As physician-advocates, our ability to talk about immigration-related issues and concerns to patients, families, and fellow healthcare providers is extremely important. Drs. Anisa Ibrahim and Lanre Falusi of the Executive Committee of the AAP Council on Immigrant Child and Family Health (COICFH) provide a framework for clinician-advocates and suggestions for how to introduce and reframe narratives. With this goal, important changes that we may want to make in practice are the following: 1) centering our narratives about immigration on shared values (e.g. shared prosperity, human potential, human dignity), 2) reframing common perspectives, and 3) avoiding common pitfalls that elevate certain groups to the detriment of other groups. For a small portion of the content in the table, Jennifer Moore, MD and Madeline Wozniak, MD from the Pediatrics Health Equity Infographics group have also provided some guidance.
Key Principles of Effective Messaging:
- #1: “It’s not them, it’s us”
- Focus on collective orientation
- Moves away from labeling immigrants as “other”
- Avoid the following pitfalls:
- “Exceptional immigrant” stories - rhetoric serves to boost the myth of merit and further the erroneous belief that only the “deserving” and exceptional should be in the U.S.
- Model Minority
- Nation of Immigrants - an attempt of solidarity, however this ignores native populations that were here or the history of slavery
#2 Strength-based language
- Focuses on assets rather than problems or deficits
- Recognizes that disparities are based on social and political inequities
- Avoids words of oppression
#3: Humanizing stories
- Include brief but detailed human stories
- Provides an emotional appeal
- Recognizes unique faces within the “immigrant story”
- Provides counter-narrative for “illegal immigration” or overuse of social services
- Avoid the following pitfalls:
- Centering your perspective and not the perspective of immigrant families
- Not asking patients for input
- Long story that buries the main point
Examples of Key Messaging:
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Rather than... |
Let’s consider... |
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Reframing the narrative |
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“Them,”“They,”“Those people”, labeling immigrants as “other” |
“Us”, “We” (“We” expresses empathy and solidarity) |
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Concerns about “security” or “control” |
Focus on the “value of diversity” |
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Immigrants taking jobs |
Immigrants are hard-working people |
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“We must give these children and their immigrant families the tools and skills that will help them succeed.” |
Phrasing problems in a way that focuses our shared responsibility to fix them: “Much of the country’s future success depends on whether we will equip children living in immigrant families and their parents with the tools and skills that will help them learn, develop, and contribute.” |
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Avoid “Qualify” or “Eligible” for resources such as food, housing, employment, medical care |
Emphasize that food, housing, employment, and medical care is a human right. |
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Strength-based language |
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Minorities Underserved Illegal or unauthorized Vulnerable or at-risk |
People/communities of color, People/children in immigrant families Under-resourced Undocumented People experiencing barriers/ discrimination/ vulnerability because... |
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“We want to empower families/communities” |
“We want to support families/communities.” |
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“Giving people/communities a seat at the table” |
“We want to facilitate the voice of people/communities.” |
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We want to help you. |
We want to support you. (Avoid help/savior power dynamic) |
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I will refer you. |
I will connect you. (“Refer” can have a negative connotation. “Connect” fosters trust.) |
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“Assistance” |
“Resources” (“Assistance” perpetuates a negative power dynamic) |
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Communication needs |
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The patient needs an interpreter. |
The provider needs an interpreter. |
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The patient does not speak English. |
The patient is proficient in a language other than English. This patient knows many languages and is multilingual. |
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NES - Non-English Speaking |
PLOE - Preference for languages other than English |
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Humanizing Stories |
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It is not illegal to… |
I imagine anyone in that circumstance would… |
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Victims |
Survivors |
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Statistics and facts |
Detailed personal story |
References:
- Anisa Ibrahim, MD and Lanre Falusi, MD. “Communication for Advocacy for Children in Immigrant Families” Lecture in the Migration is Beautiful Campaign. Massachusetts General Hospital (MGH), Boston, MA. 17 December 2020.
- Jennifer Moore, MD and Madeline Wozniak, MD. “What to do with a positive screen: CAREE”, https://pedshealthinfograp.wixsite.com/website/post/food-insecurity-screening