Articles

When Algorithms Shape Access: Designing AI for Equity in Healthcare

When Algorithms Shape Access: Designing AI for Equity in Healthcare

By Racheal Hernandez, MAS

Introduction

Artificial intelligence is transforming industries at breakneck speed, from healthcare and finance to hiring and law enforcement. One of the most pressing ethical questions about AI in healthcare isn’t technical, but structural: Will AI help reduce inequities in care delivery, or unintentionally reinforce them?

Because AI is trained on massive datasets composed largely of existing human knowledge from books, articles, internet content, and social media its outputs are only as objective as the inputs. And much of that data reflects a historical bias shaped by a dominant cultural lens, often white, Western, and male.

For those working in diversity, equity, and inclusion (DEI), the implications are profound. If left unchecked, AI could not only mirror but reinforce systemic inequities. So how do we navigate the risks and unlock the potential of AI as a tool for equity rather than exclusion?

Bias In, Bias Out

At its core, AI works by learning from patterns. If those patterns reflect biased hiring practices, underrepresentation of minority voices in media, or criminal justice disparities, the AI system learns and perpetuates those patterns (Buolamwini & Gebru, 2018).

Healthcare algorithms are a stark example. For instance, an influential study found that an AI system used to allocate healthcare resources was less likely to refer black patients for additional care than white patients with the same medical conditions. This disparity occurred because the algorithm used healthcare cost as a proxy for health needs which reflects the systemic underinvestment in black communities rather than actual need (Obermeyer et al., 2019).

Who Writes the Rules?

Most AI systems are designed by a narrow demographic of technologists. According to a 2020 study by the AI Now Institute, over 80% of AI researchers are men, and the overwhelming majority are white (West et al., 2019).

When design teams lack lived experience with racism, ableism, or gender bias, they may fail to anticipate harmful impacts. What’s seen as “neutral” is often just a reflection of dominant norms.

The Myth of Objectivity

One of the greatest dangers in AI is the illusion of objectivity. When a system makes a recommendation on a job applicant or a loan approval it may seem more trustworthy because it's data-driven. But if the underlying data reflects decades of exclusion or prejudice, then the algorithm simply automates injustice (Noble, 2018).

Steps Toward Equity-Driven AI

While the risks are real, there are also opportunities. With intentional design, community input, and transparent oversight, AI can be made more equitable. Here’s how:

1. Diverse Data Curation
Ensure that training data includes a broad range of voices, experiences, and cultural perspectives. This includes language data, imagery, and behavioral models. Diverse data leads to more equitable algorithms.

2. Inclusive Design Teams
Recruit, hire, and empower technologists from marginalized communities. Inclusion at the table leads to better, fairer technology.

3. Audit for Bias
Conduct regular algorithmic audits to test for disparate impact. Independent, third-party reviews can identify risks that internal teams may miss.

4. Center Ethics in Development
Ethics should not be an afterthought. It must be embedded in the design process from ideation to deployment. Organizations should develop frameworks for responsible AI governance (Whittaker et al., 2018).

5. Listen to Affected Communities
Those most impacted by biased technology must have a voice in shaping and governing it. Participatory design models are critical.

6. Transparency and Accountability
Organizations must disclose how AI systems make decisions and allow users to challenge or appeal outcomes. Without transparency, trust breaks down.

Conclusion

AI is not inherently racist or inclusive but reflects the data, values, and choices of its creators. The question is not whether AI will shape society, but whose vision it will serve.

If we’re serious about equity, we must build technology that challenges historical bias rather than codifies it. This requires systemic change in how we train, hire, and hold accountable the institutions developing AI.

Used with intention, AI can help us identify and undo patterns of discrimination. But only if we lead with justice—not just code.

About the Author

Racheal Hernandez, MAS, is a Healthcare Administrator with over 20 years of experience in ambulatory care and healthcare leadership. Passionate about creating strong operational teams that deliver high-quality care.

References

• Buolamwini, J., & Gebru, T. (2018). Gender Shades: Intersectional Accuracy Disparities in Commercial Gender Classification. Proceedings of Machine Learning Research, 81:1–15.
• Noble, S. U. (2018). Algorithms of Oppression: How Search Engines Reinforce Racism. NYU Press.
• Raji, I. D., & Buolamwini, J. (2019). Actionable Auditing: Investigating the Impact of Publicly Naming Biased Performance Results of Commercial AI Products. AAAI/ACM Conference on AI Ethics and Society.
• West, S. M., Whittaker, M., & Crawford, K. (2019). Discriminating Systems: Gender, Race, and Power in AI. AI Now Institute.
• Whittaker, M., et al. (2018). AI Now Report 2018. AI Now Institute.

Inclusive Language in DEI: Fostering a Culture of Belonging

Inclusive Language in DEI: Fostering a Culture of Belonging

By Daphne Smith Marsh, PharmD, BC-ADM, CDCES, and Natasha Gomes, FRM, MAOL 

Introduction

Language is a powerful tool. It shapes our perceptions, influences our interactions, and can either build bridges or create barriers. In the context of Diversity, Equity, and Inclusion (DEI), the intentional use of inclusive language is paramount.

What is Inclusive Language?

Inclusive language is communication that acknowledges and respects the diversity of individuals and groups. It avoids words, phrases, or tones that are biased, discriminatory, or could exclude or offend any group of people based on their background, identity, or characteristics.

Why Does It Matter in DEI?

• Promotes Respect: Shows respect for all individuals and their unique identities.
• Fosters Belonging: Creates an environment where everyone feels valued, seen, and heard.
• Reduces Bias: Challenges stereotypes and unconscious biases embedded in our communication.
• Enhances Communication: Leads to clearer, more accurate, and less ambiguous messaging.
• Drives Equity: Contributes to a more equitable society by ensuring fair representation and treatment through language.

Why Inclusive Language Matters: The Impact

Our words have a profound impact, whether intended or not.

• Individual Impact:

• Validation: Inclusive language validates an individual's identity and experience.

• Psychological Safety: When people feel their identity is respected, they feel safer to be themselves and contribute fully.

• Alienation: Exclusive or biased language can make individuals feel invisible, misunderstood, or unwelcome, leading to feelings of alienation and reduced engagement.

• Organizational/Societal Impact:

• Culture: Language reinforces culture. Inclusive language builds an inclusive culture.

• Reputation: Organizations known for inclusive communication are often viewed more positively by employees, customers, and the public.

• Innovation: Diverse perspectives thrive in an inclusive environment, leading to greater innovation and problem-solving.

• Legal & Ethical Considerations: Using discriminatory language can have legal repercussions and is ethically unsound.

Key Principles of Inclusive Language

Adopting inclusive language is a journey of continuous learning. Here are fundamental principles to guide your communication:

1. People-First Language: Focus on the person, not their characteristic or condition. This principle is particularly important when discussing disability, but applies broadly.

• Instead of: "a disabled person," "an autistic child" “diabetic”

• Use: "a person with a disability," "a child with autism" “person with diabetes”

• Reasoning: Emphasizes the individual's humanity over a single attribute, avoiding the implication that the characteristic defines them.

2. Specificity and Accuracy: Be precise with your language. Avoid vague terms or generalizations that can perpetuate stereotypes or misrepresent groups.

• Instead of: "the elderly," "minorities"

• Use: "older adults," "people of color," "specific racial/ethnic groups (e.g., Asian Americans, Latinx individuals)"

• Reasoning: General terms can strip individuals of their unique identities and experiences.

3. Avoiding Assumptions: Do not assume someone's background, gender, sexual orientation, family structure, or abilities. If unsure, ask respectfully or use neutral language.

• Instead of: "he/she" (when gender is unknown), "moms and dads"

• Use: "they/them" (as a singular neutral pronoun), "caregivers," "parents"

• Reasoning: Assumptions can lead to misgendering, disrespect, and reinforce traditional norms that exclude diverse realities.

4. Respecting Self-Identification: Always defer to how individuals and groups refer to themselves. Terminology can evolve, and the most respectful approach is to use the language preferred by the community.

• Example: Some prefer "Black," others "African American." Some prefer "Latinx," others "Latino/Latina."

• Action: Stay informed and listen to how communities refer to themselves. If an individual shares their preferred pronouns, use them.

5. Considering Context: Language effectiveness depends on the context and audience. What's appropriate in one setting may not be in another.

• Example: Formal vs. informal settings, internal vs. external communications.

• Action: Be mindful of your audience and the purpose of your communication.

Visual from UIC PMPR | Inclusive Language in Education

Examples of Inclusive Language in Action

Let's look at common areas where inclusive language makes a significant difference.

1. Gender

• Gender-Neutral Nouns:

• • Instead of: "fireman," "policeman," "chairman," "stewardess"

• • Use: "firefighter," "police officer," "chairperson," "flight attendant"

• Gender-Neutral Pronouns: When an individual's gender is unknown or irrelevant, or they prefer them:

• • Instead of: "he or she," "s/he"

• • Use: "they," "them," "their" (singular 'they' is grammatically correct and widely accepted).

• Inclusive Groupings:

• • Instead of: "ladies and gentlemen," "guys"

• • Use: "everyone," "team," "colleagues," "folks"

2. Race and Ethnicity

• Avoid Stereotypes: Do not use language that reinforces stereotypes or implies a group is monolithic.

• • Instead of: "model minority," "articulate for his race"

• • Use: Be specific about individuals' achievements or contributions without linking them to racial stereotypes.

• Capitalization: Capitalize proper nouns for racial and ethnic groups (e.g., Black, White, Indigenous, Asian).
• Specificity: As mentioned, use specific terms when possible (e.g., "Japanese American" instead of just "Asian").
• "Person of Color" vs. "Colored Person": "Person of color" is widely accepted; "colored person" is outdated and offensive.

3. Disability

• People-First Language (re-emphasized): Crucial for respectful communication.

• • Instead of: "the disabled," "wheelchair-bound"

• • Use: "people with disabilities," "a person who uses a wheelchair"

• Avoid Victimizing Language:

• • Instead of: "suffers from," "afflicted with"

• • Use: "lives with," "has" (e.g., "a person who has Parkinson's disease")

• Focus on Ability:

• • Instead of: "confined to a wheelchair"

• • Use: "uses a wheelchair" (a wheelchair is a tool for mobility, not a confinement)

4. Age

• Avoid Ageist Terms:

• • Instead of: "the elderly," "seniors," "old people"

• • Use: "older adults," "older persons," "senior citizens" (if preferred in a specific context).

• Focus on Relevance: Only mention age if it's truly relevant to the discussion.

5. Socioeconomic Status

• Avoid Judgmental or Stigmatizing Terms:

• • Instead of: "the poor," "welfare recipients"

• • Use: "people experiencing poverty," "individuals receiving public assistance"

• Focus on Circumstances, Not Character: Avoid language that implies poverty is a moral failing.

6. Sexual Orientation and Gender Identity (SOGI)

• Respect Self-Identified Terms:

• • Instead of: "homosexual" (can be clinical or stigmatizing), "sexual preference"

• • Use: "gay," "lesbian," "bisexual," "queer," "sexual orientation"

• Pronouns: Always use an individual's self-identified pronouns. If unknown, use "they/them" or ask respectfully.
• Gender Identity vs. Sexual Orientation: Understand the distinction. Gender identity is one's internal sense of being male, female, both, neither, or somewhere else along the gender spectrum. Sexual orientation describes who one is attracted to.

• • Instead of: "transgendered"

• • Use: "transgender"

7. Religion/Belief System

• Avoid Assumptions: Do not assume someone's religious beliefs or lack thereof.
• General Terms: Use inclusive holiday greetings (e.g., "Happy Holidays" instead of "Merry Christmas" unless you know the person celebrates Christmas).
• Respect Diverse Practices: Be mindful of religious observances (e.g., dietary restrictions, prayer times).

Tips for Implementation

Incorporating inclusive language into your daily communication is an ongoing practice.

1. Educate Yourself: Stay informed about evolving terminology and best practices. Follow DEI thought leaders and organizations.
2. Listen and Learn: Pay attention to how people refer to themselves and others. When someone corrects your language, accept it gracefully and learn from it.
3. Pause Before You Speak/Write: Take a moment to consider if your words align with inclusive principles.
4. Embrace "I Don't Know": It's okay to admit you don't know the preferred term or pronoun. Politely ask, "What pronouns do you use?" or "How do you prefer to be addressed?"
5. Focus on Intent AND Impact: While good intentions are important, the impact of your words is what truly matters. If your words unintentionally cause harm, apologize and correct them.
6. Review Your Materials: Periodically review presentations, documents, website content, and internal communications for inclusive language.
7. Encourage Feedback: Create a safe space for colleagues and friends to provide feedback on your language use.
8. Be Patient (with yourself and others): Language habits take time to change. Celebrate progress and view mistakes as learning opportunities.

Conclusion

Inclusive language is a fundamental component of building truly diverse, equitable, and inclusive environments. It's not just about political correctness; it's about genuine respect, understanding, and creating spaces where every individual feels valued and empowered to contribute their authentic self.

By being mindful and intentional with our words, we contribute to a culture where everyone belongs. It's a continuous journey of learning, listening, and evolving our communication to reflect the rich tapestry of human experience.

Let's commit to using our words to build a more inclusive world, one conversation at a time.

Content developed from Inclusive Language in Education Seminar (April 2024) by Daphne Smith Marsh, PharmD, BC-ADM, CDCES. https://www.youtube.com/watch?v=IwFea2zssSU 

Additional References and Resources

Here are some valuable resources for further learning on inclusive language and DEI:

• APA Style Guide: Bias-Free Language Guidelines: The American Psychological Association (APA) provides comprehensive guidelines on inclusive and bias-free language, particularly useful for academic and professional writing.
• https://apastyle.apa.org/style-grammar-guidelines/bias-free-language
• The Diversity Style Guide (Center for Integration and Improvement of Journalism): A practical guide with an alphabetical listing of terms and detailed explanations, covering various aspects of diversity.
• https://www.diversitystyleguide.com/
• ACLU: Understanding LGBTQ+ Equality: Provides resources and definitions related to sexual orientation and gender identity.
• https://www.aclu.org/issues/lgbtq-rights/understanding-lgbtq-equality
• United Nations: Gender-inclusive language: Guidelines from the UN on how to use gender-inclusive language in all forms of communication.
• https://www.un.org/en/gender-inclusive-language/
• Purdue OWL: Inclusive Language: A useful resource for students and writers covering various aspects of inclusive language.
• https://owl.purdue.edu/owl/general_writing/academic_writing/establishing_arguments/inclusive_language.html