• communication
• health system
• Education
• medical leadership

As we publish the next series of papers in BMJ Leader’s topic collection on leadership and social justice, we reflect on an interesting observation that we discovered during the reviewing and editing process. This observation is related to the language various authors used to describe specific concepts, situations or ideas in their papers. Some words, such as equity and equality, were used interchangeably to describe similar points and differed depending on geographical context. There were other examples of the language used to explain certain situations without cognizance of the historical sources underlying the words or terms and the concomitant contextual sensitivity associated with such language for different groups.1

Language can be described as the aggregation of different words used in a discourse. It encompasses how the words are combined, connected, pronounced and understood by a group or community. Regardless of context, all forms of language are valid and of equal significance, so long as they work for the community using it. So also are the components that constitute the language, that is, the lexicon (the vocabulary of the language associated with a specific group), the syntax (the way the linguistic components or words) are combined to form components of discourse (phrases or clauses) and the semantics (the meaning related to the use of vocabulary and grammar in the language) and can in no way be inferior to any other language so long as the group can effectively communicate with each other.2

One of the complexities of the work in antiracism and antioppression (ARAO) and social justice is the language used in such conversations, which has evolved and continues to change over time. Certain concepts used in ARAO conversations and their expression in English have changed - for example, it is insufficient to not be racist, rather one must be anti-racist. Furthermore, because English is the language we (the authors) spend most of our working time with, it has, by default become the frame of reference. Hence, it is difficult for us to know how the language in the space of ARAO has evolved in other parts of the world and in languages other than English. This fact in itself, is a bias towards non-English-speaking communities when viewed from the context of clinicians and academics working and living in Western cultures. Furthermore, members within Western society are responsible for language-based discrimination when we consider that mastery of (written) language, specific vernacular and accents in spoken language differentiate certain groups from the majority in different geographical contexts.3

Therefore, we need to explore the use of language in a scholarly fashion especially when we acknowledge that like in all facets of life, language needs an ongoing application of a social justice lens. With the aid of some specific examples, we shall expand on what we mean by these ‘complexities’ and how we could and should do better.

One example of these complexities is the use of colloquialisms. ‘Low hanging fruit’ has a symbolic association with ‘strange fruit,’ which refers to lynching—the Billy Holliday song written by Abel Meeropol. Moreover, while the term low hanging fruit in the business world has very different connotations—‘high return, low risk’, or ‘quick wins’, we might consider how its use could conjure harmful meanings for some.4 The slang ‘you guys’ may lead to the exclusion of those who identify as woman, non-binary, fluid or two-spirited. Terms like ‘blind spot’ or metaphors like ‘falling on deaf ears’ are other examples of ableist language. Individuals who are blind have different ways of obtaining knowledge, it is not a matter of a deficit or lack of knowledge.5 Using lacunae instead of ‘blindspot’ has not quite resonated, so finding better, more inclusive language is definitely a work in progress. Similarly, when we say, ‘That is crazy,’ it could be hurtful to those with mental illness, and a more helpful message might be, ‘That just does not make sense.’5

Another complexity is in the shortcuts and short forms of language we use daily. For example, who has not been on a videoconference call where we or another on the call start speaking while our audio/microphone is set to ‘off’? Most get the feedback that ‘we are muted,’ and this statement is cued by the words below the microphone icon that read, ‘mute and unmute’. Needless to say, if one does not have expressive language or the ability to make vocal communication, then ‘muting or unmuting’ would not make a difference. The visual cue of those words, ‘mute and unmute,’ also makes it difficult to retrain our brains to say the more inclusive, less oppressive phrase, ‘turn the microphone on and off.’ This situation is just one example of structural elements that can perpetuate an oppressive environment. It would be better (and so simple to change) if the icon read ‘on and off’ underneath the symbol of the microphone on our videoconferencing platforms.

Of course, there have always been nuances to language and different understandings of what the same word might mean in English, never mind across different cultures. For example, the term programme director in the educational space refers to an individual who organises and supports educational programmes for learners. However, in the clinical space, a programme director runs a clinical programme. You can see how these individuals might interact with each other in the healthcare setting, thinking they are more similar than they are and leading to moments of potential confusion.

Another complexity is our terminology regarding social justice itself. More and more, the discussions framed around equity, diversity and inclusion, for example, have been felt insufficient by some groups who have a preference for using the terms ‘ARAO’, which they believe are more explicit outcomes to strive towards. Consider the concept of visible and invisible disability - if we did not have the ability to see, then another’s disability would not be visible or invisible to us. Others use the term hidden, although that has a connotation of ‘hiding.’ Perhaps instead, the term should be non-apparent.6

These complexities have made editing and reviewing contributions to the BMJ Leader topic collection on ‘leadership and social justice in times of crisis’ a complex journey—pun intended. In fact, we initially used the language of special issue to refer to this collection only to receive feedback that the term ‘special’ has negative connotations in English, and we have worked on changing it to the term ‘topic collection.’ When reviewing and editing, it is a fine line to honour the concepts and beliefs of the authors and how they wish to express themselves while ensuring, on the other hand, that the messaging about addressing racism and oppression to reach social justice is clear and consistent across the entire topic collection.

At BMJ Leader, the editorial team is striving to do and be better—to educate themselves in the space and to collaborate and cocreate with others, especially experts in the ARAO field, to create a publishing environment where everybody feels they belong. We welcome ongoing feedback and the opportunities they provide for reflection and further action.