"The A.M.A. objects to referring to 'vulnerable' groups and 'underrepresented minority' and instead advises alternatives such as 'oppressed' and 'historically minoritized.'... I’m all for being inclusive in our language, and I try to avoid language that is stigmatizing. But I worry that this linguistic campaign has gone too far, for three reasons.
First, much of this effort seems to me performative rather than substantive. Instead of a spur to action, it seems a substitute for it.... Second, problems are easier to solve when we use clear, incisive language. The A.M.A. style guide’s recommendations for discussing health are instead a wordy model of obfuscation, cant and sloppy analysis.
Third, while this new terminology is meant to be inclusive, it bewilders and alienates millions of Americans. It creates an in-group of educated elites fluent in terms like BIPOC and A.A.P.I. and a larger out-group of baffled and offended voters, expanding the gulf between well-educated liberals and the 62 percent majority of Americans who lack a bachelor’s degree — which is why Republicans like Ron DeSantis have seized upon all things woke."
Here's the AMA document. It is fascinating. I read a lot of it, and I suspect that absolutely
no one will read the whole thing. Talk about things that are not inclusive: it excludes everyone. But that's the reason for long bureaucratic documents — to create an impression that something complicated has been worked through but to make it impossible to check the work. I mean, it's
possible, but no one will do it.
There are a lot of tables and diagrams, and these jump out as more readable than the rest. I spent some time absorbing this diagram:
Shouldn't the "deep" part be at the bottom? Are they using a pyramid the way the government used the old
"food pyramid" — just to represent the size of the particular groups of things? And what's with the yellow arrow pointing upward? What is this gravity-defying process?
I spent some time on the narrative/story distinction. "Narrative" and "story" are buzzwords, and you might tune out when you hear them, but this pyramid teaches that a "story" tells of related events — or "experiences" — and a "narrative" is a collection of stories
or messages.
So don't confuse "stories" and "messages." A story is an "account" but a "message" is "words, images, and/or sounds that convey and idea or belief." Now, I can't see how an "account" can be anything other than "words, images, and/or sounds," so I presume the "story"/"message" distinction is that a "story" relates news of something that happened and how people felt and thought about it, and a "message" is more inward and abstract, "an idea or belief."
I see in the fine print that this (helpful?) diagram comes from "Guide to Counter-Narrating the Attacks on Critical Race Theory." I guess the advice to "counter-narrators" is that when you hear your opponent's "message," you then climb the pyramid of story and narrative until you get to the top, "the deep narrative." When you've reached the highest point, you are at the greatest depth.
I'm just noticing that the pyramid is labeled "The Narrative Ecosystem." Mixed metaphor! Is the locked-in-place stone to be thought of as alive?
I also read some of the various tables. I paused on this one, because of the buzzword "narrative" and because I could see that it was instructing the reader to perceive sets of deeply held beliefs and therefore to be in a position to question them (or is it to be vigilant about not repeating them? ):
And I read the text on "The narrative of individualism":
Individualism is a philosophy and group of ideas, expressed in symbols, practices, and stories that supports a belief that self-sufficient individuals are rational beings that freely make consumer-like choices, independent of political influences, living conditions or historical context. Among these ideas is the concept of meritocracy, a social system in which advancement in society is based on an individual’s capabilities and merits rather than on the basis of family, wealth or social background. Individualism is problematic in obscuring the dynamics of group domination, especially socioeconomic privilege and racism. In health care, this narrative appears as an over-emphasis on changing individuals and individual behavior instead of the institutional and structural causes of disease.
This narrative acknowledges that class inequities may be unfortunate, but falls short of declaring them unjust, thus obscuring political, structural and social determinants of health inequities. Diseases become the main target rather than the social and economic conditions that produce health inequities. This focus ignores the role of political struggle in the advances that have been made over time. For example, the major advances in
life expectancy in the early 20th century resulted from the actions of social movements
to eliminate child labor, institute housing and factory codes, and raise living standards, not advances in technology or economic growth. Health promotion in medicine and public health typically means educating people as individuals about their health without acknowledging the influence of living conditions, which are themselves conditioned upon societal, structural inequalities. We argue that much can be gained by shifting this narrative, from the individual to the structural, in order to more fully understand the root causes of health inequities in our society.
But shouldn't doctors focus on the individual? Even if the greatest advancements in health would come from improving economic conditions for large groups of people, what good is it to have doctors preoccupied with these matters? They're not experts, and they have expertise in something tremendously important that is delivered at the individual level.
