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Choosing the right words in global health and development

Choosing the right words in global health and development

Recently I read an article describing the need for a shift away from the phrase “car accident.” The argument, a popular one among some road safety advocates, is that the term “accident” implies a lack of accountability on the part of the driver. In the words of Mark Rosekind, head of the National Highway Traffic Safety Administration, “When you use the word ‘accident,’ it’s like God made it happen.” In fact, the vast majority of traffic “accidents” occur in situations where the driver is impaired or distracted. True accidents with no or limited driver responsibility only account for about 6% of all collisions.

Indeed, language choice can be a crucial factor in making decisions about how to handle certain issues. Research shows that the language we use can affect how people report on and remember traffic collisions. In an experiment, people were shown videos of traffic “accidents” and asked to guess how fast the car was going at the time the collision occurred. Participants who heard the word “smashed” were more likely to make higher speed estimates than those who heard the word “hit.” After a week had passed the participants who heard the word “smashed” were more likely to report seeing broken glass in the videos despite the fact that there wasn’t actually any broken glass.

car crash health
Glass shatters from car during collision. Photo from Pixabay.

All of this got me thinking about the ways in which our choice of words affect how we make decisions in global health and development. Global health has undergone a linguistic transformation, most notably in the shift from the term “international health” to “global health,” which is currently the preferred term. One of the main reasons for this shift was the idea that “international health” implied health issues that were separated by borders. “Global health”, on the other hand, reflects a more globalised view consistent with a significantly more globalised world. In addition, “international health” tended to focus on developing countries and subsequently acquired a troubling colonialist connotation. The term “global health” is preferred by many who think that the focus exclusively on the developing world is a bit short-sighted. It would be interesting to understand how, if at all, this linguistic shift has actually affected how people see “global health” and the way we conduct our work and make our decisions.

Debates about linguistic choices can be found in the development sector as well. A thoughtful piece by Julia Kramer argues that the terms “need” and “help” are detrimental to the empowerment and true development of low-income communities. The word “need” creates a focus on lack and the word “help” produces a sense that some higher-order beings must come in and save the day. This results in a “need-help” cycle in which national innovation and capabilities are often overlooked and communities remain dependent on “external” resources for their basic needs. The “need-help” model also produces a stark contrast between those “in need” (“them”) and those “helping” (“us”). This dichotomy can contribute to a general lack of community member participation in interventions and programs meant to improve their lives. Thinking in terms of “need” and “help” can even result in a reduced sense of accountability and the maintenance of an “outsider” perspective that can have damaging effects.

help health
We need to change the language we use. Image from Pixabay.

Although changing our language is not a panacea, it can start to shift mindsets and result in work that focuses more on empowerment and less on “aid.” We’ve seen changing semantics make a big difference particularly in many areas of healthcare, such as mental health and HIV/AIDS. There have been many patient movements in these areas to move away from language that defines people by their illnesses. For instance, rather than saying “an HIV-positive person,” we now prefer to say “a person living with HIV/AIDS.” This formulation distances the person from the illness. The use of the phrase “living with” also emphasises the full life of the person rather than framing them predominantly in reference to their illness. The same goes for using the phrase “a person with schizophrenia” rather than referring to someone as “schizophrenic.” It may not be entirely clear how these semantic changes have precisely affected attitudes toward people living with HIV or schizophrenia, but it is safe to say that changing the words we speak can slowly change our minds.

The words we use are some of the most powerful tools we have to persuade others and change toxic attitudes – important activities in the fields of global health and development. Let’s make good use of them with careful, sensitive and thoughtful communication.

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Sara Gorman is a Project Manager at Janssen Global Public Health, Pharmaceutical Companies of Johnson & Johnson. She is also currently working on a book about the psychology of healthcare decision making and the public perception of risk (Oxford University Press). Sara holds an MPH, as well as a Ph.D. in English Literature.

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