October 24, 2022
Children’s National Hospital has proudly served the early childhood and K-12 school systems for more than two decades. We currently…
October 24, 2022
Children’s National Hospital has proudly served the early childhood and K-12 school systems for more than two decades. We currently…
A land acknowledgement statement, also known as Indigenous land acknowledgement, are formal statements used to spread awareness and understanding of the longstanding history of the Indigenous population genocide that occurred on the land that we reside on. They can be verbal or visual: signage, short theater presentations or simple spoken-word greetings before large events such as conferences.
“When we talk about land, land is part of who we are. It’s a mixture of our blood, our past, our current, and our future. We carry our ancestors in us, and they’re around us. As you all do.” Mary Lyons (Leech Lake Band of Ojibwe)
Land acknowledgements do not exist in a past tense, or historical context: colonialism is a current ongoing process, and we need to build our mindfulness of our present participation. It is also worth noting that acknowledging the land is Indigenous protocol.
Why are land acknowledgement statements necessary?
Land Acknowledgement Statements became popular in countries like Australia, New Zealand and Canada. These countries started these statements for various reasons, for example in 2008, Canada launched a Truth and Reconciliation Commission that included 94 recommended calls to action created by First Nation people to address the historical harm done to their communities.
Land acknowledgements started in the United States’ from within the arts community due to the direct call to action from the North Dakota Pipeline protests starting in 2016. The US Department of Arts and Culture launched a social media campaign called #HonorNativeLand and provided a resource on Indigenous People’s Day 2017 (October 11): ‘Honor Native Land: A Guide and Call to Acknowledgment.’ Soon after, higher education institutes started providing statements. The first university to provide an official land acknowledgement statement was in 2018 by Northwestern University (NU) read at commencement, printed in programs, and published online. Due to the growing popularity of these statements on college campuses and the spark of the Black Lives Matter movement, this demanded that organizations take a look at their practices and traditions.
These statements and movements led to the historic name change of the NFL Washington Football Team. Why is that important? It may seem like a small change, but the term “redskin” is considered a slur by Native American activists and has been used since the 18th century. This slang was used by the first colonists settlers and utilized to label Native Americans (or known as “Indians” during that time) as lower than white people. Some historians say that the term “redskin” could be reference to when Native Americans were scalped when they were hunted for bounty in the 1800s. Since the 1960s, activists have tried to encourage the NFL to change the mascot and name of the Washington team. Land acknowledgements and civil rights movements help to bring awareness and hold large corporations like the NFL accountable.
How to Use Statements
In order to spark awareness, you can have a simple statement at the end of your emails such as this one:
“In the spirit of healing, I acknowledge and honor the Piscataway and Nacotchtank Tribes, and all of the original Indigenous peoples of the land upon which Children’s National Hospital stands. / Whose land are you on?”
The link provided shows the historical territories of Native American tribes throughout the United States. Links like this can be provided or another education link regarding land acknowledgements.
In the spirit of healing, CHAI has created a land acknowledgement statement. Children’s National Hospital has not established an official statement yet, but we encourage you all to spread awareness. You may utilize this statement for your own needs during appropriate times before large gatherings or in need of reflection regarding racial equity topics. If you do choose to use this statement, please reach out to Lin Chun-Seeley at firstname.lastname@example.org to ensure you are using the statement appropriately.
Our Example: CHAI Land Acknowledgement Statement
The Child Health Advocacy Institute at Children’s National Hospital acknowledges that Washington, DC is the traditional territory of the Nacotchtank/Anacostan and Piscataway people. This land acknowledgement is read to recognize and honor the Indigenous peoples and the genocide, forceful removal and displacement of their elders whose lands and territories were stolen from them. We acknowledge their legacy and find inspiration in their great stewardship of the region for generations.
The CHAI recognizes and celebrates the resilience, strength, and enduring presence of Indigenous people in Washington, DC and in all communities around the world. We have a shared responsibility to acknowledge the history and legacy of colonialism in our history as a community, as a nation, and as an institution. We commit to supporting the Indigenous members of our community as we educate ourselves on Indigenous histories, cultures, and issues.
In the spirit of reconciliation, healing, and collaboration, please join us in a moment of reflection to acknowledge the injustices of our past and present as we work to dismantle the ongoing legacy of colonialism. Land acknowledgement is only one small part of supporting Indigenous communities. We hope our land acknowledgement statement will inspire others to stand with us in solidarity with Native nations.
Have you ever used words like ‘vulnerable,’ ‘disadvantaged’ and ‘underserved’ to describe the people you serve? In education and health, we learn to use these words to describe people who live in under-resourced communities. These words have pejorative undertones that are demeaning, belittling and discriminating.
The term underserved connotates a group of people who are “waiting to be handed something on a silver platter and that all of their challenges relate to services when in fact their challenges reflect a lack of resources – of which services is only one.”1 The term is also “part of a suite of commonly-used, vague words and expressions” and does not adequately describe the structural forces that limit the resources for particular populations.2 In fact, their challenges reflect a lack of resources or under-resourced, which includes leadership, physical assets
, and power.
I began to understand the use of my own language after participating in a webinar led by Jerry Hawkins from Dallas Truth, Racial Health & Transformation. I learned why language matters and how to stop racist and discriminatory narratives. 3
The use of appropriate language is critical to building bridges in our community. Over the last year with the Child Health Advocacy Institute at Children’s National, we have trained over 300 employees on how to incorporate an equity lens in their communication. We encourage inclusive language to avoid perpetuating negative biases and instead embrace diversity and inclusivity to promote equity and strengths in our society. We remind our colleagues that this is a continuous learning process and share the quote from a collaborative organization called SumOfUs: 4
“Reclaiming power from racist systems takes a willingness to come to the conversation with curiosity and openness and a willingness to get it wrong without letting that stop us from continuing to try to understand and do better.”
Below are a few ways you can incorporate inclusive language in your writing and when speaking to colleagues, patients and families.
PEOPLE-FIRST LANGUAGE places the person at the center rather than the problem. Focusing on the individual rather than the condition minimalizes generalizations and stereotypes. Using the terms “a person with” or “person experiencing” a specific condition.
Rather than saying…
EMPOWERING LANGUAGE seeks to frame issues with an agency lens, rather than depicting people living in poverty as helpless. The use of empowering language portrays affected people as the agents in their own story.
Rather than saying…
STRENGTH-BASED LANGUAGE draws on a person’s strengths rather than deficits. The use of strength-based language focuses on a person’s contributions and aspirations as opposed to the challenges they face.
Rather than saying…
1. Burke NS. How to Fix a Broken Tongue. https://medium.com/@natalie4health/how-to-fix-a-broken-tongue-cade93816add. Accessed February 22, 2021.
2. Katz AS, Hardy B, Firestone M, Lofters A, Morton-Ninomiya ME. Vagueness, power and public health: use of ‘vulnerable’ in public health literature. Crit Public Health. 2019 Aug; 30(5): 601-611.
3. Hawkins J. Dallas Truth, Racial Healing & Transformation, Language Matters: Storytelling for Racial Justice. https://www.youtube.com/watch?v=hGrTvrl2HIM. Accessed March 8, 2021.
4. Thomas H, Hirsch A. A Progressive’s Style Guide. https://interactioninstitute.org/wp-content/uploads/2016/06/Sum-Of-Us-Progressive-Style-Guide.pdf. Accessed March 8, 2021.
Almost everything about the COVID-19 pandemic has been politicized: mask wearing, school re-opening, vaccination development, social distancing protocols, and many other public health and scientific efforts and recommendations. This politicization undermines public health efforts, science, and public trust. It also creates a polarization that makes dialogue, trust building and any progress forward very challenging. Most critically, this politicization and the ensuing polarization harm the health and well-being of children. While less impacted by morbidity and mortality due to coronavirus, children have borne the brunt of the coronavirus pandemic in a myriad of ways, from watching family members cope with illness, unemployment and other challenges, to social isolation and academic disruption due to school closures. In the spring of 2020, with the coronavirus racing around the globe, most US schools shut down for in-person learning, affecting over 50 million public school students.
Let’s focus on school reopening. One year later, many communities are still grappling with when and how to send students, teachers and staff safely back to school. What started as two weeks of school closures has evolved into a yearlong debate that has become politicized and polarized. Communities are seeing parents, teachers’ unions, school boards, and school districts plunged into conflict. As spring turns to summer and school districts release plans for the fall, families will need to weigh the risks and benefits of returning to school in-person. And we’re asking families to do it during a time of tremendous conflict and controversy.
If ever there was a moment for pediatrics, this is it. Pediatrics is part of the solution to politicization and polarization. Our exam rooms and our interactions with families create a space for open dialogue and honest communication. Families face a barrage of information from traditional and social media sources, as well as their friends, family members, and communities. Our exam rooms, our video visits, our phone calls with patients and family members – these are all spaces where we can remove polarization and politicization of issues like return to in-person schooling and apply a family-first focus. Much has been written about what we can do at a policy level, and much controversy remains, but let’s focus on the practice level.
The conversation with every patient and family about return to in-person school is going to be individual and nuanced. We must provide our patients the space, a safe space, to express their concerns about in-person school and virtual school. We can help families weigh the risks and benefits in their own family, and for each child, of different school options. We can share what we’ve learned about coronavirus and school safety. We can discuss how to best meet each child’s needs, by considering their academics, their nutrition, their physical activity, their socialization. And we can help families figure out what kind of return to school is going to work best for their child – virtual, hybrid, in-person, or even a slow ramp up to an in-person experience. Our visits with patients and families can focus on their unique questions and considerations, not the broader public debate and discord.
Let’s not let this opportunity pass us by. Families are counting on us to be the safe space focuses on their child, and their family. Let’s make our practices the prescription for politicization and polarization.
Hello, I am Tonya Vidal Kinlow – the Vice President of Community Engagement, Advocacy & Government Affairs at Children’s National Hospital. I welcome you to our CHAI blog and hope that you come back often to learn about the important work we do to help improve the lives of children in DC, our region, and the country. We – me, my staff, colleagues, partners and collaborators – will share our views on matters that impact the health and well-being of children. The views we express are our own and not necessarily that of Children’s National Hospital. In this post, I’ll share my thoughts on what health equity means to me and how the CHAI works to elevate equity for all children and families.
Most Americans are taught and believe the idealized version of our country’s commitment to equality – “that all men (and women) are created equal.” A close review of public policies related to determinants critical to a high-quality life – health care, education, housing, income, employment – sheds light on the structural impediments to equality and equity in our country. The current COVID-19 pandemic aggressively aggravated how a crisis can impact people who have been systemically marginalized. These inequities are built on centuries of policies and established cultural norms, within government and business, that were designed to deprive this country’s people of color of the opportunity for a high-quality life. Achieving equity through policy and systems change must be our top priority if we are ever to achieve the true potential of the American ideal.
Household income is one of the social determinants that affects many other quality- of-f life factors. Like a snowball rolling downhill, low income often results in lower quality housing, education and health. According to a Pew Research report, the Black-White income gap in the United States has persisted over time. The difference in median household incomes between White and Black Americans has grown from about $23,800 in 1970 to roughly $33,000 in 2018. 1 Making real change in this one area could have a tremendous impact on the lives of so many Americans. One possible policy solution to the income gap is to provide a living wage. Yet, Congress just rejected a proposal to establish a $15 per hour minimum wage.
The facts on disparities in health care, education, housing and employment are no different than the income indicator and are often linked. People living in poverty or in lower income groups often have poor health, poor housing and poor education. Programs to address system inequities are great, but most only offer temporary solutions.
Confronting these inequities takes a commitment to change. Children’s National Hospital made that commitment when it created the Child Health Advocacy Institute (CHAI). More than 30 years ago, Children’s National was the first hospital in the nation to establish a center to champion policies that build better lives for children. The CHAI achieves its mission through four core operational areas – community engagement, public policy advocacy, data and research, and education.
We are starting with the children. They are our priority. The health care system can be complicated and difficult to navigate. Our community engagement team works strategically with our Children’s National clinical staff and partners in other organizations to improve health literacy. The CHAI team helped to create new systems and processes that improve the coordination of care, making it easier for families to get the quality health care they need. These efforts ensure fundamental health literacy supports, such as making sure families get patient discharge instructions in a language they understand. Additional systems changes establish more high- touch care coordination follow-up, such as, provider to patient calls to address any concerns that the patient might have complying with home care instructions.
We are focused on eliminating health disparities. Our Data Lab helps us to identify community health needs. The data drives where we focus our efforts to make change. And, the community consistently ranks mental health care at one of its top needs. Due to a growing level of socioeconomic inequality among races, African Americans are less likely to have access to mental health care and are more likely to have lesser quality care when they do find it. In one study, of all those who received mental health care, minority populations reported a higher degree of unmet needs and dissatisfaction with the services they were given (12.5% of whites, 25.4% of African Americans, and 22.6% of Hispanics reported poor care).
Children’s National supported the development of a new system of mental health care. One that relies on a trusted health care provider – pediatricians. Child and Adolescent Psychiatry Access Programs (CPAPs) or Pediatric Mental Health Care Access Programs (MAPs) are a recent innovation designed to address the dire child psychiatry workforce shortage by supporting pediatricians and other primary care providers (PCPs) to address their patients’ mental health concerns within the primary care setting. When mental health services are available, families face serious barriers in accessing care, including difficulties with transportation or attending regular appointments and overcoming the stigma often associated with seeking mental health support. In this context, PCPs are often asked to care for children with complex mental health needs without adequate support. MAPs are regional or state-level programs that allow PCPs to access a centralized team of professionals who they can consult about their patients’ mental health needs. MAPs promote health equity by ensuring all children, including those who live in communities with limited resources, have access to high quality mental health care. The CHAI government affairs team advocated for a national expansion of MAPs. President Biden’s COVID supplemental appropriations, the American Rescue Plan, includes $80 million to expand MAPs.
We are advocating for health equity. According to the Center’s for Disease Control (CDC), infant mortality is the death of an infant before his or her first birthday. CDC’s data shows that Black children are more than twice as likely to die before their first birthday than White children (10.8 deaths per 1000 live births for Black infants and 4.6 for White). Birth defects is one of the leading causes of infant mortality and early detection is a way to save an infant’s life. The Children’s National Government Affairs team was an early leader in efforts to require birthing hospitals to conduct newborn screening that would detect birth defects. This life saving public policy is now law in all 50 states. There is also a federal law that defines the birth defects that all American infants must be screened for. While newborn screening is only one strategy used to reduce infant mortality, it creates equitable access for all children regardless of race and ability to pay.
We are training the next generation of pediatric health care providers to care for the whole child. The CHAI team understands that excellent clinical care is only a small part of what it takes to keep a child healthy. We want our young doctors to also understand this. Social factors, such as housing, education and access to quality food, also make a difference in health outcomes for children. The CHAI advocacy education team developed a national model for socially accountable, interprofessional advocacy education, that will result in a skilled workforce driven to advocate for child health equity and systemic change. Trainees learn about food insecurity during a day long interactive session at the Capital Area Food Bank. Their experiential learning also includes strategies for helping families resolve this need.
Eliminating inequity across all social systems will take determination to untangle systemic bias in public policy that have been entrenched for centuries. At Children’s National, the focus is squarely on making a difference in the lives of children. We are guided by our community; use data and research to focus our efforts; and advocate for public policy and systems change. Children are only a small part of the U.S. population, but they are our future. The Child Health Advocacy Institute, through policy and systems change, will champion polices that improve the quality of life and create equity for all children.
Header photo by Ponsaksitphotos on Canva