The American Medical Association has just issued a guide to advancing health equity through changing the narrative, terms and concepts used in healthcare. See the extract given below (taken from page 24) for an example of its Critical Social Justice-driven focus on undermining individual personal agency/responsibility and centering instead collectivist notions of oppresive societal conditions. It won’t be long before professional bodies in counselling and psychotherapy follow suit with similar guides for practitioners.
The purpose of a health equity-based narrative
There are many dominant narratives that attribute health to personal choices (weight,
drug/alcohol abuse, preventive health care) without taking into consideration equity
in the greater society. However, it is almost impossible to be or stay healthy in an
unhealthy environment. Consider the health effects of living in chronically disinvested
neighborhoods, with poor quality and unsafe housing, with limited options for exercise
and healthy foods, expensive or unreliable public transportation, a dearth of pharmacies
and an overabundance of fast-food outlets. The harmful effects of these characteristics are
the basis of the social determinants of health model, as well as newer models that go even
further “upstream” to the root causes of health inequities.
We have seen that a dominant narrative in health care regards health as a personal
responsibility. The prominent social epidemiologist Nancy Krieger calls this the “medical
and lifestyle” explanation of health inequities.3 It focuses on biological explanations of
disease, treatable and amendable through health care and individual-level behavior
change. Krieger argues that this narrative is limited and ignores social context, leading to
a simplistic understanding of the causes of health inequities. This dominant narrative does
not take into consideration social justice, but rather, looks at people and/or communities
failing or succeeding with no bearing of responsibility by the systems and structures of
power influencing their lives.
A health equity-based public narrative would:
• Focus attention on inequitable systems, hierarchies, social structure, power relations, and
institutional practices to reveal the sources of inequalities and the mechanisms that
• Avoid both blaming individuals for their condition or assuming that inequity can
be resolved through programmatic fixes that ignore the social responsibility of
corporations and government agencies.
• Encourage public dialogue on structural racism and all forms of oppression and inequity
to encourage a broad public response.
• Foster efforts to strengthen community-driven initiatives that fundamentally improve
A health equity narrative grounded in equity and a social justice framework also would:
• Provide possibilities and the space to reflect, engage and fearlessly advance possibilities
for a more just society.
• Highlight examples drawing on experiences from throughout the world.
• Expose the political roots underlying apparently “natural” economic arrangements, such
as property rights, market conditions, gentrification, oligopolies and low wage rates. Advancing Health Equity: Guide to Language, Narrative and Concepts—25—
• Develop from collectively recognizing and denouncing oppression in all its forms.
• Make visible not only the injustice, but the varied voices of those oppressed, and their
perspectives on social justice.
• Redistribute power and resources to those most in need