The Battle Against Cancer Metaphors: A Case for People-First Language

“Please stop calling me brave.”

I wrote that in a Facebook post in the fall of 2019, after I’d been diagnosed with late-stage colorectal cancer. I didn’t mean it as an admonishment. Friends and family from across the globe had reached out, sent gifts, and generally showered me with more love and support than I ever expected. But some people called me brave, others reminded me that I’m a fighter, a survivor. I saw this echoed by members of online and in-person support groups I’d joined. Even my dentist told me that she was a cancer survivor and, soon, I would be, too! We were Cancer Warriors and we would win this battle!

The truth is this kind of language makes me very uncomfortable.

For some people, underscoring their strength and resilience helps them in the dark moments, when it feels like the treatment is worse than the disease. Focusing on all that we have to live for—to fight for—can make it easier to endure the myriad indignities of testing, prodding, and poking that are inherent in cancer care. But for some of us, framing the disease experience using violent fight language leaves little room for nuance and raises more questions. Are people who have hit five years with no evidence of disease somehow better warriors than those who don’t? If my treatment doesn’t work, does that mean I’m weak or didn’t fight hard enough? If I die, am I less worthy of being remembered as a strong person, a role model, or a good friend?

Cancer is a complex set of diseases, and different people living with it have different preferences for how to describe themselves. I prefer people-first language that emphasizes me over my disease. Phrases like person with cancer versus cancer warrior highlight humanity over condition and hold space for the person involved to be more than one thing. It also allows the person to have multiple feelings about their cancer as things change over time. A year and a half after my initial diagnosis, my feelings have only become more nuanced and complicated; saying I’m “fighting” cancer reduces my experience to the days I have treatment or the drugs I take, rather than encompassing the whole of my emotions, struggles, and accomplishments.

As marketers in the health space, this presents an interesting challenge: How do we reach our target audience without inadvertently alienating a segment of it by using language some appreciate but others don’t? We do what we always strive to do: We listen. It’s important to remember that knowing your audience is one thing; listening to your audience is another. Do we hear people with cancer using these metaphors when they talk with one another? Do oncologists and clinicians use these metaphors? Or do we mainly hear them used in the mainstream media or among the general public? It is our responsibility as communicators to actively listen and take our cues from the audiences we are wanting to inform, educate, and empower.

I find myself in the role of both health communicator and target audience. It’s a surreal place to be sometimes, but it also offers me an opportunity—an opportunity to inform the way we communicate with people with cancer, by improving the way we listen. People-first communication requires intentionality and action. As health communicators it’s time we listen to understand and then incorporate what we hear. In the simplest terms, there are three steps to incorporating a people-first approach:

  • Listen to the patient audience—actively and with the intent to understand;
  • Value their experiences and their perspectives—as they are shared, not necessarily as you assume them to be; and
  • Reflect those learnings in your messaging and outreach.

I value being heard as a person with cancer. And I value the opportunity to bring that experience to my work as a health communicator by both incorporating and promoting messages that put people first.

Allyson Harkey
Digital Content Strategist

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See how Hager Sharp is getting out the vote

Over the last few weeks, we’ve seen an unprecedented number of Americans cast early ballots—by mail, by drop-off box, and by waiting in long lines to vote in person. A week before Election Day, 75 million Americans had already voted and that number continued to rise, with more than 93 million casting votes by the eve of the election.

At Hager Sharp, we believe voting is crucial, regardless of political party. It ensures all our voices are heard, all our viewpoints are represented, and all our elected officials meet the needs of our communities. We also believe that voting should be easy. Every American should have access to plain-language information, alternative means of voting, polling facilities, and reliable transportation.

That’s why many members of the Hager Sharp team have spent the last few months volunteering their time to get out the vote. In total, we’ve dedicated over 250 hours to increasing voter participation, defending voter rights, and ensuring a fair election. We’ve supported organizations such as Vote Forward, MomsRising, Reclaim Our Vote, Fair Fight, Election Protection, and others by writing nearly 700 letters and postcards, sending hundreds of texts, and making dozens of phone calls to voters. We’ve also worked with our local election boards and precincts across the District of Columbia, Georgia, Maryland, and North Carolina to serve as election judges, poll greeters, and poll watchers.

Hager Sharp is incredibly proud of our team’s dedication and is committed to reducing work-related barriers so our staff can not only support these efforts, but also have the opportunity to cast their own votes. As staff have volunteered their time, we’ve encouraged them to use Hager Hours (company-paid volunteer hours for each employee, provided annually), and we’ve also encouraged staff to use Hager Hours or flextime so they can get to the polls at a convenient time, without worrying about their workload or other personal responsibilities.

All of these efforts are one of the many ways we turn ideas that make a difference into actions that matter—and on the eve of this important Election Day, we are hopeful that our team’s efforts have made a positive impact on voter turnout so that each American’s voice is heard and every American’s vote is counted.

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Hager Sharp’s Commitment to Racial Equity

At Hager Sharp, we are devastated and outraged over the murders of George Floyd, Breonna Taylor, Ahmaud Arbery, Rayshard Brooks, Kathryn Johnston, Trayvon Martin, Tamir Rice, Michael Brown, Tony McDade, Stephon Clark, Eric Garner, Philando Castile, and countless others. These murders highlight the systemic racism that exists in our country—racism that has been allowed to permeate and take root for centuries. It is way past time for it to end.

Our agency is dedicated to providing marketing and communications support to organizations committed to making meaningful change in the world. Central to the fulfillment of this mission, we are committed to ensuring inclusion, diversity, equity and access within our agency and to supporting these ideals within our clients’ organizations and within our industry and community. We expect the same from organizations with whom we partner.

Our commitment is baked into our vision and values. We embrace diversity, equity and inclusion. We believe our work is better when we include and reflect multiple voices and perspectives. We seek to recruit and retain a team that represents and reflects the many dimensions of diversity: gender, race, ethnicity, age, sexual orientation, veteran status, disability, medical condition, culture, relationship status, interests, heritage, work background, educational background, religion, and more.

In 2018 we determined we could do even better. We took it upon ourselves to look inwardly and improve how we live our core values. After an internal survey and small group discussions, we realized that we needed to do more, in particular, in support of our Black colleagues. Thus began the development of a formal Inclusion, Diversity, Equity and Access Strategic Plan wherein we established specific objectives, strategies, activities, and metrics to hold ourselves accountable to maintaining and enhancing our diverse and inclusive company culture.

With guidance and support from an outside consultant, regular internal conversations specifically around the topics of equity, access and inclusion, formal professional training for managers, and workshops for all staff occurred over the following months. While we are proud of the progress we have made through this program, we know there is more to do.

Over the last few weeks we’ve been working together to identify the specific action steps we can take as a company to be even more deliberate in our stand against racism and for inclusion, diversity, equity, and access. As part of that process, we have taken time as a team to reflect, to listen, to understand, to talk, to cry, and, most importantly, to determine how we can do better.

Today we pledge our commitment to driving meaningful change. We know words are shallow if not backed by substance. The concrete actions we will take include:

  • Forming a taskforce that will meet weekly to discuss and implement ongoing plans
  • Granting all Hager Sharpers a day off in June to support their mental and emotional well-being and provide time for education, volunteering, or taking anti-racism action
  • Creating a space for open forums on racism, including holding monthly town hall discussions with all staff to continue to share experiences and ideas, increase our awareness and understanding, and foster open communication
  • Steadily increasing the percentage of our staff who are people of color, especially those who are Black and Hispanic/Latino
  • Investing additional funds for recruiting to ensure a diverse pool of candidates for every position for which we are hiring
  • Creating a formal mentoring program led by Hager Sharp leaders (VP and above, cross practice) to ensure that all Hager Sharpers of color benefit from professional development and career coaching, have equal advancement opportunities, and stay and grow at Hager Sharp
  • Reviewing our promotion criteria and establishing clearer career paths for all employees
  • Continuing our IDEA training initiative, led and facilitated by our external consultant, with trainings on inclusive behaviors for leaders and cultural competency workshops to motivate the use of inclusive language and help staff recognize identify and mitigate unconscious bias
  • Conducting an audit of our spending with vendors and establishing a specific goal to increase the percentage of our vendor dollars spent with Black- and Hispanic/Latino-owned companies
  • Developing a resource list/library of books, podcasts, videos, etc. that shine a light on racism, and regularly choosing such books for Hager Sharp’s book club
  • Expanding our Education, Labor, and Economy practice to include work dedicated to racial justice and other forms of social justice
  • Expanding the work in our Health practice to tackle healthcare equity, access, and discrimination faced by people of color
  • Identifying and exploring opportunities to focus our existing Hager Hours program (company-paid volunteer hours for each employee, provided annually) on initiatives that directly impact local communities of color through service

Some of these actions are already completed or underway; others will begin immediately, with specific action plans developed for each. As we accomplish these actions we will expand our efforts into new areas that have an outward impact beyond our company. We are actively developing a detailed strategic plan to tackle this issue, approaching it with the same diligence and rigor with which we approach our clients’ challenges. As a company that rejects racism and stands in support of our Black employees, Black clients, and the entire Black community, we are committed to implementing these action steps so we can achieve greater diversity and true equality throughout our agency, our industry, our communities, and our country.

I am profoundly grateful for our task force and the commitment of our entire staff to this effort. We know this is a journey. As long as I am leading Hager Sharp, ensuring that we make forward progress on this journey – to achieve true inclusion, diversity, equity, and access – will be a top priority of mine. This I promise.

Jennifer Wayman, MHS
President & CEO

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Life in a Pandemic: How Coronavirus Can Change Our Approach to Public Health

If you’re anything like me, you’ve been thinking about the coronavirus (or COVID-19) pandemic almost constantly.

Though we’ve experienced outbreaks and other public health emergencies in the past (like Ebola, Zika, and the swine flu, to name a few), this outbreak is arguably having more of an impact on Americans’ daily behaviors and lifestyle than any public health emergency in recent memory. Life as we know it is being upended to contain and mitigate the spread of COVID-19: Millions of children are out of school; employees are working remotely; public transportation systems are cutting back on service; public gatherings are being cancelled daily; gyms, bars, restaurants, and movie theaters are closing; and more.

And, while local, state, and federal governments are taking drastic (but necessary) measures, we as individuals are also taking simple, easy-to-implement steps to protect our communities. For example, we are increasing the length and frequency of our handwashing and are bumping elbows in lieu of handshakes. These are all part of regular, common sense preventive behaviors that public health educators have been communicating to people for years.

So, this has me thinking: What is it about coronavirus that has driven these changes, and what can we learn to make sure people continue practicing these common-sense preventive behaviors post-COVID-19?

Rapidly evolving risk perception. We’ve learned from our research on behalf of numerous health clients that a person’s perception of risk—including whether they think they are susceptible to a disease or condition and whether they believe the consequences are severe—is crucial to his or her adoption of preventive behaviors. This explains why the uptake of handwashing, staying at home when feeling sick, and other behaviors aimed at preventing coronavirus were slow to start: Initial reports suggested that only 16 percent of coronavirus cases were considered severe, and very few cases of coronavirus were identified in the U.S. during the initial weeks of the outbreak.[1] So, with a limited spread in the U.S., individuals had little reason or incentive to change their behavior: “Coronavirus is not severe, nor is it spreading in the U.S., so I am not at risk.”

However, as coronavirus hit closer to home, people began to take it more seriously and began to change their behavior. But it wasn’t necessarily one’s own risk perception that was driving the behavior change. As we’ve come to more fully understand the impact of coronavirus, we’ve learned that it doesn’t impact young, healthy people the same way it impacts older adults or those with underlying health conditions, like heart disease, lung disease, or diabetes.[2] Because of this, so many people I’ve talked to, especially my millennial peers, aren’t concerned with contracting coronavirus themselves. But they do worry about infecting others, whether it’s passing it along to a co-worker who recently completed chemo treatments or their aging grandmother. It is this concern about protecting those we care about that has driven individuals to practice preventive behaviors, like social distancing.

We’re also seeing our leaders leverage this concern. In a recent news conference, Washington Governor Jay Inslee said the penalties for not practicing social distancing are that “you might be killing your grandfather if you don’t do it.”[3] And in a recent White House press conference, Dr. Deborah Birx, the White House coronavirus response coordinator, specifically called on millennials to follow her team’s recently-released guidelines. In a follow-up interview on CBS News, when asked whether we could stop coronavirus by following the guidelines, she said, “This is a road map to prevent your grandmother from getting sick. This is a road map to prevent your grandmother from having to be hospitalized, or your grandfather. This is a road map of what everyone can do today to really protect the people who have been on cancer treatments, to really ensure that they can survive through this epidemic.”[4] Though difficult to hear, the sentiment is one that Americans have embraced: “This disease might not hurt me, but it can hurt my loved ones, and it’s up to all of us to protect each other.”

In addition to our desire to protect our loved ones, the exponential spread of COVID-19 over the last few weeks (and even days) is further driving people’s preventive behaviors, particularly as the virus has spread to those we know and respect. Relatively young, healthy, and prominent people have contracted the virus, forcing us to face the reality of the pandemic: Tom Hanks; Rita Wilson; Idris Elba; several NBA basketball players, including Utah Jazz center Rudy Gobert and Brooklyn Nets forward Kevin Durant; Sophie Gregoire Trudeau, the wife of Canadian Prime Minister Justin Trudeau; and I’m sure several other notables by the time this is posted. The spread of coronavirus across the country—and to people whose names we know—makes the virus a reality: “If people I know and respect are at risk of getting it, then I’m at risk of getting it, too.”

Altruistic tendencies. Part of our preventive behaviors around coronavirus are driven by our perception of risk, but they are also driven by our internal, altruistic motivation to act. Sometimes people are just genuinely inclined—and perhaps even eager—to do their part to end this pandemic. For example, many people have willingly taken on the burden of inconvenience by cancelling vacation plans or opting to eat at home instead of at a restaurant (when it’s an option) so that they can protect others in their communities. And it is truly admirable to see the willingness of many to embrace inconvenient alternatives for the sake of others.

Changing social norms. In addition to evolving risk perception, and perhaps even more so than altruistic tendencies, rapidly changing social norms—both at the institutional and individual level—have motivated social distancing in communities across the U.S. For example, just a couple of weeks ago it was unfathomable that mass sporting events, like the NCAA basketball tournament, the Masters tournament, or Major League Baseball opening weekend, would be cancelled. Yet, as soon as a few leagues began cancelling events, the dominos quickly fell. Certainly, these institutions want to keep people healthy and safe, but they also want to show that they are doing their part, just like their peers.

The same applies at the individual level. While many gyms across the country have closed either voluntarily or by mandate, my gym in North Carolina is still open. I’d still love to go to maintain a somewhat regular routine as well as my physical and mental health, but I have chosen not to. In this current climate, social norms dictate preventive behaviors, so I fear that others will judge me for going. After all, running on the treadmill next to someone isn’t exactly social distancing. I want to practice social distancing because I know the enormous benefit that can come from it, but admittedly, that is not the only reason why I’m avoiding the gym these days. Even though I know the benefits of preventive behaviors, I want others to perceive that I am doing my part to stop the spread of coronavirus in our community—and I think that sentiment speaks to many of us. Social distancing—perhaps to an extent initially driven by fear of judgement—has now become a social norm that people have embraced.

So, is there a silver lining to all of this?

While this outbreak is difficult to deal with and is going to have significant economic, social, and emotional ramifications (and more), it is laying the foundation for long-term behavior change. It’s clear that we don’t want to be in this situation ever again—and I believe that because of that, we will continue to be more committed to preventive health behaviors, like washing our hands for 20 seconds (not just when we use the restroom), avoiding touching our faces, and staying home and keeping our distance from others when we are sick. And whether we started engaging in those behaviors because of our perceived risk perception, our altruistic tendencies, or the impact of social norms, what’s important is that these behaviors stick so that we have an impact on future public health efforts and make a lasting difference in our world.

Laura Koehler, MPH, CHES
Account Supervisor





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