As physician Fellows and trainees, we are powerful advocates for the communities we serve. As words convey concepts and shape world views, it is imperative that we use precise and transparent language in the various roles we undertake. How we frame health as an issue has never been more far-reaching than in today’s world of online platforms and instant communication. Whether we observe the effects or not, the language we employ each day can have immense ramifications on the lives of those around us.

The word ‘vulnerable’ and similar terms such as marginalised, disadvantaged, disenfranchised, at-risk and underserved are widely used throughout health discourse (Munari 2021). Although these terms have been used with good intent to help identify needs and appropriately direct funding and resources, there are two predominant problems with this kind of terminology.

Firstly, the term vulnerable is indiscriminate and vague, concealing, in certain cases, the wider structural and systemic causes of health inequity. It is a term of convenience used strategically to draw political and financial attention to the issue in question (Katz 2019). Instead, we should use language that precisely and transparently identifies the underlying problem at hand, resisting temptation to label a population or group ‘vulnerable’. By adopting this approach, the true nature of the situation can be unveiled and targeted solutions better conceptualised and applied.

Secondly, the use of terms such as vulnerable is deficit language, implying an inherent inadequacy on behalf of the labelled. Such categorisation can create or reinforce a power imbalance between the labeller and the labelled, also implying an assumption of ‘invulnerability’ of the former. Use of such terms has elsewhere been likened to scientific racism, veering perilously close to biological determinism, eugenics and social Darwinism (Katz 2019).

After reading this, Fellows and trainees might ask, “So what term am I supposed to use instead?” Yet the solution is not a simple matter of substitution. Ask yourself, “Why am I using this term?” – moving from an unconscious to a conscious process. We aim to provoke thought and discussion on this concept and to challenge the reader to look beyond the term itself.

Before writing your article or giving your presentation to Grand Rounds, ask “Why is this person, group or community seen as vulnerable?” Fellows and trainees hold positions of power in our communities by virtue of expert knowledge and respected positions within society. With this privilege comes the responsibility to advocate for our patients and communities in a way that respects and affirms those whom we serve. As a group, we are much more likely than many others to be economically comfortable and socially secure, so our choice of words is critically influential.

To illustrate, people from refugee backgrounds living in Australia who are culturally and linguistically diverse have been described as vulnerable due to the high rates of mental health problems within this population (AIHW 2018). But why are these people vulnerable? Is it because they live in a predominantly English-speaking community with few services and supports that address their needs in an accessible way? Is it because they are unable to work in their trained professions and earn an adequate income due to immigration law and visa restrictions? These are worthy questions, even more worthy of comprehensive answers. Unpacking the ‘why’ invokes a wider lens and helps us identify the upstream structural influences on our community’s health and wellbeing.

Others have used the term ‘vulnerable’ to secure greater government attention for a cause or need. Yet this is counterproductive in the longer term, typecasting a population or group as desperate or without agency. There is no simple solution to this challenge. The College, in preparing its own media statements and advocacy position papers, must start asking “why?” and ensure that complete analysis is explained in its communications. Why are elderly people or Aboriginal and Torres Strait Islander people seen as vulnerable? What circumstances and societal factors contribute to the situation, for which the College defaults to using the term ‘vulnerable’? What exacerbates ‘vulnerability’? When you peak behind the curtain, the cause will often lie beyond the individual themselves.

This point was powerfully conveyed by Cree‐Anishinaabe Assistant Professor Dr Marcia Anderson, Chair of the Indigenous Health Network for the Association of Faculties of Medicine at the University of Manitoba in Canada, when she Tweeted “From now on instead of ‘vulnerable people’ I’m going to use the phrase ‘people we oppress through policy choices and discourses of racial inferiority’. It’s a bit longer but I think will help us focus on where the problems actually lie.” (Anderson 2017, as cited in Munari 2021). Employing this kind of critical thinking readily unveils many of the upstream causes of health disparity and can help clarify strategic responses by more accurately describing the true determinants of the situation. This way of thinking also reminds us that a person’s health and wellbeing is a culmination of biomedical, relationship, community and societal drivers that extend beyond the individual, as described by the socio-ecological model (Bronfenbrenner 1989, as cited in Kilanowski 2017).

Finally, consider strengths-based language. This way we can instead focus on what the population in question has to offer, rather than describing only a deficit. Strengths-based language is affirming, beneficial and respectful. It requires analysis of positive drivers of health and wellbeing for an individual, groups and communities. An example of such language is the use of ‘priority population or communities’. These are people for whom focused attention through funding and resources is required to work towards a more equitable health status (Blow 2020). A partnership approach is required to reduce the risk of irrelevant policy, programs or advocacy that miss the mark. Like any language used to define a population, strengths-based terminology should equally be clearly defined when used in discourse. Using such affirming language can also act to shift our attention towards an improved future and start to lay the bricks on the pathway needed to get there.

Language will continue to change and evolve, and it is our professional responsibility to stay abreast of how the language we use influences the opinions constructed in policy and practice. As physicians we are advocates. The obligation to reframe many of the issues affecting our community’s health is not only in our hands but in our words.

Stephanie C Munari, Trainee member, AFPHM Policy and Advocacy Committee, in collaboration with the AFPHM Policy and Advocacy Committee