Words shape our understanding of the world around us. In public health, the power of our words can sway perceptions, public opinion, and consequently, policymaking and its effect on people’s health and well-being.
Public health is a wide, encompassing field. When the language we use lacks fairness and accuracy, it can obscure critical issues and exacerbate existing health inequities.
Recognizing this, Vital Strategies is developing a health equity language guide, identifying commonly used terms and phrases that should be avoided and offering essential principles for conversations about public health. This is a living document, growing and changing as we continue to reflect on language and keep up to date with the latest thinking on how our words can best embody our values.
This is the first part of our “Reimagining Language” series.
Here are five commonly used public health and development terms we’re ditching and the alternatives to use instead:
Use:
“Person with substance use disorder” or a “person who uses substances”
Ditch:
“Drug user” or “drug addict”
Why:
When writing about people with substance use disorder, the goal should be to recognize the whole person, rather than boiling their entire identity down to just one dimension. A term that is still commonly used today in discussions of substance use is “drug user,” which is often interchanged with “abuser” or “addict.” The way that a person is described is critical to mitigating stigma against them for their substance use. Some especially offensive terms–such as “druggie” or “junkie”–are obviously inflammatory and intended to denigrate, but other common terms such as “drug user,” “abuser” and “addict” can also be damaging. Portraying the person as a whole person with many dimensions who is deserving of support and treatment can influence equity and accessibility to resources and treatment.
Use:
“Crash” or “collision”
Ditch:
“Car accident”
Why:
The words that we use have the power to accurately tell stories about the communities we work with and calls attention to the root causes of health outcomes. Within the field of road safety, the use of inaccurate terminology has obscured the root causes of road crashes. The commonly used term for road crashes, “accident,” dehumanizes people involved, undermines the severity of the problem and deflects attention from the proven solutions that can prevent almost all crashes. Road crash injuries are a symptom of systemic issues—ranging from roads designed to prioritize moving cars over pedestrians to a lack of best-practice laws that help make roads safer. Framing crashes as isolated and beyond our control implies that there may not be a solution. Using the word “accident” conveys an undue sense of inevitability and leads the audience to interpret these events as unavoidable or the result of bad luck or destiny.
We should instead use the terms “crash” or “collision,” which not only highlight the human perspective of the issue, but also facilitates important policymaking that addresses road crashes as preventable.
Use:
Be as specific as possible when referencing a particular country or region
Ditch:
“Low- and middle-income countries”
Why:
Using overly generic language in public health unintentionally drives inequities and causes confusion about what you are actually referring to. “Low- and middle-income countries” is an overly generic phrase that continues to be widely used within public health and development, and it unfairly categorizes groups of people.Try to avoid this term unless you are very clearly referring to the groupings as described by the World Bank,such as in a study that analyzed something according to those categories, and note that the categories are updated each year. Don’t use it as a synonym or label for what have been alternatively, and often controversially, been called “developing” or “Third World” countries.
Instead, can you name a particular country or region you are referring to? Can you be more specific according to the context or topic? Is the designation needed at all? Rather than looking for an alternative that could also become an automatic label, think carefully about what you are really trying to express.
Use:
“Resident” or “people who live in [location]”
Ditch:
“Citizen”
Why:
The term “citizen” refers to people who belong to a specific country, which grants them certain rights based on their birth or legal status. In contrast, “resident” or “people living in [location]” encompasses anyone who resides in a particular area, regardless of their citizenship status. Using “citizen” can inadvertently exclude those who live in a location but do not have citizenship, making “resident” a more inclusive choice. By opting for these terms, we acknowledge the diverse populations that contribute to our communities. In addition, be intentional and accurate when referring to a group of people who live in a particular country: For example, “Black Americans” is not the same as “Black people who live in the United States.”
Use:
“Increased risk” or “more likely”
Ditch:
“Vulnerable Populations”
Why:
The term “vulnerable populations” is commonly used in public health as a broad label to describe groups assumed to have a status that negatively affects their well-being, suggesting they require protection because they cannot adequately safeguard themselves. This can be disempowering, implying that individuals or groups lack agency and are unable to care for themselves. It distracts from the multiple layers of marginalization that affect certain groups, preventing a nuanced understanding of who may benefit most from targeted policies or services. It also leaves room for the audience to fill in the blanks based on personal assumptions, which can reinforce stereotypes.
In many cases, the word “vulnerable” can be replaced with a term like “increased risk” or “more likely.” For instance, it is more accurate to say, “Children are at increased risk for lead poisoning because…” and give specific reasons, rather than labeling them as inherently vulnerable.
Discussing language is a learning exercise for all of us and the meaning of language evolves with history, current events and our greater understanding. This guide is a starting place, and it is possible, even likely, that we will not have total consensus on these terms. The words people use to discuss power, privilege, racism and oppression hold different meanings for different people. By beginning to scratch these top offenders of inequitable language in public health, we can work toward a more inclusive public health that prioritizes the human perspective over ongoing biases.
To read and download the full guide, visit: https://www.vitalstrategies.org/inclusive-language-in-health-guide/