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Person-first and Destigmatizing Language

Person-first language is a way to emphasize the person and view the disorder, disease, condition, or disability as only one part of the whole person. Describe what the person “has” rather than what the person “is.” Person-first language avoids using labels or adjectives to define someone, e.g., a person with diabetes not a diabetic; or person with cancer not cancer patient; or a person with bipolar disorder not a person who is bipolar.

Some communities, however, prefer identity-first language because they consider some characteristics as inseparable parts of their identity. Those who prefer identity-first language consider it a way to show pride in who they are and their membership in a community of similar people. The deaf and autistic communities, for example, often show a strong preference for identity-first language. When possible, ask if a person or group uses identity-first language (deaf students) or person-first language (students who are deaf). Default to using person-first language if preference is not known or cannot be determined.

See the and the NIH article Writing Respectfully: Person-First and Identity-First Language for more on person-first language and other inclusive principles.

Brain injury vs. brain damaged

A traumatic brain injury (TBI) can be caused by a forceful bump, blow, or jolt to the head or body, or from an object that pierces the skull and enters the brain.

A traumatic brain injury should not be referred to as a head injury, which should be reserved for cases where the head is injured without damaging the brain.

Blind

says to use the term blind to describe someone with complete loss of sight. Use legally blind to describe someone with “almost complete loss of sight.” Another option is low vision. NCDJ recommends against using the term visually impaired. Ask your source what they prefer and if they prefer identity-first (blind students) or person-first (students who are blind) language.

Caesarean delivery vs. c-section

In general, use caesarean delivery, caesarean birth, or abdominal delivery instead of caesarean section or c-section. This is a divergence from AP style.

Caregiver, care partner vs. caretaker

Use caregiver, rather than caretaker, to describe people providing care. The term caretaker generally refers to a person who takes care of something, such as a house, when the owner isn’t present.

Both caregiver and care partner are acceptable but consider the situation and individual’s preference before choosing a term. A caregiver provides care for someone who cannot care for themselves. A care partner is a partner in care, and this term is sometimes preferred to show that the person with the disease is able to care for themselves with some assistance.

Deaf

According to : “Deaf and hard of hearing became the official terms recommended by the World Federation of the Deaf in 1991. Many people in the Deaf community prefer the use of the lowercase ‘d’ to refer to audiological status and the use of the capital ‘D’ when referring to the culture and community of Deaf people.” Always ask your source what they prefer; some deaf people do not consider themselves to be a part of the Deaf community. If writing generally, it’s best to use what the community at large uses, which is identity-first language (deaf adults).

Avoid the term hearing impaired.

NCDJ says: “When quoting or paraphrasing a person who has signed their responses, it’s appropriate on first reference to indicate that the responses were signed. It’s acceptable to use the word ‘said’ in subsequent references.”

Developing nations vs. third-world countries

Use developing nations or developing country instead of third-world countries. The term third-world country is dehumanizing and offensive. The World Health Organization uses the following data-based terms instead (abbreviations included because they are commonly used). Whenever possible, specify the exact country or countries to avoid labeling altogether.

• Low- and middle-income country (LMIC) and low- and middle-income countries (LMICs)
• Upper-middle-income country (UMIC) and upper-middle-income countries (UMICs)
• High-income country (HIC) and high-income countries (HICs)

Disproportionately affected vs. vulnerable groups

Avoid use of terms such as vulnerable, marginalized, and high-risk as adjectives. These terms are stigmatizing and vague. They also imply that the condition is inherent to the group rather than referencing the actual causal factors.

If possible, be specific and reference the actual causal factors. For example:

• Disproportionately affected [by climate change]
• Groups that have been [economically/socially] marginalized
• Communities with high [incidence/prevalence/burden]
• People exposed to [HIV]
• Groups experiencing disadvantage
• Groups experiencing a disproportionate impact [of air pollution]
• Population of focus
• Under-resourced communities
• Medically underserved communities
• People who lack access to health care services

Diversity

Diversity is a broad, umbrella term and should not be used as a stand-alone buzzword when a specific term or phrase would be more applicable and meaningful. Diversity includes all aspects of human identities and encompasses every aspect of difference, including race, ethnicity, sex, gender, religion, disability, neurodiversity, socio-economic status, education, and much more. For example, are you using diversity when you really mean minority health and other NIH-designated populations that experience health disparities in clinical study populations?

Or, when you use the term diversity are you referring to the biomedical research workforce? While not a complete list, see NIH’s Office for Scientific Workforce Diversity’s page on for an example of the groups that have been identified as underrepresented in the workforce.

Diversity, Equity, Inclusion, and Accessibility (DEIA)

Please see the NIH-Wide Strategic Plan for Diversity, Equity, Inclusion, and Accessibility (DEIA).

This term is appropriate to use in the context of NIH or federal workforce diversity, where we have specific metrics and measurements for structural and organizational change. The term DEIA is not appropriate for NOFOs or external communications where we couldn’t know or approximate the metrics institutions outside the federal government are using.

Engage, prioritize vs. target, tackle

Use engage, prioritize, or consider the needs of instead of tackle, target, combat, or other terms with violent connotation when referring to people, groups, or communities.

These terms are okay to use when referring to disease, e.g., “NIH works to combat Alzheimer’s disease and related dementias...”

Failed treatment

Do not use the patient failed treatment, which inappropriately blames the patient. Use the treatment was not effective in the patient or the patient did not respond to treatment, instead.

Food insecurity

Food insecurity, when households lack access to adequate food because of limited money or other resources, is a leading health and nutrition issue in the United States. Reference the for ranges of food security and use recommendations. These terms may require brief explanations if the meanings aren't clear from the context.

Food insecurity is related to suboptimal and/or poor diet quality, which increases chronic disease risk among the socioeconomically disadvantaged.

Health disparities

Please see the .

A health disparity is a health difference that adversely affects disadvantaged populations in comparison to a reference population, based on one or more health outcomes. All populations with health disparities are socially disadvantaged due in part to being subject to racist or discriminatory acts and are underserved in health care.

Populations that experience health disparities include:

• Racial and ethnic minority groups
• People with lower socioeconomic status (SES)
• Underserved rural communities
• Sexual and gender minority (SGM) groups
• People with disabilities

HIV vs. HIV/AIDS

Please see the National Institute of Allergy and Infectious Diseases’ .

HIV stands for human immunodeficiency virus, which is the virus that causes HIV infection. The abbreviation “HIV” can refer to the virus or to HIV infection.

AIDS stands for acquired immunodeficiency syndrome. AIDS is the most advanced stage of HIV infection.

Immigrant, refugee vs. illegal aliens, foreigners

Use people with undocumented status, mixed-status households, immigrant, migrant, asylum seeker, refugee, or non-U.S.-born people (as appropriate and contextually) instead of stigmatizing terms such as illegals, illegal immigrants, illegal aliens, illegal migrants, foreigners, or the foreign-born.

Intimate partner violence vs. domestic violence

Use intimate partner violence or gender-based violence instead of domestic violence. The preferred terms are more specific and include relevant violence outside of a shared home.

Participants vs. subjects

Use participants, people, individuals, or patients, depending on the context, instead of subjects when referring to clinical trial participants, unless research subjects is specific to a policy or regulation. Not all study participants are patients, particularly in research involving people who are generally in good health.

People experiencing homelessness vs. the homeless

Use people experiencing homelessness, people without housing, or people without homes instead of the dehumanizing collective noun the homeless.

People with HIV

Use people with HIV or people living with HIV instead of HIV-infected people or people infected with HIV. Infection carries the stigma of being contagious, a threat, or unclean. HIV advocates frequently highlight the damaging consequences of this word choice. Living with is an affirmation of life some advocates prefer.

Both PLWH and PLHIV are accepted abbreviations for people living with HIV.

People with lower incomes vs. poverty-stricken, the poor

Use people with lower incomes, people/households with incomes below the federal poverty level, people experiencing poverty, instead of poverty-stricken, the poor, or poor people. Do not use underserved when meaning low socioeconomic status. The term people with lower socioeconomic status (SES) should only be used when SES is defined (e.g., when income, education, parental education, and occupation are used as measures).

Stakeholder vs. collaborator

Avoid the term stakeholder when referring to interest groups, working partners, and community collaborators. Instead, use terms that describe the nature of their influence or involvement.

Stakeholder can be used to reflect a power differential between groups and has a violent connotation for some Tribes and Tribal members. It also groups all parties into one term, despite potential differences in the way they are engaged or interact with a project or activity.

Some alternative terms are interest groups, community members, people affected by [policy/program/practice] or funders, partners, collaborators, allies, community engagement, or Tribal engagement.

Suffering from, afflicted with

Use caution and context to determine whether phrases like suffering from or afflicted with (condition/disorder) are appropriate. The words suffering and afflicted have social and emotional implications that are unhelpful and can be stigmatizing for groups that have experienced discrimination. Use specific medical language instead.

The word suffering can be appropriate in certain contexts, however, like when describing a condition, disorder, or disease with limited treatment options or no cure. E.g., “When patients are suffering, NIH can never move fast enough to help.”

Suicide

Use died by suicide or attempted suicide instead of committed suicide. Commit connotes criminality or sin.

Suicide attempts should not be described as successful, unsuccessful, or failed. Instead, use survived a suicide attempt, just as one might describe an individual who has survived cancer or a heart attack.

Underrepresentation

Underrepresentation is a workforce term, as opposed to health disparities, which relates to population health.  Underrepresented populations are represented in the workforce in numbers that are disproportionately low. For example, women now earn more than half of the Ph.D.s conferred each year in the life sciences, but they make up less than half of assistant professors and few of full professors in academic institutions; in this way, women are underrepresented at the assistant and full professor faculty levels.

Underrepresentation in extramural programs is tied to national representation ratios, not institutional demographic data.

Avoid using the term underrepresentation when discussing study population participants, and use the term understudied, minority health, health disparity populations, or more specific terms, if appropriate. See also: Disproportionately affected vs. vulnerable groups.