This episode is about language, communications, diversity, and equity as they relate to public health and health care. Logan and Anya welcome University of Iowa College of Public Health alumna Bella De Soriano (17MPH) as she talks about her work with Healthline Media to create The Conscious Language Guide, a tool to improve patient-provider communication and advance their work toward health equity. You can find the guide at transform.healthline.com/language

De Soriano is the senior public health integrity manager at Healthline Media and has spent her career examining health equity in research and community settings.

Logan Schmidt:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Logan Schmidt and I am joined today by Anya Morozov. And if this is the first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and out of the field of public health. Today, we’ll be chatting with the University of Iowa College of Public Health alumna Bella De Soriano. Bella is the senior public health integrity manager at Healthline Media and has spent her career examining health equity in research and community settings. She was instrumental in creating the conscious language guide to improve patient provider communication and advance public health work toward health equity. Welcome to the show, Bella.

Bella De Soriano:

Thank you so much. I’m very happy to be here with you today.

Logan Schmidt:

Absolutely. So to start us off before we dive into the deep questions with our discussion on health communication, can you fill us in and our listeners in on what you’ve been up to since graduating from the University of Iowa?

Bella De Soriano:

Yes. So I graduated in 2017 from the community and behavioral health department. I was lucky enough to continue working with some of my mentors and some of the faculty after I graduated. So I did that for a while, I moved to Chicago during that time. And when I was attending an APHA conference, I managed to network with someone and who was working and I was so excited because she also had an MPH. And she was working in a field that I had never even considered open to somebody with our degree. And so I started to do some work with, a little bit of contracting, and then at the end of that, they offered me a full-time position. So I joined them full-time on the medical team during… What was it? 2019. So I’ve been there just over three years now. And that’s what I’ve been up to. Still living in Chicago.

Anya Morozov:

Healthline.com has been around since 2006. Can you expand on what Healthline Media is and what their mission is?

Bella De Soriano:

Yes. So Healthline Media actually consists of four different websites. So that would be healthline.com, medicalnewstoday.com, greatest.com, and psychcentral.com. And all of those websites make up Healthline Media. They just started at the very beginning in 2006, just as healthline.com, but all of those four makeup Healthline Media. And our mission really is to make a stronger, healthier world. And the way that we envision doing this is by providing accurate, reliable, and relatable health information. And we are the number one digital health information publisher in the US through these four different websites that I mentioned. And we meet millions of unique visitors on our sites every single month. So we are reaching a lot of people and we do then have a responsibility to make sure that our content isn’t just medically accurate, but it’s also inclusive and empathetic for the people that we’re trying to get information to.

Anya Morozov:

So how do you think health communications and media have evolved over the years? And how do you think the pandemic has impacted the way we communicate about public health?

Bella De Soriano:

A very interesting question. The parallels I see between media and health communications is that we have a lot to learn from each other. But health communication can learn and has learned from marketing, which is part of media. And so that looks like social marketing, where you’re looking to sell a behavior or promote a behavior or some kind of healthy habit rather than marketing a product. And so that’s one parallel and one way that folks can learn from each other between media and health communication. Also, tailoring messages specifically for your audience. I think media has some space to learn about what it really means to tailor your message and who are you really tailoring it for. So I don’t necessarily think that they have evolved together on purpose maybe, but those are ways that the two fields can really learn from each other really to create positive outcomes for users and for communities.

Bella De Soriano:

There’s so much learning that can happen there and it’s very exciting. And for the pandemic, when you ask that question the thing that comes first to mind is trust, right? And so how do we as a health information site build trust with our users so they know that when they’re reading information on one of our websites, they can essentially believe what they’re reading and that it’s trustworthy, it’s reliable, it’s accurate. And how do they know that? And so part of our job is to showcase our internal processes. And part of that is our medical review process.

Bella De Soriano:

So content is reviewed by a medical professional before it’s published as an extra layer to show to users that you can trust our online health information. And I think that’s something that you, members of the public found difficult during the pandemic was to know where to get that type of information that they could trust and was giving them the most up to date information as it came out, even if that was different to what was said before, that’s still trustworthy information because you’re keeping up to date with the newest stuff that’s coming out for a completely emerging public health issue.

Logan Schmidt:

Yeah, that’s great. And going further into the work that healthline.com does and what you’ve been doing, you’ve had a big part in creating the conscious learning guide. So we’re interested to hear about that and what is it and how can it be used?

Bella De Soriano:

I’m super excited about this guide. It can be thought of as a handy reference tool for those looking for alternative ways to talk about topics that might have stigma attached to them. Or if folks are a little uncertain about how to frame certain topics, or they know that they want to talk about something a little bit differently, but they’re not sure even where to start, with alternative ways the guide can be used for that. And I think an important caveat is to say it is not the be all and end all in language and what should be used because context is hugely important. I think one of those examples is… One of the first things in the guide is about autism. And so one of the big considerations we see here is autistic people have a preference for identity first language is what we found, the majority of folks. But there are other people in what we might call the autism community that might see it differently.

Bella De Soriano:

And so even just the term community can be difficult to define. So how do we balance those two? And it really depends on context, and it also depends on where the person sits with a certain experience. And so the caveat with this guide is it’s not going to be a definitive guide. It’s really here to provide options and to provide a more expanded view of how we can talk about health topics, particularly if they have stigma attached to them. And the way that it was created, Healthline Media has a really great background and core value when it comes to content that’s just focused around empathy. And this is reflected in all of our internal guides and documentation, including our editorial style guides, which is used by editors, writers, copy editors, all the folks that have a hand in creating the content from start to finish. And so it started as an internal guide just to aid in editorial decision making at times on, should we use this word? Should we use that word? How do we want to frame this topic?

Bella De Soriano:

So it started as an internal guide, but we found it so useful. And we still had a lot of questions when creating it and creating content. So it made sense that if we have questions and if we were looking for some kind of guidance, other folks would also be looking for that. So we decided to publish it. And it’s also a way for us to really live our brand values as well, and our values around empathy and content. So we published it and I really have to take a moment to give a huge shout out to all of those editors and the copy editors who do go in everyday and are writing content and utilizing the guide and our internal documents. They’re the ones really putting all of this into practice. And so I have to always, always give a shout out to our editorial teams and their work in this area.

Anya Morozov:

Wow. Well, I love that… I mean, I love so many things about what you’ve said, just the idea that it’s a guide and not necessarily this hard set of rules, because in language being something that’s constantly evolving, it’s hard to have a hard set of rules. And also just the idea that it started as an internal thing that you were like, this is so useful, we’re going to give it to other people as well. I think that’s just really awesome.

Bella De Soriano:

Thank you, I appreciate that. And it reminds me of not being the gatekeeper to information because that’s how you control the narrative, that’s how you control power dynamics. And so just giving out information and sharing knowledge is in its own way a work towards health equity.

Anya Morozov:

I love that. So keeping in mind kind of information sharing, can you talk about what stakeholders were involved in creating the guide? You are talking about a lot of different communities, so how do you get input from those communities?

Bella De Soriano:

That’s a great question. I always tried to keep in mind that our most important stakeholder is going to be the reader or the end user, the person who’s reading the information. So they are kind of the ultimate guiding stakeholder, if you will. That doesn’t mean that there weren’t other folks involved who had considerations. And so some internal stakeholders I had to work with included our brand department marketing editorial folks, product as well. So that’s kind of stakeholders in how to actually get the guide to people and putting it up on the website. And we did have to redefine definition of expert and maybe redefine is the wrong word, I’m going to say expand our definition of expert here. Because when it does come to stigmatize conditions, the experts are the folks living with the condition, their lived experience, how they see the world, how they are treated by the world.

Bella De Soriano:

So we did ask community members to give their inputs into creating the guide, just to make sure that there were no assumptions being made, biases weren’t baked into this. And then also we had to draw on public health and health communications, we had to draw in history, anthropology, psychology, to understand all of these different ways that intersecting identities will lead to preferred language choices. And so one example for that would be the use of the term queer. So we’re writing a lot of different content that reaches different people. And so when is it appropriate to use the term queer in an article? And when is it better to maybe not use that term?

Bella De Soriano:

And so understanding the political landscape, history, the history of psychology to understand that queer was a slur, right? And now it’s being reclaimed by younger generations. So taking that into a practical application, if we’re talking to a younger audience that might be acceptable to use that. There’s the article is a general topic or it’s geared towards older adults, maybe we don’t use that because we know that there’s a history there. So there’s a lot that went into it. And a lot of people who needed to be involved to really make sure that we were making it the most accurate and kind of context driven guide that we can make it.

Anya Morozov:

One more quick question kind of along those lines, is there going to be or is there a process for continuing to edit the guide as new information comes out?

Bella De Soriano:

Yes, we are always keeping an eye on how language is changing and trying to do we call it surveillance, but I don’t love that word. I haven’t found a better one for it. But just trying to keep up to date with how language is changing and then updating our guide and then any other additional internal resources we have. We also really have a great team that does updates so this team is focused on just updating content. And it’s not just about when a new guideline comes out, it’s also about, okay, so do we need to change this language now because there’s a different thing that we need to be using? So we have these processes in place to act quickly when language changes come along, but also knowing that we have to be a little bit kind to ourselves as well and say that it is moving so fast, that it is hard to keep up with everything all the time sometimes.

Logan Schmidt:

Absolutely. So language is ever changing and it seems like you’re having that full team to always make sure that are aware of their surroundings and the cultural cues that are happening. And the aspect of tailoring messages to the groups that you’re trying to spread that message to. I want to keep talking about this language guide and those who want to implement this guide into their organizations or their groups of people. And specifically this whole aspect of improving the patient provider communication. And one of the things about implementing diversity equity inclusion type initiatives is that they’re not always received well. In the sense of the message is delivered, but it’s not received and implemented in individual’s practices in terms of healthcare or otherwise. So I want to ask you how you’ve promoted this kind of work, the conscious language guide to improve receptivity to individuals who have otherwise not gravitated towards these topics of DEI? Or just generally changing language to pertain to their specific audiences that they’re talking to.

Bella De Soriano:

I think what serves us well when thinking about this question is not only is the guide helping people to tailor messages to the person they’re talking to, but we need to tailor our message to the person that we’re trying to get the guide to. And so taking that step back if we are talking to… Yeah, it depends on who we’re talking to. But some of the core things that come to mind, like I said, it’s not a definitive guide, not everything is going to work for the context that you’re in for this guide. And so you have, I think not forcing that on people and nobody wants to hear you should be doing this, you should be doing that. It’s saying here are some other options that you might want to consider if what you’re doing, isn’t working. Or if you are looking for other ways to talk about topics and tying it to outcomes.

Bella De Soriano:

So if you are working with communities and you’re looking to, for example, uptake HIV treatments or something, you might consider the language that you’re using to talk to folks. And then see if that has an impact on the health outcomes. I think if there’s an impact there that is measurable, or you can draw associations to, that’s a really big thing for people to be able to see that there’s something positive happening from the language that you’re using. So not telling people that they should be doing this, they should be doing that.

Bella De Soriano:

And then tying it to something that they find valuable. You have to know what the person cares about and then say, okay, I know you’re trying to do this, here’s another tool that you can have at your disposal to use so that you can reach this outcome that I know that you really care about. So tailoring your message for the people who are trying to tailor their message, I think can work really well to try and increase uptake. And also not saying nobody wants to hear that they’re doing something wrong either. And so being empathetic and saying, hey, here’s just another way of doing it. Not saying you’re doing this wrong, and then you need to do this instead. So a bit of a soft handed approach, I would say.

Logan Schmidt:

That makes total sense. Going a little bit further into that, would you say that… Or what advice do you have in terms of organizations implementing a culture? And you definitely did speak a little to this, but to have a discussion around these topics where promoters of certain initiatives or use certain language and skeptics of those such initiatives can actually have open discussions in a way where both parties can benefit and continue this culture of inclusivity, both in terms of the populations we’re trying to serve, but also the varying opinions people have about these initiatives. How would you go about that as a leader of an organization?

Bella De Soriano:

Not a simple question to answer, I will say. I think the thing that comes to mind is listening doesn’t equal agreeing. So if you agree to listen to somebody, it doesn’t mean that you are agreeing with what they’re saying. But it is saying that you are agreeing to allow them to have space to air their thoughts. And I think starting from that position can be very powerful. A lot of people would like to be heard and they would like to feel seen. And none of that means that you have to agree with what they’re actually saying, but allowing them to have space to say it can be very powerful. There are obviously exceptions to this rule, right? If it is some topics, it can be very difficult to listen to. So I’m not saying that that is a blanket rule either, but helping people feel seen and heard goes a long way to creating some kind of common ground.

Bella De Soriano:

And I think that’s what we were looking for, is to find some common ground from which we can work from and say, okay, we don’t agree on some of this stuff, but we do agree on some of the stuff down here. And this is where we can start from, this is our foundation and we can work from there. And modeling, modeling the behavior, right? So if you believe that it is important to call people in when something problematic is said, you can model that behavior and do it in a way that allows for discussion rather than shutting down the conversation. So, oh, I heard another way to say this is another thing that I’ve been practicing, or I recently learned about another phrase that could be useful for our conversation. This is what it is, and this is how I found it to have an impact on my conversations with folks. So modeling that type of behavior, where you call people in and not shut down the conversation as well.

Logan Schmidt:

So going into the research aspect of your line of work, what does health equity and research look like? What’s the history of research related to this topic and where is it heading in the future?

Bella De Soriano:

The pandemic really highlighted the need for a lot more research around health equity. I think some of the problems that arose from that, from what I’ve read, there was a flurry of grants that came out. But the people who were given the grants, weren’t always folks who were the most knowledgeable in health equity, how to study it. And then the research that would come out of that may have a different angle or may find something different. So we also have to be thinking about who’s doing the research by whom and for whom. And just because there’s a lot of research about health equity, doesn’t always mean that it is contributing to the body of evidence in a way that is actionable. So I’m hoping that there’s a lot more research that’s going to come out around health equity, but there’s always this caveat about who’s doing it and how are they doing it?

Bella De Soriano:

One of the things that I learned in the college during one of my classes, which has been really great I have to say in my position, is the principles of CBPR, community based participatory research, which works to redress the power imbalance between researcher and community. But when you look at the approach of that, you can really say between community and any other kind of institution or industry. So making sure that the community is involved in every single step of the research project or program or initiative, whatever you’re working on, including the creation of the question itself. So that you know that it is a priority for them. And you don’t assume a lot of things about community priorities based on you simply looking at epidata. There may be high prevalence in a community, but it may not be their health priority. Is that really the best allocation of resources for a researcher or for a company or for even a media company?

Bella De Soriano:

We have to make sure that we are writing on things that people are actually finding interesting and will be useful for them. So there’s research about health equity and looking into that. And then there’s kind of equity within research. And I just would love to see CBPR kind of get more out there and have that be much more widely used approach to research. But it comes with a bunch of tricky things as well, so I can understand why there are barriers to it. But I do think it is super important to be thinking about those things, not just in public health, but anywhere you might be where there’s a marginalized community and a large industry or institution where they’re working together.

Anya Morozov:

Yeah, I think the emphasis on community based participatory research is super important. And like you said, it does come with some caveats, sometimes you have to move a little bit slower when you’re considering community input. But there’s some phrase I heard once where if you want to go quickly, go alone, but if you want to go far, go together, and I think that’s really big in community based participatory research, anyway.

Bella De Soriano:

I love that phrase by the way, if you want to go fast, go alone, and if you want to go far, go together. I love that.

Anya Morozov:

Yeah, I wish I could remember where I heard it and give credit where credit is due. So I also want to say, I think I’m probably going to use the conscious language guide in my own projects here at the College of Public Health. Because even in one of my classes right now, we are designing an intervention for a community that we are not a part of. And I think this will be a good starting place for learning kind of how to talk about that community, which I’m very excited about.

Bella De Soriano:

You have no idea how happy that makes me right now so thank you. There is nothing that gives me more joy than to see this guide being used in practical settings. And I really appreciate you sharing that with me. And if there’s anything I can do to facilitate, or if you have any questions, just email me and I would love to help.

Anya Morozov:

Awesome, thank you.

Bella De Soriano:

Which reminds me, sorry, I just have one more caveat with the guide. Now, the thing that we also need to stress is that because the guide is not be all and end all, if there’s somebody who uses a term to describe themselves in the guide that is under don’t use this word, we don’t want to “correct them” because we also really cannot be telling people how to describe their own experience or their own identities. And so when folks are talking about themselves and they use a word that maybe I wouldn’t use, I don’t ever correct them or think how do I tell this person that that’s not the word that they should be using to describe themselves? Because we don’t want to take away anyone’s autonomy.

Anya Morozov:

That makes a lot of sense. And I will take that into account for sure. So lastly, we talked a little bit about my education, but we also are happy to hear that you yourself are an alumni of the College of Public Health. And wanted to know how your education at Iowa helped you get where you are today.

Bella De Soriano:

Definitely the health communication part, all the classes that they took in how to tailor messages and health communication campaigns. The bio science was not my favorite to be fair, but it was a required class and it has served me well to have a baseline understanding of epibiostats policy. I mean all of the kind of intro class that you have to take for the MPH, they’ve all been beneficial in some way along my journey here. And just having the opportunity because the college is a little bit smaller than some other schools, having the opportunity to really get to know faculty and build relationships with them, to get to know staff, to get to know other students, to be part of any student groups that are there. It’s all just been a fantastic experience in learning because folks really can’t dedicate some time to you like they might not be able to it with a larger class size and CBPR, obviously.

Logan Schmidt:

To wrap it up, Bella, we usually ask the same question to guests when we have time, what is one thing you thought you knew but were later wrong about?

Bella De Soriano:

Can they also just be everything?

Logan Schmidt:

Yeah.

Bella De Soriano:

Wow, that is kind of a tough question because the answer really is everything. At some point you will always unlearn the things that you’ve learnt and you’re continually finding out that what you thought was… I don’t want to say real, or true, maybe isn’t or looks a little bit different. I think the emphasis that I had in college around health equity and systems I always took for granted. And so now that I’ve had a little bit of distance from that space, I realize that that’s not the case. And most people aren’t looking at those things, they’re not top of mind.

Bella De Soriano:

And so it’s put an emphasis on thinking how do I continue to have these discussions outside of the university settings with folks who might not have those top of mind? And that’s just a big learning process and it’s going to change over time. But I think that was something that I found I was wrong about thinking that everyone’s knowledgeable about this or is interested in making this their top priority. And that’s just not the case, which is totally fine because that’s why we’re here to add that into the situations that we go into.

Logan Schmidt:

Absolutely. And that’s why we have the conscious learning guide for the future and continue benefiting from your work. And Bella, it’s been great to talk to you and it’s been great to learn how to tailor messages, whether it’s for an individual themselves or the people who are doing the tailoring of the messages to other individuals. So these are things that we’ll definitely take into our careers and hopefully the individuals listening to this podcast can also do that in their personal lives and professional lives. So thank you again.

Bella De Soriano:

Thank you. This has been really great. I appreciate the chance to share the guide with folks if it helps. If it’s useful, it’s useful and if it’s not, then it’s not. But I’m happy to answer any questions that folks have about it or implementing it or provide further information.

Alexis Clark:

That’s it for episode this week, big thanks to Bella De Soriano for coming on with us today. This episode was hosted by Logan Schmidt and Anya Morozov, written by Logan Schmidt and Ben Stint, edited and produced by Alexis Clark. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues. This episode was brought to you by the University of Iowa College of Public Health. Stay happy, stay healthy and keep learning.