What to know
The list below is a collection of terms and phrases that, depending on the context and situation, should be carefully considered before use. These terms can be used in global public health communication activities like scientific literature, web content, social media, interviews, reports, presentations, discussion with communities and colleagues, etc.
Overview
The terms below can be used to advance global health equity. Visit our index page to find a full list of terms.
Questions or feedback?
Adjectives like vulnerable, marginalized, and hard-to-reach
By themselves, the terms below are vague and can influence stigmatization by implying that the disease or situation is inherent to the person, rather than to causal factors.A It may still be appropriate to use these terms, but it is important to carefully choose how to use them.B
Instead of...
- Vulnerable, marginalized, disadvantaged, or high burden [groups].
- Hard-to-reach, underservedC, or underprivileged [communities].
- High-risk [groups/people/ population].
- At-risk [group].
- High burden [groups].
- Priority [population].
- In need or in despairD.
Try this...
- Ask people from the population/community how they wish to be addressed.
- Center the population.
- Add context that focuses on the systems in place.
- Explain the various factors of why and/or how some groups are more affected, vulnerable, or marginalized than others.
- Try to use specific language that explains the effect of systemic factors; "impact" and "burden" are vague.
Adapt the adjectives into person-first language and add context:
- [X, y] populations who are more vulnerable to [disease] outbreaks due to [Z factors].
- Groups that have been historically marginalized by not having access to [x resources, rights, opportunities].
- Groups that have been economically/socially marginalized.
- [X, y] groups experiencing marginalization in [Z society].
- Rural communities / communities living in [area/location] where routine service delivery or program implementation is challenging due to [x, y, z].
- Communities that are underserved or have limited access to [specific service/resource].
- People living with increased risk of [x] because of [y].
- People who are not equitably served by [public health programs, initiatives, infrastructure, systems].
- Groups experiencing disadvantage because of [reason].
- Groups who experience increased [health/social/legal/political] risk of [x, y, z].
- People who live/work in settings that put them at increased/higher risk of contracting [x] or exposure to hazards.
- Population of focus.
For scientific publications:
- Disproportionately affected groups.
- Groups experiencing disproportionate prevalence/rates of [condition].
- People [in x area / from x population] who are disproportionately affected by [x].
- Groups experiencing disproportionate risk of/ impact from [x].
Other considerations
- Under-resourced communities.
- Use only in the literal sense when an area lacks resources (e.g., clean water). Be specific about which resources are lacking.
- Use only in the literal sense when an area lacks resources (e.g., clean water). Be specific about which resources are lacking.
- Avoid referring to people only as acronymsE, such as MARPs for 'most at risk populations'; or IDPs for 'internally displaced people'; or PLHIV for 'people living with HIV'. Try to spell-out the full term/label as often as possible and use person-first language.
Developing vs. developed countries
Dichotomous terms overgeneralize diverse countries and reinforce an "us vs. them" mentality. These terms also carry unhelpful notes of superiority and inferiority, while reflecting painful histories of colonialism, neo-colonialism, slavery, and indentured servitude.F
Instead of...
- Developing and developed countries.
- First World and Third World.
- Global North and Global South.
- Resource-rich and resource poor settings.
Try this...
Name the specific country and populations you are referring to or name the broader geographic area.
- Try general regions, such as Southeast Asia, West Africa, North America, the Caribbean, Eastern Europe, etc.
- Try the African Union's Regional Economic Communities: the Maghreb, Eastern and Southern Africa, Sahel-Saharan States, East Africa, Central Africa, West Africa, Southern Africa
- These region names could be used instead of "sub-Saharan Africa," which has been criticized as inaccurate and generic.
- These region names could be used instead of "sub-Saharan Africa," which has been criticized as inaccurate and generic.
- Try the World Health Organization's regions: Africa, Americas, Eastern Mediterranean, Europe, South-East Asia, Western Pacific.
Although less preferable, broader alternatives include:
- Settings, areas, or regions with more/less access to resources (like running water, electricity, robust supply chains, healthcare, economic stability).G
- For example: Areas with less access to resources like clean water and sanitation systems are at a higher risk of water-borne diseases like cholera.
- For example: Areas with less access to resources like clean water and sanitation systems are at a higher risk of water-borne diseases like cholera.
- Partner countries.
- The World Bank's country groups organized by GNI per capitaH:
- Low-income countries (LICs).
- Lower-middle income countries (LMICs).
- Upper-middle income countries (UMICs).
- High-income countries (HICs).
- Low-income countries (LICs).
Ethnicity and race
Broad phrases related to ethnicity and race can miss important sub-groups of people who deserve recognition and visibility. If appropriate, communicators can be more specific to avoid generalizations and demonstrate respect for the unique sub-groups.
Instead of...
Try this...
Ask groups of people what their preferred name(s) and descriptors are.
As appropriate, be as specific as possible about the populations you are referring to and about who is disproportionately affected around the globe.
- [X] communities in [place] who are disproportionately affected by [public health issue].
- Communities in [country/region/locality] who experience [x,y,z] health disparities.
- [X health disparities] experienced by [population/community].
- People from [specific ethnic group(s)] in [specific neighborhood, province, country, or region].
- People from [specific group], who often experience racism/ discrimination/ marginalization.
- People from [specific group with common identity based on sex, gender, language, religion, etc.] in [specific location].
Framing of socio-political conflicts
Framings of socio-political conflict like the below can be interpreted as insensitive and judgmental, even if it is factual that a conflict is making public health work more difficult. From a government agency, this framing could also be seen as representative of the broader government's official stance and unintentionally increase diplomatic tension.
Instead of...
- Political strife has weakened systems.
- Civil unrest has hampered service delivery.
- Challenges in [location] stand in the way of [agency's] public health efforts.
Try this...
In situations where it is especially important to consider political and diplomatic ramifications of a government agency's communication, try to:
- Succinctly and factually describe the situation, challenges, and implications for public health.
- Exhibit a milder level of emotion and prioritize diplomacy when communicating in an official manner. For example:
- "The ongoing conflict in [area] has added to the challenges that [people from x population(s) of focus] face when [accessing treatment/coordinating emergency response, etc.]."
- "Due to the challenges associated with the current [x socio-political situation in x area], we find it is more difficult to travel to certain areas or conduct [x, y, z public health activities]."
- "The ongoing conflict in [area] has added to the challenges that [people from x population(s) of focus] face when [accessing treatment/coordinating emergency response, etc.]."
Global health security
Contextualize...
- Global health security
Try this...
When discussing 'global health security, clarify what it means. Consider pairing "global health security" with other terms such as:
- Public health system strengthening
- Strengthening capacity for:
- Disease surveillance.
- Laboratory systems.
- Workforce development.
- Emergency management and response.
- Public health informatics (i.e., systematic use of computer science and technology in public health practice, research, and learning).
- Disease surveillance.
Idioms and cultural references
When communicating cross-culturally, be cautious with idioms and cultural references, which may be irrelevant to the intended audience.L
Try this...
Idioms can be useful for tailoring scientific principles into interesting, relatable, and accessible plain language. However, these phrases and expressions must be linguistically and culturally relevant to the intended audience. Work with community members and partners who are familiar with the language and culture. Specifically, to identify relevant local idioms and cultural references.
If locally or culturally appropriate phrases and expressions cannot be identified, focus on using plain language to explain the concepts.
Income-related descriptors
Invoking poverty to support or validate assistance and aid can heighten savior and superiority complexes and position people/countries as being in need of perpetual help, which can hinder short and long-term independence.
Instead of...
- Poverty-stricken.
- The poor.
- Poor people.
Try...
Use person-first language and specify who you are referring to:
- People with lower income.
- People/households with incomes below the national poverty level.
- People with self-reported income in the lowest income bracket (if defined).
- People experiencing poverty in [locality].
"People with lower socioeconomic status" should only be used when this is defined. For example, when income, education, parental education, and occupation are used as a measure of socioeconomic status.
Migrants, refugees, and displaced populations
The terms below lack nuance to describe the different reasons different people move across borders. Try to bring more precision into descriptions of migrants, refugees, and displaced populations.
Instead of...
- Mixed migrant or mixed migration.
- Boat migrants.
- Illegals.M
- Forced migrant or forced migration.N
- Illegal migrants, Illegal immigrants, or Illegal aliens.
- Foreigners or 'the foreign-born'.
Avoid labeling a large group of people with unknown/unclear reasons for moving solely as "refugees" or solely as "migrants."O
Avoid referring to people only as acronyms (e.g., IDPs for "internally displaced persons").E
Try this...
Use specific terms, as defined by the UN International Organization for Migration:
- Immigrant or people who are immigrating to [country].
- Migrant or people who are migrating from [x to y].
- Refugee or refugee populations.
- Asylee or asylum-seeker or people who are seeking asylum.
- Internally displaced persons or people who are internally displaced.
For groups (such as refugees) who are migrating due to war, violence, persecution, and human rights violations, try:
- Forced displacement.
- People who are forcefully displaced.
For groups of people in which individuals are moving for mixed or unclear reasons:
- Refugees and migrants.P
- Mobile populations.
- People with undocumented status.
Seasons or holidays
Not all seasons or holidays are experienced/celebrated around the world. It is U.S.-centric to only describe time periods as based on North American winter, spring, summer, and fall or popular U.S. holidays like Thanksgiving or Christmas.
Instead of...
- Using seasons or holidays to specify time periods.
Try this...
- Use specific months or days according to the local calendar and culture.
Slum
"Slum" and local language equivalents are generalizations are generalizations that often carry negative or deprecatory connotations. Such terms can also foster stigmatization of people who live in "slums." However, this term may not have negative connotations in every country or language and could simply refer to low-quality or informal housing.
Instead of...
"Slum" or similar terms with negative connotations in other languages, such as:
- Aashwa'i' (Arabic; Egypt).
- Favela (Portuguese; Brazil).
- Similar terms in other languages in the UN's 2003 Global Report on Human Settlements.
Try this...
- Informal settlements (definition).
- Informal urban settlement.
- Settlements with inadequate housing (definition).
- People living in informal urban settlements.
- People without access to adequate housing.
Consider mentioning common characteristics of informal urban settlements such as a lack of:
- Access to an improved water source or sanitation facilities.
- Sufficient living area.
- Housing durability.
- Security of tenure.Q
Terms related to sex workers
UNAIDS defines sex workers as "female, male, and transgender adults and young people (ages 18-24) who receive money or goods in exchange for sexual services, either regularly or occasionally."
Instead of...
- Prostitutes.
- Other slang terms.
Try this...
When referring to adults, use:
- Sex worker.R
- Try to specify whether sex workers are female, male, transgender, etc. This avoids the assumption that only women are sex workers.
- Try to specify whether sex workers are female, male, transgender, etc. This avoids the assumption that only women are sex workers.
- Person who sells sex.
- Person who exchanges sex for money, goods, or services.
When referring to people who are trafficked into sex workS, try:
- People who are trafficked for sexual exploitation.
- Adults who are sexually exploited.
- People who are coerced into selling sex.
When referring to childrenT, use:
- Children who are sexually exploited.
- Sexual exploitation of children.
- Children who have been sexually trafficked.
- Children who are/have been trafficked for sexual exploitation.
Tropical, missionary, colonial, and Eastern/Western medicine
Some historically loaded terms like the below portray or frame global public health with a western-centric worldview. This can lead to attitudes and beliefs that judge non-European or non-U.S. worldviews, approaches, or standards as peculiar or inferior.
Instead of...
- Tropical medicine.
- Missionary medicine.
- Colonial medicine.
- Eastern/Western medicine.U
- International health.V
Try this...
When referring to public health work that occurs globally and has the potential to impact populations (e.g., strengthening disease surveillance systems), try:
- Global public health.
- Public health on a global scale.
When discussing global public health with local partners or referring to public health work in another country, try:
- Public health.
- Public health in [x country/region].
Instead of "Eastern/Western medicine," try:
Violent connotations
Words and framing with violent connotation risk militaristic connotation and can perpetuate power imbalances by conveying non-participatory, top-down approaches.
Instead of...
- Target communities for interventions.
- Target population.
- Target audience.
- Tackle issues within the community.
- Aimed at communities.
Try this...
- Engage/prioritize/partner with/serve [population of focus].
- Consider the needs and wants of [population of focus].
- Tailor to the needs and wants of [population of focus].
- Communities/populations of focus.
- Intended audience.
- Prevent/control transmission of [x disease].
- Eliminate or eradicate [issue/disease].AA
War and military metaphors
Metaphors are helpful when communicating technical information but should be used carefully since no metaphor perfectly applies to everything. War and military metaphors are not inherently negativeAB, but they do exude an air of temporarily "parachuting" into a "developing nation" to "save people." These metaphors can also inflame painful memories and distrust if a country has previously engaged in military combat in an area where they are now engaging in public health activities.
Instead of...
- On the ground or boots on the ground.
- Ground zero or on the frontlines.
- Combat [disease] or War against [disease].
- Battle/battling [disease].
- Fight against [disease].
- Winning or losing the war/battle/fight.
- Enemy [pathogen/ disease].
Try this...
Examine local, historical, and situational context to determine which metaphor is most appropriate: journey, fire, or other, or none.
Consider fire metaphors:
- "[Disease] is like a fire burning in a forest. All of us are trees. The contagiousness of the disease is the wind speed. The higher it is, the faster the fire tears through the forest."
- "A few fire lines – [x and y mitigation measures]—keep the fire from hitting all the trees."
Consider journey metaphors:
- "We are not over the mountain-top yet."
- "Progress in controlling the spread of [x disease] is a marathon, not a sprint."
When describing a location where an agency has long-term presence, programs, and collaboration, be specific about the location/public health issue. For example:
- In [community/country/region/city] where [agency] works to address [public health issue].
When an agency is temporarily traveling to a location to respond to an emergency, consider using:
- In [location], where cases were first identified.
- In [location], where [x disease] is spreading rapidly.
- In [location], where the [natural disaster] caused the most damage and loss of life.
- Adjectives like vulnerable, marginalized, hard-to-reach: By themselves, these terms are vague and can influence stigmatization by implying that the disease/situation is inherent to the person, rather than to causal factors. These terms can also be received as condescending and imply that some people need someone else to ‘save them’. These terms have evolved into euphemisms for low-income communities, communities of color, and communities in particular geographies.
- Adjectives like vulnerable, marginalized, hard-to-reach: The intent is not to say "never use these words"; the intent is to carefully choose how these words are used. It may still be appropriate to use these terms to say that immunocompromised populations are especially 'vulnerable' to an infectious disease outbreak, or that a group was put 'at risk' by researchers through errors or mistreatment.
- Underserved: This term relates to limited access to services that are accessible, acceptable, and affordable, including healthcare. Do not use ‘underserved ’when you really mean ‘disproportionately affected.’
- In despair: Invoking desperation to support or validate assistance and aid heightens savior and superiority complexes and stigmatizes people as being in need of perpetual help. This can hinder the actualization of short-term and long-term independence.
- Using acronyms for people: Referring to people only as acronyms can be dehumanizing in that ‘IDPs’ or ‘MARPs’ or ‘PLHIV’ become viewed as objects instead of people. Although word/character limits may exist, spell-out the full term/label as often as possible and use person-first language.
- Developing country, developed country, first world country, third world country, global north, global south, resource-rich, and resource poor settings: 1) These terms reflect painful images and recent histories of colonialism, neo-colonialism, slavery, and indentured servitude. Although language and terminology may change, it remains important to remember and learn from history so that injustices are not repeated. 2) Dichotomous terms such as 'developing/developed country' overgeneralize diverse countries and establish an 'us vs. them' mentality. These terms also have unhelpful connotations of superiority/inferiority, and can imply that a country is incomplete, according to a U.S. or European-centric view. 3) Inaccurate dichotomies of 'first vs. third' and 'north vs. south' imply geographic determinism. However, countries south of the equator are not 'destined to have low-income economies' and countries north of the equator are not 'destined to have high-income economies.'
- "Settings/areas/regions with more/less access to resources" can serve as a reminder that areas with limited resources exist everywhere, not only in "other countries."
- LIC, LMIC, UMIC, HIC, and "countries with more/less resources" are improvements but are still not perfect since they continue to impose hierarchy between countries.
- Global Minority: As often used in the global context, ‘global minority’ is an inaccurate framing of health disparities because it clusters billions of people living in LMICs as one minority, irrespective of diverse subpopulations. This use also tends to center populations from high-income nations as normative. For example, avoid, "The global minority is disproportionately affected by COVID-19." Instead, try, "Globally, populations such as the [x communities] in [x region/country/province] are disproportionately affected by COVID-19."
- Minorities/Minority Groups: As used in socially constructed racial categories in North America, ‘minority’ centers Whiteness as normative. In the global context, ‘minority’ is often used to imply ‘global populations who are not White’, which perpetuates racial hierarchy and privilege. Domestically and globally, avoid centering any one race as normative.
- Race: Not all countries and cultures implement the same level of racial categorization. Considerable pushback can arise when racial categories are used in ways that are inappropriate to the local culture and context.
- Idioms: North American idioms such as “hit a homerun” or “hit it out of the park” (i.e., perform exceptionally well, succeed) are culturally irrelevant to people who are not familiar with baseball. Similarly, ‘silver bullet’ (i.e., a seemingly magical solution to a complicated problem) is likely irrelevant to non-English speakers in general. Even with translation, these concepts will not translate well across languages and cultures and will require more explanation than if the message was stated without idiomatic expressions.
- 'lllegal' implies criminal behavior, suggests that people crossing borders have no rights, and can reinforce prejudices against migrants and refugees.
- ‘Forced migration/migrant’ and ‘mixed migration/migrant’ are sometimes used to describe movements in which the reasons or individuals’ status are unknown or mixed. These terms can cause confusion and obscure the specific needs and legal rights of refugees and migrants.
- ‘Refugee’ and ‘migrant’ are often used interchangeably (i.e., only referring to a group as ‘refugees’ or only as ‘migrants’), which obscures key legal differences between them. Confusion in the use and understanding of these terms can impact the lives and safety of refugees and asylum-seekers. Under international law, refugees who leave their homes are entitled to a range of legal protections and aid that migrants are not. Lack of nuance can also undermine public support and success of government efforts to respond to refugee and migrant population movements.
- ‘Refugees and migrants’, while still broad, acknowledges the different reasons people in large groups have for moving.
- Security of tenure: Documentation showing legal protection against forced eviction.
- ‘Sex worker’ is intended to be non-judgmental and focuses on the working conditions under which sexual services are sold.
- People trafficked into sex work: There is a distinction between people who are sex workers by choice and people who are sex workers due to force, fraud, or coercion (i.e., sex trafficking).
- Children are not considered sex workers. Children are considered victims of sexual exploitation.
- Eastern/Western Medicine: These terms oversimplify the diversity of medical practices/beliefs/systems that exist around the world. Use of the Western vs. Eastern dichotomy can also reinforce the dynamic of ‘Western’ professionals approaching public health and medicine with top-down methods that lack cultural humility/responsiveness and community engagement.
- International health: Tends to focus on high-income countries 'helping other nations' with low- and middle-income economies. Instead, 'global public health' may help focus attention on interdisciplinary global cooperation that strives for global health equity across the world and for all people. With this framing, global public health encompasses cross-border and domestic health issues, which is crucial in a globalized world where the health of one nation can impact the health of all nations. See additional commentary from Koplan et al. (2009): Towards a Common Definition of Global Health
- Conventional medicine: Healthcare professionals like doctors, nurses, and pharmacists treat symptoms and disease.
- Traditional medicine: Per the WHO, traditional medicine has a long history. It is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.
- Complementary medicine: Per the WHO, the terms “complementary medicine” or “alternative medicine” refer to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system. They are used interchangeably with traditional medicine in some countries.
- "Traditional and complementary medicine" encompasses the products, practices and practitioners of traditional and complementary medicine.
- Eliminate or eradicate: Be aware that epidemiological terms like "eliminate" or "eradicate" can sometimes be interpreted with violent connotations.
- War and military metaphors. PROS: These metaphors can be easily understood; raise general awareness of an interest in important public health issues; increase perception of issues as serious and urgent; justify the need an increase willingness to modify behavior; enhance morale and unity of those "fighting the disease." CONS: These metaphors can be counterproductive by increasing fatalism; stigmatize and place blame on anyone who ‘loses the fight’; influence unhelpful aggressive attitudes and unethical action for the sake of ‘winning the battle’; shift the emphasis away from the population of focus to the actions of external actors and can overlook personal experience and emotion for sake of ‘maintaining the fight’; culturally inappropriate among cultures that prioritize peace and coexistence with nature.