Problematic terms and alternatives

PATH no longer uses beneficiary to describe the people, communities, and countries with whom we work. Beneficiary patronizes those it describes in a few key ways: it defines a person, community, or country in terms of support received; it removes agency and implies dependency and passivity; and it fails to provide any context as to why the inequity or disparity in question exists in the first place. Most damaging of all, beneficiary suggests that organizations like PATH are deciding who deserves some "benefit”—as though health isn’t already a human right. (It is a human right.)

For more accurate, effective, and ethical alternatives, PATH prefers referring to people, communities, countries, clients, partners, or end users.

Like beneficiary, we began phasing out developing country several years ago, but it’s worth revisiting why. To do so, we must go back further to the developing country’s predecessor: the Third World country.

As a term, Third World grew out of the Cold War to describe nations not aligned with the East (Communist Bloc) or West (NATO). Because this category included most countries in Africa, Asia, Latin America, and Oceania, the term grew in use within the global health and development sector and became a euphemism for other descriptions like poor or non-white.

Then, in the late 1990s, the term developing country arrived with the Human Development Index, a mathematical model that combines life expectancy, education, and income to rank countries according to their level of development.

Even within its original context, this word choice is problematic. Describing a country as developing implies that it is, by definition, incomplete. Despite its problems, developing country was silently adopted as the preferred sector terminology and is still widely used today.

Low- and middle-income countries or LMIC is an adaptation of World Bank country and lending groups, which define countries as having “low-,” “middle-,” or “high-income economies” according to gross national income per capita. Within the context of banking, “low-,” “middle-,” or “high-income economy” is a relevant and appropriate term, but broadened into “low-,” “middle-,” or “high-income country” for use in global public health, several issues immediately arise. First, though sometimes a necessity, discussing health challenges at the national level is imprecise and, depending on the context, potentially harmful. Second, LMIC frames health challenges in terms of economics, but health disparities exist along other lines as well—like race and gender. When communicators define things only in terms of economics, they unintentionally erase other root causes that need to be addressed. Third, LMIC fails to attribute the disparities being faced to the oppressive structures and practices that actually created them (namely, colonization).

For more accurate, effective, and ethical alternatives, PATH prefers referring to specific countries by name, to countries according to health-specific details like malaria-endemic, or, in more general cases, simply to countries or places where we work.

PATH is taking a critical approach to here versus there phrases like “on the ground” and “in the field.” We recognize the public health definition of “fieldwork” as denoting “getting out of an office and into a community.” However, within the broader context of global public health and development, these phrases can reinforce harmful and pervasive power dynamics in two key ways. First, they suggest that PATH is physically removed from the communities and countries in which we work. This is simply not the case. Sixty percent of our staff live in Africa and Asia, with that percentage growing rapidly. Second, here versus there phrases paint a picture of global public health as something that takes place in rural communities on dirt roads. Some of it does, but 55 percent of all human beings live in urban areas. By 2050 it will be 68 percent.

If you find yourself using these terms, you may be too far removed from the work itself. Rather than replacing these terms with alternatives, we encourage you to collaborate with a member of PATH's global team who can provide an authentic local perspective.

For the past several years, empower has become badly overused. It seems that everything nonprofits do has been reframed as one form of empowerment or another. But what actually empowers? People can empower themselves through advocacy. Policies can empower people. Gaining representation in government can empower people. What do these things have in common? They’re all examples of structural authority codified by a group of people. PATH believes empowerment is something that occurs across groups and within shared structures. With this understanding, our communicators are shifting many uses of the word empower to more specific verbs (listed below). In addition to being more precise, these words also avoid the harmful power dynamic of one group bestowing power upon another.

For more accurate, effective, and ethical alternatives, try more specific verbs like equip, inform, educate, or train.

Within a public health context, it is accurate and appropriate to say that immunocompromised populations are especially “vulnerable” to an infectious disease outbreak or that a group may be put “at risk” by researchers through errors or mistreatment. However, these terms become problematic when they are used as general descriptions of populations or communities, or used as euphemisms for poor communities, communities of color, communities in particular geographies, etc. This is a disrespectful and over-generalized way to describe a group of people. In each of the examples above, the specific context provides the framework needed for the term to be used accurately and appropriately. Using these terms more broadly, or with inadequate context, suggests personal weakness or helplessness on the part of those being described rather than drawing attention to the systemic reasons the vulnerability exists in the first place. At PATH, these and similar terms should only be used in clarifying context. If communicators cannot name precisely what people are at risk of, vulnerable to, marginalized by, etc., they should avoid using those words.

Rather than replacing these terms with alternatives, we encourage you to either include the context (what the group is vulnerable to and why) or simply remove the modifier.