Why should equality be a priority for all of us? Genuine intentions are essential to tackle diversity—when the intention is not genuine, one ends up with little more than tokenism.
Equality and inclusive language go hand in hand. Inclusive language is complex, seeking to embrace diversity and treating all people with respect, dignity, and impartiality. What is more complex than diversity?
What should medical writers focus on when they aim to be inclusive when drafting texts?
To start with, what is #inclusivelanguage❓
"𝘓𝘢𝘯𝘨𝘶𝘢𝘨𝘦 𝘵𝘩𝘢𝘵 𝘢𝘷𝘰𝘪𝘥𝘴 𝘩𝘢𝘳𝘮𝘪𝘯𝘨 𝘰𝘳 𝘰𝘧𝘧𝘦𝘯𝘥𝘪𝘯𝘨, 𝘪𝘴 𝘳𝘦𝘴𝘱𝘦𝘤𝘵𝘧𝘶𝘭, 𝘢𝘤𝘤𝘶𝘳𝘢𝘵𝘦, 𝘢𝘯𝘥 𝘳𝘦𝘭𝘦𝘷𝘢𝘯𝘵, 𝘢𝘯𝘥 𝘥𝘰𝘦𝘴 𝘯𝘰𝘵 𝘱𝘦𝘳𝘱𝘦𝘵𝘶𝘢𝘵𝘦 𝘱𝘳𝘦𝘫𝘶𝘥𝘪𝘤𝘦, 𝘴𝘵𝘪𝘨𝘮𝘢, 𝘰𝘳 𝘦𝘳𝘢𝘴𝘶𝘳𝘦." (Emilia Harding)
Observers need to advocate, confirm, and utilise the terminology people use to describe themselves. Check with each person to see which terms they prefer. This may not always be feasible, but we must remember several concepts to avoid non-inclusive and ableist language.
There are two approaches to using inclusive language:
- "Person-first"; and
The "Person-First" approach prioritises the human aspect in everyone, using language that places the person ahead of a specific part of their identity. An example of this is the term "person with a physical disability" instead of "disabled person." This method is beneficial in creating inclusive environments for everyone and complements the "Identity-First" approach.
The "Identity-First" approach acknowledges that people's experiences and circumstances are often crucial to their identities, and some individuals who identify with a particular term may prefer this approach. An example of this is stating gender identity only if relevant. "Guests are cordially invited to attend with their partners" instead of "Guests are cordially invited to attend with their wives". (un.org)
What are the 8 key considerations when writing an inclusive text you should not forget❓
- Race, ethnicity and appearance: This refers to the different races and ethnicities people may identify with. Remember that a person’s race, ethnicity, or nationality cannot be determined simply by looking at them. Using preferred terminology and self-identified by a community is crucial when discussing matters related to race and ethnicity, rather than relying on what is accepted by those in positions of dominant power and influence.
- Sexual and romantic orientation refers to how people may identify their sexual and/or romantic attractions. This also relates to age without considering that certain age groups cannot be sexually active or romantic. Denote a specific gender, sex, and gender identity only where it is relevant. Take care to distinguish between three interrelated terms, biological gender, sex, and gender identity, when necessary.
- Age refers to the different stages of life that people may be in, from children to elderly adults. We should avoid stereotypes, such as 'the elderly may be frail, while young people may be healthy', as this is not always the case. The c4disc guidance (referenced below) advises avoiding age discrimination and only including an individual’s age or age grouping if it is essential to the text or context.
- Religion refers to people's different beliefs and practices regarding spirituality or faith. In most cases, it is unnecessary to specify people's religious beliefs or affiliation unless it is contextually relevant and essential to convey a particular meaning.
- Neurodiversity refers to the natural variations in how people's brains function. Neuroinclusivity deserves an article alone, as it is a vast field. Still, there are fascinating publications, and the aim here is a brief introduction. If this field interests you, I encourage you to start by reading an excellent piece by Dr Sarah Chellappa (https://www.nature.com/articles/s44220-023-00028-w).
- Socioeconomics and geopolitics refer to the different economic and social classes that people may belong to, including but not limited to their income levels, education or occupation. This consideration could also refer to the different political and geographical contexts that people may come from, including, but not limited to, nationalities and languages. Consider who is controlling the narrative. A good example would be to contemplate whether it is appropriate to mention someone's lower-income family background when the background of an individual from a higher-income family would not be disclosed.
- Crime/incarceration refers to the different experiences that people may have had with the criminal justice system, including but not limited to being incarcerated or having a criminal record. Vaes, J et al. published an interesting study analysing how Italian journalists cover crime. Results showed that the style and language changed when reporting crimes involving marginalised racial or ethnic minorities (“outgroups”), revealing that using linguistically biased language increased crime-related associations with the outgroup.
- Disability refers to the different physical or cognitive impairments that people may have. There is no consensus on distinguishing a disability from a disorder, disease, or other health condition. Some people do not consider their condition an impairment, and under the social model of disability, the environment, not a physical or cognitive difference, could be the disabling factor. Only mention disability when needed and relevant, and avoid labelling or framing.
We all do better when we all do better. -Paul Wellstone
Finally, we know that words alone are not the only primary tool in communication processes. Medical writers are increasingly using visual communication to convey an effective message. Inclusive images intentionally include people with diversity and seek to portray people respectfully, and disrupt stereotypes. In a 2019 Forum One blog post, Acacia Betancourt suggests asking specific questions to prevent bias when selecting images, including the crucial question of "Who is missing or excluded?" Also, it is relevant to ask who has traditionally been excluded or omitted from this type of content. But again, remember not to end up in tokenism.
There are so many resources out there that it is time to stop creating them and start using them! This reminds me of a close field; lay language (plain language, non-technical language, etc.). So much research has been published on the topic. It is time we stop studying it and start using it.
Here are a few resources that may help you navigate the topic.
Inclusive language guides
Would you happen to know which publications and webinars are a good start? Here you have some useful ones:
- Emilia Harding's EASE webinar: https://www.youtube.com/watch?v=MS9NuaIoxog
- Chellappa, S.L. Language matters for neuroinclusivity. Nat. Mental Health 1, 146 (2023). https://doi.org/10.1038/s44220-023-00028-w
- Vaes, J., Latrofa, M., Suitner, C., & Arcuri, L. (2019). They are all armed and dangerous! Biased language use in crime news with ingroup and outgroup perpetrators. Journal of Media Psychology: Theories, Methods, and Applications, 31(1), 12–23. https://doi.org/10.1027/1864-1105/a000216
- Guizzo, F., Cadinu, M., Galdi, S., Maass, A., & Latrofa, M. (2017). Objecting to objectification: Women’s collective action against sexual objectification on television. Sex Roles: A Journal of Research, 77(5-6), 352–365. https://doi.org/10.1007/s11199-016-0725-8
- ‘Tokenism Isn’t the Way To Achieve Diversity and Inclusion’. Health, https://www.health.com/mind-body/health-diversity-inclusion/tokenism. [Accessed 31 Mar. 2023].
Acknowledgement: I thank Heather Mason PhD Mason for her assistance in editing the text and contributing to the topic.