Unbanning Those Seven Words May Not Be Enough

After learning last month of a purported ban on seven words – science-based, evidence-based, vulnerable, diversity, transgender and fetus – by the Centers for Disease Control and Prevention, we in the health community counteracted, calling the news an assault to the integrity of our practice.

This is only the beginning of our fight. We must recognize that this censorship of terms is a way of restricting any scientific research that challenges the growing inequality in this country. We must therefore use more intentional, progressive, and precise language to create a broader public health narrative connected to principles of health equity and social justice.

We can start by realizing that our seemingly “objective” terms to describe people and illness are not always objective. Racist and oppressive institutions and interests have produced today’s inequities, including our own as a discipline. Science has a long history of not being nearly as value-free as is sometimes assumed.

Let’s examine three of the words on the “banned” list – vulnerable, evidence-based, and diversity.

Vulnerable has been commonly used over the past 20 years to describe communities and neighborhoods who are labelled at-risk for poor health outcomes and other social ills. The challenge with this word is that it implies the people referenced as “vulnerable” caused their own risk or have some group feature that puts them at risk.

What is consistently ignored is an investigation of the context explaining why they are at risk or vulnerable in the first place. People and communities have been made vulnerable because of racist and oppressive policies, systems and structures that often prevent oppressed population groups from buying homes, deny them adequate education or employment, market unhealthy foods to them, and increase their difficulty to access needed healthcare. These are not vulnerable populations; they are people and communities that have been made vulnerable and should be described as such as it relates to advancing health equity.

Evidenced-based -- a term originally derived from academic and clinical medicine and now applied to public health practice and other fields -- reflects decision-making determined by the best objective, available knowledge and values that research can offer. However, no research exists independent of values, frameworks, theory, culture, historical context, and political power. Whose questions and interests determine what counts as legitimate evidence? Who pays for the research? And for example, why do we not demand evidence for why communities of color and those burdened with poverty have the most toxic waste sites, land-fills, and incinerators in their communities and who made these decisions?

Ironically, the administration advised not to use the word diversity, which once meant variety but over time has become a code word for a certain kind of tokenism meaning a person of color. This ignores the broader injustice of white privilege and white supremacy. Moreover, it distracts from the more difficult struggles and structural changes necessary to create a more equitable society.

Moving forward, we in the field of health equity must continue to investigate the causes inherent in imbalances of political power, the historical knowledge of structural racism and its legacies, and the mechanisms and accumulation of policies that produce poverty and segregation. Additionally, we must recognize that people and communities have valuable knowledge about their own circumstance, even if it is not scientific or observable. This will move us beyond simply documenting poor health outcomes and patterns of poor living conditions.

To do this demands vigilance, courage, and the reclaiming of our legacy of alliances with movements for social and economic equality. We must stand up to those who are fearful of our perspective and the power of our ideas to awaken the public consciousness.