Health Equity and Inclusive Language

DynaMed aims to provide the most helpful information to healthcare professionals at the point of care to improve health outcomes worldwide regardless of race, ethnicity, sex, age, national origin, mental or physical abilities, sexual orientation, or gender identity and expression.

In effort to address this goal, DynaMed has engaged in many initiatives such as:

  • Onboarding of Section and Topic Editors that specialize in health equity and social determinants of health, including Dr. Fatima Cody Stanford, Associate Professor of Medicine and Pediatrics and Equity Director at Harvard Medical School, Director of Diversity at the Nutrition Obesity Research Center at Harvard (NORCH), and Director of Anti-Racism Initiatives at Massachusetts General Hospital Neuroendocrine Unit
  • Training specialty editors to identify and prioritize health equity research within their field for inclusion in DynaMed
  • Large-scale content expansion with specific attention to health equity and social determinants of health
  • Development of an Inclusive Style Guide to support the intentional use of language across the product

Below, we offer an overview of our approach to health equity issues along with a rationale for the inclusive terminology we use within DynaMed.

Race and Ethnicity in DynaMed

Race and racism, both interpersonal and systemic, are intertwined with medical care, as well as the research we rely on to inform care.

There is increasing concern in the scientific community about using race or ethnicity to inform healthcare decisions. Demographic terms referring to an individual’s race or ethnicity (e.g., Hispanic, Latino or Latina, Asian, Native American, Black, African American, White, Caucasian) can be ambiguously defined and understood, reflecting diverse geographies, histories, cultures, and experiences. Aligned with the prevailing guidance from the American Medical Association (AMA), in DynaMed, we strive to use terms such as Black rather than African American and White rather than Caucasian to avoid presumptions about ancestry and to promote inclusivity, clarity, and consistency. However, to represent accurately the evidence on which our product is based, our editorial team will defer to racial and ethnic terminology as reported in the published systematic reviews, clinical trials, and other studies comprising the evidence we summarize or otherwise cite. Consequently, usage of demographic terms in DynaMed may appear inconsistent.

We also acknowledge that highlighting race or ethnicity as a risk factor for disease and using race or ethnicity within treatment algorithms or predictive models is at serious risk of ecological fallacy. Doing so can perpetuate health inequities by promoting undertreatment (delaying or restricting care) or overtreatment (exposing people to additional treatment burdens and adverse effects with no additional gain). However, altogether abandoning race and ethnicity in healthcare research also risks obfuscating or perpetuating existing health disparities. DynaMed strives to identify race and ethnicity as proxy variables for many unmeasured social and structural determinants of health that may better explain differences in health outcomes among population groups. We continually review the literature and revisit our content as needed to ensure we offer the best available evidence, including promoting equity in health care.

Sex and Gender in DynaMed

Sex and gender are similar yet distinct concepts that have historically been imprecisely defined and operationalized within medical research. Sex is a multidimensional biological construct based on anatomy, physiology, genetics, and hormones. Gender can be broadly defined as a multifaceted construct that encompasses gender identity and expression, as well as social and cultural expectations, characteristics, and behavior as they are associated with certain sex traits. Understandings of gender vary throughout historical and cultural contexts.

Sex and gender are both crucial constructs to measure and explore within medical research, as they both have been shown to impact health outcomes. DynaMed strives to use inclusive terminology by acknowledging that people receiving care may not identify as gender concordant with their anatomy. Using "women" or "men" universally within our product perpetuates the assumption that the patient before a clinician identifies as a woman or a man and conflates sex with gender while using inclusive language does not. Wherever possible, we use gender-neutral language within our product. However, to accurately represent the evidence on which our product is based, our editorial team will defer to the terminology reported in the published literature we cite if gender-neutral language may obfuscate the research outcomes. Consequently, usage of sex and gender terms in DynaMed may appear inconsistent.