legitimacy, perhaps becoming followable. It’s becoming clear what needs to happen ‘inside’ health departments, what needs to happen ‘outside’, and how the two dovetail. But the terms ‘inside’ and ‘outside’ have been used differently over the years. And that’s a huge problem. You can’t build a field of practice if people are not sure what you’re saying. So, that’s what I’m working on right now – the definition of ‘inside’ and ‘outside’ in the context of social movements. 

Clear, plain language definitions are important. They not only help build a field of practice, they help us pursue the things that matter when the powerful try to stop us.