The old adage, “sticks and stones may break my bones but words will never hurt me” has long been disproven.
In fact, language carries weight and history. The blow of an inconsiderate word or cut of a thoughtless comment can often form wounds that we carry with us over a lifetime.
The shift that we are now seeing to being intentional in the words that we use is one much-needed in society. And for us in health care, and providing care to people who encounter stigma and disadvantage via the systems that are supposed to help them, words have never carried more weight.
Why the Words We Use Matter
“Stigma is a public health issue — it contributes to high rates of death, incarceration, and mental health concerns among dependent populations.”
At Providence, our goal is to deliver the highest quality of care to those who need it most, and this means paying attention to the stigmatizing potential of language.
For instance, for some people, the words ‘addict’, ‘addiction’, or ‘substance abuse’ are stigmatizing.
According to the Canadian Centre on Substance Use and Addiction, “Even though substance-use disorder is a health condition, people often do not seek help, not wanting to be labelled “an addict”… Such language can lead to a cycle of behaviours and attitudes that isolate and marginalize people who use substances.”
And in the past, we had often used the word “vulnerable” to describe the people that we serve. As explained in the Australia and New Zealand Journal of Public Health: “When used as a term to describe certain individuals or populations in a nondescript and vague manner, the reader ‘fills in the blanks’ of why a certain individual or group is vulnerable.
Being vulnerable could be seen as an intrinsic deficit, inferiority or inability to protect the individual’s own best interests. This can in turn reduce both perceived and actual agency of the individual or group, depicting them as ‘others’ who are powerless and in need of protection. This may also result in further stigmatisation and exclusion of these individuals and groups.”
“What we have been hearing, and what we have learned, in the last couple of years is that this the use of this term is problematic, and can feel incredibly stigmatizing and disempowering for those to whom the term is being directed,” says Fiona Dalton, President and CEO of Providence Health Care.
What we now know and have learned is that when people don’t see themselves the way that we have chosen to describe them, like for example, as an “addict” or as “vulnerable”, the judgement that an ill-placed term carries can lead to people avoiding seeking services when they need it most. The exact opposite of what we are striving for.
How Stigma Hurts, And Language Triggers
Equally troubling is referring to a group of people as “ours”. Patients, residents, clients – they do not belong to us, and to imply as much can be deeply offensive and triggering.
Learnings have taught us that when we refer to First Nations groups, or Indigenous Peoples as belonging to us or to Canada, it is profoundly insulting and not easily forgiven, as it invokes an entire history of paternalism and control.
Language is a cultural construct – that is, it is created and maintained by each culture. The important thing to remember about all cultural and social constructs is that they change over time.
And this is a time for us as an organization to change and to reflect upon how we refer to the various groups who we serve.
Changes We Are Making
A lot of time has been spent working on finding a descriptor for “vulnerable” that is more specific and clear, regarding the people we are supporting and caring for. Where we have landed is: those with complex medical and social service needs.
“Certainly, it’s a longer phrase, but in terms of other ways in which we use words, we are all realizing that words are important and carry a lot of weight,” explains Fiona. “As an organization, need to pay more attention to stigmatizing language.”
While we recognize that people with complex medical and social service needs is an improvement over vulnerable, it is also imperfect; no one word or phrase can cover the many individuals we serve and the many factors that contribute to health status. We can all consider a few principles when choosing how to best refer to a person or group, instead of using generalized assumptions or one-right-way approaches.
- Take the time to ask how people identify themselves and which term they prefer. This respectful approach puts the person at the centre, and builds relationship
- Specificity is always better than generalizing. If you know why you would have previously termed a group ‘vulnerable’, endeavour to be specific about what is creating a position of disadvantage when accessing care.
- Person-first language: It is always best to ask a person which term they prefer; however, when this is not possible, the standard for those of us not within the community is person-first language. Examples of person-first language include saying “a person with diabetes” rather than “a diabetic, or to say “a person with OCD” or refer to someone as “living with OCD” rather than someone is “OCD”.
In light of the ongoing overdose crisis and toxic drug supply, we need to do all we can to de-stigmatize and make services accessible. “While the term ‘addiction’ is one that’s still widely utilized to describe a medical condition, and as a specialty area of medical practice, we don’t use the term when describing patients. For example, Providence’s Addiction Medicine Consult Team (AMCT) or the Rapid Access Addiction Clinic (RAAC) are named to describe services. When it comes to the people we serve through those services, we use a person-first approach to describe our population.
A person who uses substances is not defined by their substance use, so we want to reflect that in how we describe them,” explains Julie Lajeunesse, Director, Renal, and Interim Director, Urban Health & Substance Use. “It is much like the shift we saw years ago when the term “HIV/AIDS patient” was replaced with “people living with HIV”. Using terms like “addict” or “drug-user” cause harm in that they attach a label to a person which is dehumanizing and perpetuates stigma. Every person deserves to be seen as an individual with unique experiences and needs, and using person-first language is one step we can take to show people that we see them this way.”
You will see these changes reflected in the most recent update of our Mission: Forward strategic plan, as well as in communications, the 2022 edition of Providence’s Editorial Standards Guide, the naming conventions we use for clinics and programs and, most importantly, how we refer to the people we serve. We will continue to consult with people and groups to further inform how we identify people in ways that those people feel best seen and represented.
It is up to us to take this opportunity to be intentional with how we talk about those we serve, using the most respectful, accurate and identity-affirming language that we can.
How have you seen the impact of language/the words to choose in the work you do? Please share your thoughts and/or experiences in the comments below.
 “Addiction and Stigma” American Addictions Centers 01.21.2022 https://drugabuse.com/addiction/stigma/
 “Rethinking the use of ‘vulnerable'” Australia and New Zealand Journal of Public Health 04.05.2021 https://onlinelibrary.wiley.com/doi/10.1111/1753-6405.13098
 “Indigenous Peoples: Language Guidelines Version 3.0″ University of British Columbia 2021 https://assets.brand.ubc.ca/downloads/ubc_indigenous_peoples_language_guide.pdf