Language and Public Health

By Richard A. Aronson, MD, MPH

A goal of Humane Worlds Center is to help change the language of medicine and public health so that it better reflects the underlying ideals of these noble professions. Our use of words, as I learned so well from my freshman English class at Amherst College, defines how we all approach and actually think about life. Language itself determines how we receive, process, interpret, and provide output for our thoughts and, importantly, actions. Humane Worlds Center seeks to appreciate language as a foundation for creating conditions for the use of language in ways that resonate with people from diverse cultures, across boundaries. It’s important for us to explicitly acknowledge and address the widespread use of bureaucratic jargon, complex technical terms, unintelligible acronyms, and violence related metaphors that permeate the language and culture of society as a whole. It appears everywhere in our discourse, written and verbal. For example, we “target” just about everything and everybody, most of whom don’t take kindly to the idea of being targeted; we design policies, programs, protocols, and services to, say, “combat” violence, which certainly qualifies as an oxymoron; we figure out all kinds of ways to “fight” poverty; we design “interventions” on people and communities for campaigns, for example, to “attack” high rates of asthma and its “triggers”; we describe people as “high risk cases” to be “managed” rather than as human beings to be cared for; we fill grant proposals and electronic mail with “bulleted” talking points and confusing often bizarre acronyms; in medicine, we identify babies who “fail” a hearing screen as having birth “defects”; and in public health we use the epidemiological related meaning of “surveillance” in the post-9/11 era when such a word is widely perceived in a much darker context and linked to a real war; and of course we thrive on building “infrastructure”, whatever that non-specific and vague word means to the public. The uncritical and ubiquitous use of such words and terms, though largely unintentional, contribute to cultural norms that can undermine the purpose and ideals of public health and the quest for a culture in which education and democracy thrive. In the quest for health and healing, people and communities cry out to be honored, respected, and included in the design and implementation of systems to enhance their well-being. Indeed, the genius of public health, at its best, lies in its unique ability to honor and include such cries in whole systems change. But our dominant communication patterns have the opposite effect. Our challenge is to pay greater attention to such communication and, in the long view, to change our language so that it explicitly embraces and supports the quest for a culture that affirms the ideals of education and democracy. Through such a change, we can be in a stronger position to create and sustain humane public health policies and systems that honor the dignity of all people and that reduce unconscionable inequalities. Public health has a wide array of people from around the world who carry out innovative promising practices to do just that. Our calling is to make these practices systemic and enduring.