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 second part of our “Reimagining Language” series. You can find part one here.
Here are a few commonly used public health and development terms we’re ditching and the alternatives to use instead:
Use:
“Drink driving,” “driving while impaired” or “driving under the influence” (DUI)
Ditch:
“Drunk driving”
Why:
The term “drunk driving” is used in many places, especially in the United States, to refer to describe the act of driving with blood alcohol levels above the legal limit, or, vaguely, driving after having consumed “too much” alcohol. This language implies that there may only be heightened risk of a crash with very high blood alcohol levels. However, risk of a crash increases even if the driver has consumed a small amount of alcohol, even if the person’s blood alcohol level is not above the limit set by law. Driving after consuming any alcohol is a harmful behavior, but using the word “drunk” implies a certain, subjective level of impairment. The language we use in discussions of alcohol should reflect that driving with any level of alcohol should be considered harmful. “Drink driving,” “driving while impaired,” or “driving under the influence” (DUI) are all acceptable terms that better portray various blood alcohol levels.
Use:
“Historically and intentionally excluded” or “disinvested”
Ditch:
“Disadvantaged,” “under-resourced” or “under-served”
Why:
The term “disadvantaged,” which is commonly interchanged with “under-resourced,” “under-served” and similar terms, should be used with caution and consideration. “Disadvantaged” has been used for many decades and is now widely viewed as supporting a deficit-based, rather than asset-based, model of people and communities. Many people find the term pejorative, and it has been used as an implicit descriptor for minoritized and historically marginalized communities. In some circumstances, “under-resourced” and “under-served” are used—both terms begin to describe the historical disinvestment experienced by some communities—but these terms have also been critiqued, as some communities are “overserved,” with services and resources that are not working or lack coordination. At the same time, “disadvantaged” is still sometimes used to describe processes of exclusion, recognizing that there are dimensions beyond resourcing and service receipt that are not necessarily well captured by “under-resourced” or “under-served.” We should instead use terms such as “historically and intentionally excluded” or “disinvested.”
Use:
“Equip,” “inform” or “promote autonomy”
Ditch:
“Empower”
Why:
Avoid using the term “empower” or “empowerment” to describe interventions or groups of people in conversations about public health and development. “Empowerment” typically refers to giving power or authority to someone to do something. The term can be paternalistic: The language of empowerment implies that someone else is granting power or authority to another person, as if the person being empowered is not capable of making their own decisions. When one group is portrayed as empowering another, it can reinforce existing power imbalances and perpetuate systems of oppression.
In contrast, “promote autonomy” implies self-determination. By focusing on promoting autonomy, nonprofits and health experts can help individuals and communities to take ownership of their own lives and make decisions that are in their own best interests. In addition, verbs such as “equip” or “inform” can be used to demonstrate more specific examples of how people are empowered. This language can lead to more sustainable change while avoiding exacerbating harmful power dynamics.
Use:
Person-first language such as “people who are homeless or unhoused,” “people who use drugs” or “people who smoke”
Ditch:
“The homeless,” “drug user,” “smoker” or “drug user”
Why:
It’s important to use person-first language to communicate with respect and understanding, centering the person rather than reducing them to a label or a specific behavior. This approach acknowledges the person’s humanity first, helping to foster a more compassionate and informed dialogue. By framing it this way, we can combat stigma, acknowledge that people have many identities and characteristics, and promote a greater understanding of the challenges people face.
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 that we will not have total consensus. 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/