Global Terminology Considerations
The list below is a collection of terms and phrases that, depending on the context and situation, should be carefully considered before use in global public health communication activities (e.g., scientific literature, web content, social media, interviews, reports, presentations, discussion with communities and colleagues, etc.).
- The primary goals of the list below are to foster reflection/understanding on why some terms need reevaluation and to provide recommendations on how terminology could shift to further promote equity. Be cautious not to simply replace terms with new ones that lack current stigma but could be just as harmful/vague/inaccurate as the original.
- The list below is English-specific and is neither comprehensive, nor final. Not all recommendations are applicable to every situation/context across the world. This resource is a useful starting point, but it is critical to engage varying levels of community members to localize/tailor all considerations presented below.
- The considerations below are not universally agreed upon or embraced. Thus, the below is not a style guide. The considerations below are intended to prompt discussion and reflection, raise awareness, and offer recommendations while language, terminology, and cultures continue to evolve. Avoid shaming colleagues and partners when engaging in discussion of terminology. Prioritize diplomatic discussion about why some terminology is more/less appropriate, depending on the context.
Additional terminology resources:
- CDC’s Health Equity Guiding Principles for Inclusive Communication for additional considerations that can be adapted globally, including considerations about disability, drug and substance use, homelessness, mental health, older adults, sexual orientation, and gender identity.
- CDC’s Stigma Language Guide for considerations for communication about HIV.
- CDC’s Emerging Infectious Diseases Journal Preferred Usage lists preferred usage of terms in scientific writing.
Instead of generalizations, homogenization, and dichotomies such as:
- Developing and developed countries
- First World and Third World
- Global North and Global South
- Resource-rich and resource poor settings
As much as possible, name the specific country(ies) and populations you are referring to.
In situations where it is inappropriate to name the specific country, consider naming the broader geographic area such as: Southeast Asia, West Africa, North America, the Caribbean, etc.
- Note, however, that the term ‘sub-Saharan Africa’ is sometimes criticized as inaccurate and generic. As language continues to evolve, consider using the African Union’s Regional Economic Communities (REC’s): the Maghreb, Eastern and Southern Africa, Sahel-Saharan States, East Africa, Central Africa, West Africa, and Southern Africa.
- 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.
- 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.
- 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.’
Although less preferable, in recognition that some situations may require broad terms, use:
- Settings/areas/regions with more/less access to [resources like running water, electricity, robust supply chains, healthcare, economic, etc.].
- Note: This framing can serve as a reminder that areas with limited resources exist everywhere, not only in ‘other countries’.
- Partner countries
- The World Bank’s country groups organized by GNI per capita:
- Low-income countries (LICs)
- Lower-middle income countries (LMICs)
- Upper-middle income countries (UMICs)
- High-income countries (HICs)
Note: LIC, LMIC, UMIC, HIC, and ‘countries with more/less resources’ are improvements but are still not perfect as they continue to impose hierarchy between countries.
Instead of broad phrases such as:
- “Global minority”
- “Minority groups”
- “Ethnic groups”
- “Racial groups”
- “Disability groups”
Also, when communicating cross-culturally, exercise caution when discussing socially constructed ‘race’ and racial categories.
Remember to ask groups of people what their preferred name(s) and descriptors are.
Be as specific as possible about the populations you are referring to and about who is disproportionately affected around the globe.
- [X, y, z] communities in [x, y, z place] disproportionately affected by [x, y, z public health issue]
- Communities in [x country/region/locality] who experience [x, y, z] health disparities
- [X, y, z health disparities] experienced by [x population/community]
Instead of broad terms like ‘minority/ethnic/racial groups’, try:
- 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]
- ‘Global minority.’ Additionally, 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 this: “The global minority is disproportionately affected by COVID-19.”
- Instead, try this: “Globally, populations such as the [x,y,z communities] in [x region/country/province] are disproportionately affected by COVID-19.”
- ‘Minority.’ 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.
Instead of these adjectives for populations of focus:
- Vulnerable [groups]
- Marginalized [groups]
- Hard-to-reach [communities]
- Underserved [communities]
- Underprivileged [communities]
- Disadvantaged [groups]
- High-risk [groups/people/ population]
- At-risk [group]
- High burden [groups]
- Priority [population]
- In need
- In despair
Instead of referring to people only as acronyms (e.g., 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.
- Ask people from the population/community how they wish to be referred to.
- Center the population, add context that focuses on the systems in place, and 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 [x, y, z factors]
- Groups that have been historically marginalized by not having access to [x, y, z resources, rights, opportunities]
- Groups that have been economically/socially marginalized
- [X, y] groups experiencing marginalization in [x society]
Note: The terms to the left are sourced from CDC’s Health Equity Guiding Principles for Inclusive Communication. 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.
- 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.
- ‘Underserved’ relates to limited access to services that are accessible, acceptable, and affordable, including healthcare. Do not use ‘underserved ’when you really mean ‘disproportionately affected.’
- 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.
- 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.
- 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]
Also consider using:
- Under-resourced communities. Note: Use only in the literal sense when an area lacks resources (e.g., clean water). Be specific about which resources are lacking.
Instead of using income-related descriptors for populations of focus such as:
- The poor
- Poor people
Use person-first language and specify who you are referring to:
- 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.
- People with lower income
- People/households with incomes below the national poverty level
- People with self-reported income in the lowest income bracket (if income brackets are defined)
- People experiencing poverty in [locality]
Note: ‘People with lower socioeconomic status (SES)’ should only be used when SES is defined (e.g., when income, education, parental education, and occupation are used as a measure of SES).
Instead of ‘slum’ and similar terms with negative connotations in other languages, such as ‘Aashwa’i’ (Arabic; Egypt) and Favela (Portuguese; Brazil).
- See the UN’s 2003 Global Report on Human Settlements (pg. 9) for similar terms with possible negative connotations in other languages.
Emphasize that informal urban settlements are complex and hard to define due to diverse populations, systemic factors, reasons for living in settlements, and varying definitions according to the country/city.
- ‘Slum’ and local language equivalents are generalizations that often carry negative/deprecatory connotations. Such terms can also foster stigmatization of people who live in ‘slums’.
- However, ‘slum’ may not have negative connotations in every country/language and could simply refer to low-quality or informal housing.
Alternatives to ‘slum’:
- Informal settlements (definition)
- Informal urban settlement
- Settlements with inadequate housing (definition)
Alternatives to ‘slum-dwellers’:
- People living in informal urban settlements
- People without access to adequate housing
Also consider mentioning common characteristics of informal urban settlements:
- Lack of access to improved water source
- Lack of access to improved sanitation facilities
- Lack of sufficient living area
- Lack of housing durability
- Lack of security of tenure (i.e., lack of documentation showing legal protection against forced eviction)
Instead of referring to people, groups, or communities using terms with violent connotation, such as:
- Target communities for interventions
- Target population
- Target audience
- Tackle issues within the community
- Aimed at communities
- Words and framing that have violent connotation risk militaristic connotation and can perpetuate power imbalances by conveying non-participatory, top-down approaches.
- Engage/prioritize/partner with/serve [population of focus]
- Consider the needs and wants of/ Tailor to the needs and wants of [population of focus]
- Communities/populations of focus
- Intended audience
- Eliminate or eradicate [issue/disease]
- Note: Epidemiological terms ‘eliminate/eradicate’ can sometimes be interpreted with violent connotations.
- Prevent/control transmission of [x disease]
Be cautious with war and military metaphors, such as:
- On the ground
- Boots on the ground
- Ground zero
- On the frontlines
- Combat [disease]
- War against [disease]
- Battle/battling [disease]
- Fight against [disease]
- Winning or losing the war/battle/fight
- Enemy [pathogen/ disease]
Examine local, historical, and situational context to determine which metaphor is most appropriate: journey, fire, or other, or none.
Consider fire metaphors:
- “[X disease] is 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.”
Otherwise, when describing a location where an agency has sustained, long-term presence, programs, and collaboration, be specific about the location and public health issue.
- Example: In [x community/country/region/city] where [agency] works to address [x public health issue]
When an agency is temporarily traveling to a location to respond to an emergency, consider using:
- In [x location], where cases were first identified
- In [x location], where [x disease] is spreading rapidly
- In [x location], where the [natural disaster] caused the most damage and loss of life
- Metaphors are helpful when communicating technical information. However, use of metaphor should be carefully considered since no metaphor will perfectly apply to everything or everyone.
- War/military metaphors are not inherently negative but do exude an air of temporarily ‘parachuting’ into a ‘developing nation’ to ‘save people’.
- War/military metaphors may also inflame painful memories and distrust where a country has previously engaged in military combat in an area where they are now engaging in public health activities.
- Pros of war metaphors:
- Easily understood
- Can raise general awareness of and interest in important public health issues
- Can increase perception of issues as serious and urgent
- Can justify the need and increase willingness to modify behavior
- Can enhance morale and unity of those ‘fighting the disease’
- Cons of war metaphors:
- Can be counterproductive by increasing fatalism
- Can stigmatize and place blame on anyone who ‘loses the fight’
- Can influence unhelpful aggressive attitudes and unethical action for the sake of ‘winning the battle’
- Can 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’
- Can be culturally inappropriate among cultures that prioritize peace and coexistence with nature
Instead of describing work (especially work by government agencies) in countries/areas experiencing socio-political conflicts like this:
- Political strife has weakened systems
- Civil unrest has hampered service delivery
- Challenges in [location] stand in the way of [agency’s] public health efforts
In situations where it is especially important to consider political and diplomatic ramifications of a government agency’s communication (e.g., military coup, violent conflicts, civil unrest, corruption), 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.
- While it may be factual that socio-political challenges have added to the complexity and difficulty of implementing public health goals and activities, this framing can be interpreted as insensitive and judgmental.
- Such framing from a government agency (e.g., U.S. CDC) could also be seen as representative of the broader government’s official stance on the situation and unintentionally increase diplomatic tensions.
Note: these considerations may be different for nongovernmental organizations. However, nongovernmental organizations should still review whether this kind of framing is effective.
- 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.].
- Example: 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].
Instead of these terms when referring to refugees and displaced populations:
- Mixed migrant
- Mixed migration
- Boat migrants
- Forced migrant
- Forced migration
- Illegal migrants
- Illegal immigrants
- Illegal aliens
- The foreign-born
Also avoid labeling a large group of people with unknown/unclear reasons for moving solely as ‘refugees’ or solely as ‘migrants.’
Use specific terms, as defined by the UN International Organization for Migration:
- Immigrant; People who are immigrating to [x country]
- Migrant; People who are migrating from [x to y]
- Refugee / refugee populations
- Asylee/Asylum-seeker; People who are seeking asylum
- Internally displaced persons; people who are internally displaced
- Note: avoid referring to people only as acronyms (e.g., IDPs for ‘internally displaced persons’)
- ‘Illegal’ 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.
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
- Mobile populations
- People with undocumented status
Avoid referring to children as sex workers.
Instead of referring to adults who are sex workers as:
- Any other slang terms
When referring to children, 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
- 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.”
- ‘Sex worker’ is intended to be non-judgmental and focuses on the working conditions under which sexual services are sold.
- However, 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.
When referring to adult sex workers, use:
- Sex worker (Note: try to specify whether sex workers are female, male, transgender, etc. to avoid 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 work, try:
- People who are trafficked for sexual exploitation
- Adults who are sexually exploited
- People who are coerced into selling sex
Instead of historically loaded terms such as:
- Tropical medicine
- Missionary medicine
- Colonial medicine
- Eastern/Western medicine
- International health
When referring to public health work that occurs globally and has the potential to impact populations across the world (e.g., strengthening disease surveillance systems), use:
- Global public health
- Public health on a global scale
Otherwise, 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:
- Conventional medicine (i.e., healthcare professionals like doctors, nurses, pharmacists treat symptoms and disease)
- Traditional medicine (definition)
- Complementary medicine (definition)
- Traditional and complementary medicine (encompasses the products, practices and practitioners of traditional and complementary medicine)
- Historically loaded terms like ‘tropical medicine’, ‘missionary medicine’, and ‘colonial medicine’, tend to portray/frame global public health with a western-centric worldview, which is often used as the ‘neutral’ or ‘norm’ to judge all other worldviews/approaches/standards as ‘peculiar’ and ‘inferior’.
- ‘Eastern/Western medicine’ oversimplifies 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
Exercise caution with ‘Savior language’, such as:
Emphasize partnership and collaboration when referring to core tenets of public health (e.g., save lives, prevent deaths, and protect health).
- Example: We work with global partners to save lives and prevent death from [x, y, z diseases]
- Example: We collaborate with partners to [x public health activity], which saves lives and promotes health
Consider alternate framing such as:
- [Agency] and our partners work together to promote population health and decrease deaths due to [x disease or issue]
- We seek to improve health outcomes among [x population] by increasing access to [x resource]
- We work towards a safer, healthier world by [e.g., strengthening public health systems, building global capacity for disease surveillance, increasing access to x,y,z resources]
- The framing of ‘saving lives’ is important to many public health agencies, initiatives, and demonstration of impact. However, be mindful that this language is disproportionately used by high-income nations in North America and Europe.
- Savior language can indicate an attitude and/or practice of swooping/parachuting in because ‘they need our help’. Savior language can also imply that a group, community, or population is incapable of solving major problems without help from external experts or institutions.
- Despite good intentions, the framing of “We are here in [x country] to save lives” may not be well-received by partner communities, professionals, or countries. This type of framing and attitude can significantly damage partnerships.
- However, there is nuance between “We saves lives” vs. “We collaborate with partners to implement public health initiatives (e.g., childhood vaccination, cancer screening, disease surveillance, etc.) that save lives.”
- The second option (i.e., “We collaborate…”) begins to balance the power dynamic felt between experts/agencies from HICs and partners/experts/agencies from LMICs.
Be cautious with:
- Community empowerment
Imperfect alternatives that are more precise and avoid the harmful dynamic of one entity bestowing power upon others:
- Help equip with additional [knowledge, technical laboratory skills, epidemiology skills, etc.]
- Share knowledge/expertise
- The underlying intentions may be good, but ‘empowerment’ terms are overused, have condescending and paternalistic connotations. They also play into saviorism and supremacy.
- Dependency is implied when people are assumed to be helpless, devoid of power, and thus dependent on external actors to ‘swoop in’ to give them power.
- ‘Empower’ is defined as “to give someone the authority or power to do something.” The philosophy of ‘giving power’ masks the existing potential, leadership, and solutions within a community/person.
- Non-participatory solutions from external actors, even if well-intentioned, do not respect or draw from sustainable/relevant local experience and wisdom.
- ‘Community empowerment’ is sometimes defined as “the process of enabling communities to increase control over their lives”. But if empowerment is understood as being ‘enabled’ or ‘given’ to a community by external actors, it must also be claimed and exercised by the people themselves.
- However, ‘empower/empowerment’ may still be appropriate when describing grassroots efforts to claim/exercise inherent power, such as:
- People who empower themselves through gaining knowledge, seeking information, speaking up, and engaging in advocacy
- Community members striving for community-defined goals and objectives
- Community members organizing in their own communities and gaining direct representation within local government
Instead of phrases such as:
- Giving voice to the voiceless
- Being a voice for the voiceless
- Listening to the voices of [x community/ population]
- Amplifying the voices of [x community]
- Prioritizing the voices of [x community
- These phrases tend to be used in reference to people living in LMICs and people who are most affected by health inequities.
- ’Giving voice to the voiceless’ often signifies that people who have historically been underrepresented and excluded have gained opportunities to organize, increase visibility, and express themselves by leveraging the strengths of information, media, and communication technologies.
- However, although it is a noble notion similar to ‘empower’, this phrase plays into supremacy, saviorism, and dependency by implying that someone does not have a voice until ‘we give it to them’.
- The ‘voiceless’ is a socially constructed concept that oversimplifies the complex systemic factors that leave some people considered or feeling ‘voiceless’.
- Everyone has a voice. The issue is that many voices are not sought out, included, listened to, supported, or prioritized. The priority should be less ‘being the voice’ or ‘giving the voice’ and more ‘amplifying the voice’ of the ‘voiceless’.
Exercise caution with:
Instead, try this…
Use sparingly and consider current and local contexts when determining whether it is appropriate to use these terms. For example, perhaps it is appropriate to describe a community as resilient as they recover from an earthquake. However, it is less appropriate to describe a community as resilient while they continue to experience the effects of racism, imperialism, and colonialism.
- When used inappropriately, these terms can perpetuate inequalities while telling people how strong they are, which is unhelpful.
- Also be cautious when using these terms to inspire or encourage staff/teams to “be resilient”. This can give the perception that the staff are at fault for burnout and low morale, while exempting leadership from the responsibility to create a healthier working environment.
Consider emphasizing the need for and celebration of sustainability in public health initiatives and working environments, rather than simply praising resilience.
- Capacity building
As much as possible, provide specific examples of what activities are ‘building capacity’. For example:
- [Agency] helps strengthen [x, y, z partners’] capacities/capabilities to [conduct x, y, z activities]
- [Agency] partners with Ministries of Health to increase the countries’ capacities/capabilities to [conduct x, y, z activities]
- [Agency] strengthens surveillance systems
- [Agency] helps develop laboratory skills
- ‘Capacity building’ is helpful for capturing a broad range of activities with two words. However, this term is vague jargon when used by itself and implies a one-way teacher-to-learner dynamic.
- ‘Building capacity’ can also give the impression that there were no prior, locally driven initiatives, infrastructure, or capacities present before the ‘capacity building’ agency arrived.
- As much as possible, expand and clarify further by providing detail on what ‘capacity building’ means and looks like based on the issue or activity in question.
- [Agency] leads workshops for how to collect and analyze survey data
- [Agency] trains community health workers in how to talk to community members about [x public health issue]
When a succinct and broad term is necessary, try the alternatives below to emphasize partnership and multi-directional exchange of information, ideas, and resources.
- Capacity strengthening
- Enhancement of existing capacity
- Capacity sharing
- Mutual capacity strengthening (remember that
- Donor country
Instead of ‘beneficiary’, specify exactly who you are talking about, as appropriate. For example:
- People with HIV / People living with HIV in [x country]
- People using [x health services/resources]
- People who will use [x health services/resources]
- [X, y, z] communities
- [X, y, z] populations
- Partner countries
- ‘Beneficiary’ invokes a loss of personal agency and lacks context as to why the inequity or disparity in question exists in the first place. Also, this term implies that the recipient is a passive recipient whom organizations have decided deserves some ‘benefit’.
- In the international setting, labeling one agency or country as the ‘donor’ can reinforce power imbalances and sound demeaning toward the ‘receiving country’. In most cases is best to emphasize a horizontal partnership.
Instead of ‘donor’ or ‘donor country’, specify the countries involved and emphasize partnership and collaboration. When speaking generally, try:
- Partner countries
- Technical assistance
Expand on what is involved in technical assistance. For example, specify whether the technical assistance in question involves epidemiologic investigations/studies/analysis, laboratory functions, program evaluation, emergency response, or public health law and policy, etc.
When referring to an overall focus on providing subject-matter expertise in support and collaboration with global partners, consider using:
- Technical collaboration
- Engage in technical collaboration with [partners]
- Subject matter expertise is among global public health agencies’ greatest exportable assets. But the term ‘assistance’ is vague and can cause confusion between subject-matter assistance vs. foreign assistance vs. development assistance.
- Assistance includes technical capacities (e.g., knowledge, skills, and expertise), but often takes the form of tangible resources that have been delivered (e.g., funding, equipment, reagents, etc.).
- Additionally, ‘assistance’ can sometimes imply that the technical capacity of [x team/country] is limited, which can imply imbalance of knowledge, skills, and power.
Continue to use ‘intervention’ but be mindful of the context and consider whether it is more appropriate to label a public health activity as an ‘intervention’ or one of the following:
- Program activity
- Program evaluation
- Clinical trial
- ‘Intervention’ means different things in different contexts. When describing programs at the community level, ‘intervention’ can imply ‘doing something to’ the people group. This implication undermines the concept of participatory practice.
- Not every public health action is an ‘intervention’ in the strictest sense. Many public health activities are educational workshops, trainings, and programs. Others are partnership building, collaboration, and information sharing.
- Research project/study (e.g., randomized control trial, cohort study, etc.)
As space and time allow, it is helpful to name specific examples of ‘interventions’, such as:
- Wearing a mask
- Getting a vaccine
- Burying a person who died of Ebola in a safe and dignified way
- Participating in contact tracing interviews
- Following quarantine protocols
- Receiving health care at an Ebola/HIV/ treatment center
- Using condoms during sex
- Getting tested and treated regularly for sexually transmitted infections
Consider alternatives to:
Note: ‘Collaborators’ is sometimes used as an alternative to ‘stakeholder.’ While collaborate means to “work jointly on an activity”, it can also mean to “cooperate or assist an enemy”. Depending on the broader geopolitical/diplomatic reality, exercise caution with ‘collaborators’.
If the key groups are directly involved in the project/activity, use terms that describe the nature of their influence or involvement.
For general alternatives, consider using:
- Community, community members
- Community impacted/affected
- Advocacy groups
- Interested parties/groups
- ‘Stakeholder’ may not carry the same historical weight outside of the United States. Nonetheless, it is helpful to expand and specifically name the groups and/or individuals with interest in the activity you are communicating about.
- Per CDC’s Health Equity Guiding Principles for Inclusive Communication, the term ‘stakeholder’ is used across many disciplines to reflect different levels of input or investment in projects or activities. This term can be used to reflect a power differential between groups and has a violent connotation for some tribes and tribal members in the U.S.
- ‘Stakeholder’ also groups all parties into one term, despite potential differences in the way they are engaged or interact with a project or activity.
If the key groups are people to whom you are accountable directly or indirectly, specify the relationship:
- Funders, funding agencies, donors
- Policy makers
- Broader public health community
- Government officials
- Elected officials
- General public taxpayers
- Global Health Security
When discussing ‘global health security (GHS)’, clarify what GHS means. Consider pairing GHS 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)
- ‘Global health security (GHS)’ is increasingly losing its definition due to various sectors adopting the term and applying different definitions.
- CDC defines GHS as “the existence of strong and resilient public health systems that can prevent, detect, and respond to infectious disease threats, wherever they occur in the world.”
- Top global public health security concerns include:
- Emergence and spread of new infectious diseases
- Increasing globalization of travel and trade, which enables disease to spread
- Rise of drug-resistant, disease-causing pathogens
- Potential for accidental release, theft, or illicit use of dangerous pathogens
Exercise caution when naming emerging infectious diseases or new variants and outbreaks.
When naming and referring new infections, syndromes, diseases, variants, and outbreaks that do not have a commonly used name and have never been recognized or reported before in humans, follow WHO’s best practices:
- Use generic descriptive terms, based on the symptoms that the disease causes
- Examples: respiratory disease, neurologic syndrome, fever
- Use more specific descriptive terms when robust information is available on how the disease manifests, who is impacted, and the severity or seasonality
- Examples: progressive, chronic, severe, seasonal, acute
- If the pathogen that causes the disease is known, include it in the disease name
- Examples: coronavirus, influenza virus, salmonella
- If appropriate, include the year of first detection or reporting
- Examples: 2019 as part of ‘COVID-19’
- Especially for variants, arbitrary identifiers may be helpful.
- Examples: Alpha, beta, gamma, a, b, I, II, III, 1, 2, 3
- The names of emerging infectious diseases and new variants or outbreaks can have negative, stigmatizing effects on nations, economies, and people. Historically, some disease names have provoked backlash against certain communities; created unjustified barriers to travel, commerce, and trade; and triggered needless slaughtering of food animals.
- See WHO guidance for examples of what to avoid when naming new diseases, variants, or outbreaks.
- Avoid geographic locations such as: Middle East Respiratory Syndrome, Spanish Flue, Rift Valley fever
- Avoid using people’s names such as: Creutzfeldt-Jakob disease, Chagas disease
- Avoid species or classes of animals and food, such as: swine flu, bird flu, paralytic shellfish poisoning
- Avoid cultural, population, industry, or occupational references, such as: occupational, legionnaires, miners
- Avoid terms that incite undue fear, such as: unknown, fatal
When a disease has several nicknames/alternate names aside from the official name, avoid use of names that have potentially stigmatizing effects on people, cultures, and countries. Instead, promote use of the name that best abides by WHO’s best practices.
When communicating about new variants or outbreaks of known diseases, emphasize that the places experiencing the first known cases or highest prevalence may not be where the new variants or outbreak emerged.
- For example, rather than “the India variant of SARS-CoV-2”, try “the delta variant of SARS-CoV-2, which was first documented in India.”
Instead of referring to places with high transmission of disease as ‘hotspots’…
Localize the subject by being as specific as possible and appropriate. For example:
- ‘Hotspots’ has potentially negative connotations and can influence stigma for people and places within the ‘hotspot.’
- Local epidemic in [x country/region]
- [X town] in [x province] of [x country], where case numbers and transmission rates are the highest
- [Location] where the [x disease] outbreak was first identified
- In [x location], where [x disease] is spreading rapidly
- In [x location], where the [natural disaster] is causing the most damage and loss of life
When speaking about specific areas where particular groups congregate, consider using:
- Concentration of [population/group]
- Area where [group congregates]
When speaking generally about specific areas that experience high incidence/prevalence of a public health issue, consider using:
- Areas with high/increased transmission of [x disease]
- Field staff
- The field
- In the field
- Field experience
It is helpful to expand on what ‘field’ means and who/what is involved ‘in the field’ or in ‘field work’.
Alternatives to consider for ‘field’:
- Community (e.g., rural community)
- In [x country/location that is separate from headquarters]
- [X animal reservoir] habitat
- Areas where we see many cases of [x]
- Where people from [x focus population] live
Alternatives to ‘field staff’:
- Local project staff
- Staff from [x community]
- [X, y, z staff] who are currently working in [x place]
- Colleagues who [conduct x, y, z activity]
- ‘Field’-related terms and phrases are vague. When taken literally, the place of work can be misinterpreted as a dirt road or in a crop field, not in classrooms, offices, cities, rural towns, laboratories, etc.
- ‘In the field’ most commonly refers to low- and middle-income countries as the setting or subject for external actors to conduct public health programs and research.
- ‘The field’ may denote people, patients, communities, healthcare workers, etc. However, this term can limit people ‘in the field’ as research objects to be studied, as requiring assistance, or as passive beneficiaries of services and policies.
- ‘Learning from the field’ or ‘field experience’ can imply that learning/knowledge and consequential action/change is only in the hands of ‘external’ or ‘superior’ actors (e.g., health authority, service provider, agency, research institution, policymaker).
- In the extreme, references to ‘the field’ can distance and exoticize the people and issues that should be at the center of focus, discussion, and action.
Alternatives to ‘field experience’:
- Experience working in [x, y, z] regions/countries
- Working/project experience in global public health
- Training in [x,y,z]
- Applied experience in [x public health activity]
- Collaboration with [x, y, z partners] in [conducting x, y, z activity]
Consider limiting the use of:
Name the specific location(s) or region(s) you are talking about. For example:
- In [x, y, z countries]
- In [x, y, z region(s)]
When broad terms are necessary, consider using:
- Around the world/globe
- Across the world/globe
- ‘Overseas’ and ‘abroad’ tend to be U.S.- or Europe-centric and are disproportionately used in reference to non-U.S. or non-European nations and people. Some usages can reinforce the ‘us vs. them’ mentality.
- The status of health anywhere can impact the status of health everywhere. Thus, global public health encompasses the health of populations in each nation across the globe.
When communicating cross-culturally, be cautious with idioms and cultural references, which may be irrelevant to the intended audience.
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 to identify relevant local idioms and cultural references.
Otherwise, if locally/culturally appropriate phrases and expressions cannot be identified, focus on using plain language to explain the concepts.
- 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.
Instead of using seasons or holidays to specify time periods, try using specific months or days according to the local calendar and culture.
- 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 (e.g., Thanksgiving, Christmas).