Language is a Key to Reducing Health Disparities

Language is powerful. The individual words we use to describe people can substantially impact the way others perceive them. For health funders, and grantmakers in general, we have an imperative to remember that imprecise language can perpetuate power imbalances, set unreasonable expectations and encourage nonspecific interventions that are not relevant to communities.

Some of the terms widely used in health, nonprofit and social service sectors include “vulnerable” and “high-risk” to describe people who are more likely to have relatively poor health outcomes or to experience health disparities. Using these words alone to label people without further explanation may unintentionally cause harm or reinforce negative stereotypes based on someone’s race, ethnicity, socioeconomic status or culture. Additionally, these terms may imply that those at higher risk for poorer social or health outcomes are responsible for their situation.

Healthcare providers use words like “vulnerable” or “high-risk” to describe individuals more susceptible to a particular disease or condition based on their age or other clinical risk factors. However, using these individual terms outside of a clinical setting is too vague.

A recent study of the word “vulnerable” in public health journals found that many articles use the term to describe a broad group of people. Simply describing a population as “vulnerable” does not acknowledge the inequitable distribution of resources and systemic and structural barriers that contribute to health disparities. As grantmakers, we need to name specific obstacles so that we can address them.

Don’t forget who, why and what

As bi3 works to achieve health equity and reduce health disparities, we believe populations more likely to experience poor health outcomes must be specifically defined by who is vulnerable, why they are vulnerable, what they are high-risk for and the result.

In creating our Building Health Equity Request for Proposals, bi3 was intentional about describing the specific groups of people who suffer most from health disparities based on data: Black, Indigenous and People of Color; individuals with lower levels of education and income; individuals living with disabilities; immigrants and new Americans; and individuals without health insurance.

A vast body of evidence has documented the historical ways racism and discrimination negatively impact health outcomes for these populations. bi3 used straightforward language in our grantmaking practices to describe these populations so grantee partners could deploy equitable practices and culturally relevant services to the community.

Alternative Options for Health Funders

Consider using terms and language that focus on the systems in place. Also, try to use language that explains the effect. The Centers for Disease Control (CDC) suggested the following alternatives:

• Groups placed at increased risk/put at increased risk of [outcome]
• Groups with a higher risk of [outcome]
• Groups experiencing disproportionate prevalence/rates of [condition]

bi3 envisions a day when every person has a fair and just opportunity to be as healthy as possible — a day when a person’s health can no longer be predicted by race, ethnicity, ability, or zip code. Our commitment to equity requires us to be thoughtful and intentional with the language we use.

We invite you to join us in using clear and direct language to describe the populations we seek to serve. It is a small but critical step towards achieving health equity.

Kiana Trabue

Vice President of Strategic Partnerships

Kiana Trabue is Vice President of Strategic Partnerships, for bi3, a philanthropic initiative to transform health in Greater Cincinnati.

Kiana uses a deeply collaborative approach to cultivate bi3’s internal and external partnerships. She works with grantee organizations to co-design innovative initiatives to achieve bi3’s goal of solving Greater Cincinnati’s deep-seated health issues.

Previously, Kiana served as Executive Director for The Health Collaborative where she led Greater Cincinnati and Northern Kentucky’s population health agenda, Gen-H. As the pandemic hit in 2020 Kiana quickly pivoted her focus toward helping to lead the region’s COVID-19 response efforts, specifically working to ensure equitable response strategies to target neighborhoods and populations for COVID testing.

Kiana is a 2017 YWCA Rising Star, a member of the Cincinnati Business Courier’s 2018 Forty Under 40 class, a recipient of Lead Tribune Media Group’s 2017 Healthcare Leadership Award, and was recognized as a Distinguished Alumni by Princeton City School. Trabue holds a Master of Public Health from Wright State University’s Boonshoft School of Medicine and is a graduate of the Center for Clinical and Translation Science and Training’s Community Leaders Institute and the Urban League’s Urban Leader’s Institute.