HWZ’s Bad Word List

Unlike other bad words, you can say them in public without censure and print them in the newspaper. But why bother? These are words that either blunt the emotional impact of critical health issues, or that don’t seem to mean anything at all. And please feel free to send in additions to the list — but bear in mind comments are moderated, so don’t send in the kind that can’t be printed as opposed to the kind that shouldn’t be.

Abstinence — “The U.S. Ambassador emphasized that abstinence was the best way to avoid exposure to HIV.” Because this list is in alphabetic order, this word that is at once innocuous and controversial is at the top. It is on the list though, for the same reason nearly every other word on the list is: it is a shortcut that communicates too little about a complicated concept. Although the online dictionary I use, as well as the one on my computer both insist the word abstinence primarily refers to laying off alcohol, these days, when used in health stories, the word usually is intended to mean “not having sex” or “postponing the start sexual activity.” Both are easier said than done, and concepts worthy of being spelled out and questioned, particularly as talking about “abstinence” has not yielded demonstrable gains in efforts to lower transmission rates. When people use this word, ask what they mean. Their answer will add to your story.

Food-insecurity – “food insecurity is another problem for HIV and TB patients.” How about, “people who can’t count on their next meal face another challenge to staying on life-saving medication.” While “food-insecurity” is efficient shorthand for NGO staffers, it gives the impression to readers that some people have an emotional problem — instead of a life-threatening deprivation.

Full-blown AIDS — seems redundant, carries an air of extra stigma, and gives the false impression that this is a distinct category of AIDS.

Grassroots — “The grassroots organisation built a clinic in the village.” A participant suggested this one, pointing out that he never knows what this means. It would be more enlightening and more interesting to say “the organisation made up of local residents”, or if that is not the case,  “the organisation of student volunteers” or whatever other accurate description you can give of the people involved in an effort. It is better to be specific, and avoid a word that has become overused, and frequently misleading.

Hygiene — “The official urged residents to apply strict hygiene to avoid getting the flu.” And what might those be? Again a wholesome word that simply isn’t specific enough. Hygiene encompasses bathing, laundry, housecleaning — is even frequently used to urge not littering. Here the idea is probably to wash your hands with soap and water, use a handkerchief, and sneeze or cough into your elbow, rather than your hand or the open air. Who knows? It would be good to ask, rather than send your readers on a housekeeping binge.

Imbecile — This word would be here if it hadn’t been used in a recent news story to characterise an “old and blind” woman — who had been raped — imparted a demeaning image, and failed to impart that the victim of this crime suffered from age-related mental disabilities.

Implement: To fulfill, perform, carry out or put into effect. “The program was implemented to . . .” It doesn’t say what happened.  Was it started? Did the government hire 50 people? Did it open its doors to 3000 patients? Why not ask what it did. Any answer is likely to be more interesting than “implement.”

“Innocent” victims of HIV transmission — And who isn’t? But this revealing word, used to describe people whose exposure to the virus came from a blood transfusion, and that was recently heard to describe infants whose exposure came from their mothers, reveals more about the frame of mind of the speaker, than about the nature of HIV transmission. The obvious implication, although it would be nice to believe anyone who uses this pointless term doesn’t realise it, is that others living with HIV deserved to contract it — in short were guilty of something. Needless to say, never use the word innocent to describe any of the millions of people living with this merciless virus, and if you hear it used, request clarification. In addition, note, below, the many problems with the alphabet soup of “PMTCT.”

Morbidity and mortality – “(fill-in-the-blank) is a major cause of morbidity and mortality among children younger than five. . .” – what about “sickness and death”? Read the sentence both ways, and you tell me which one has more emotional power, and is easier to understand.

Old — How old is old? Do your readers a favor and be specific.

Peer educator — overused, this word has come to substitute for information about who is doing what, and why. A paid employee who happens to be about the same age as a client, and lives in the same community is not necessarily a “peer educator.” A prisoner who has been trained to help communicate information about HIV to other prisoners is a peer educator — but the description of what the prisoner does is more interesting than the title “peer educator.”

Prostitute — Think twice before you use this judgement-laden word that sums up a woman’s circumstances as her identity.

“Risk” — as in “risk groups” or “high risk behaviors.” The first is simply inexcusably stigmatising, at a time when we should have learned that we have met the risk group and it is us. The second is simply mystifying. Why, if you are in a position to reach a mass audience would you pass on an opportunity to describe those “behaviors” (unprotected sex, sharing, or being exposed to implements (razors, needles)  that have had contact with blood), in favor of this stilted, distancing and uninformative expression. Ditto for the officials who use this language in speeches. Either grab a different quote, or grab the official afterward and ask for a fuller explanation.

Sensitize – “the results show the need to sensitise women to the risks of cervical cancer” What is it like to be “sensitized?” Is it like being told something? Is like having something explained to you? And if you are sensitized will there be a clinic near enough to help you to do something about whatever you were “sensitized” to do? Often this word sounds like a fancy way of calling the victim of a situation “insensitive” (or worse). It’s not a word you would use in normal speech “I am trying to toilet-sensitise my child” so why use it to describe situations even more in need of clarification.

Stakeholders — “He praised the innovative HIV prevention programme and urged all stakeholders to invest in it.” “Government officials, donors and stakeholders attended the opening of the new clinic” What’s a stakeholder? This always slows me down, particularly as I wonder who, within the readership or listening area, is not a stakeholder in addressing critical health issues. By the time I finish thinking about that, my attention has wandered and I am reading the next story about what one politician said about another. “Stakeholder” tells nothing and has become numbingly boring through repetition. How about “Government officials, donors and residents of the area, who say they have waited 10 years for the completion of the clinic, attended the opening.” And “He praised the innovative HIV prevention programme, and urged the students who will benefit from it the most to participate in it.”

Sustainable, Sustainability — “The official said his country was willing to invest in sustainable development.” This is a donor-world word that tends to let outsiders define what other people really need. That’s a big responsibility for a word that has slippery meanings. Is something sustainable because people are willing to keep funding it? Is it unsustainable because it doesn’t suit a donors needs? This is one of those words that could yield a more interesting story if you ask for an explanation when you hear it.

Vector – “ . . . the vector that carries malaria . . .” A journalist who has worked for many years in Africa suggested the inclusion of this word. The question is: Who are you writing for? If you are writing for a public health expert, an epidemiologist, or a biologist, or someone else who finds this word communicative, go ahead and use it. If you are writing for a diverse audience that could include people who don’t normally use words like “vector,” why not say: “ . . . the insect that carries malaria . . .”

Alphabet Soup:

This is NGO talk — acronyms that may serve a purpose for the nongovernment organizations that invented them, but that possibly do them a disservice as well, because they make critical goals abstract. They do nothing to elucidate news stories.

ART (Antiretroviral Treatment) Okay, except what does it do? Again too important not to say “only 60 percent of people living with AIDS who need life-saving treatment are getting it” instead of “the program has delivered ART to 60 percent of eligible patients.”

FGM (Female Genital Mutilation) When you have nickname for something, doesn’t that make it sound casual, benign, acceptable? Which the still-used “female circumcision” — an inaccurate, and neutral sounding term for a harmful practise also does. If you are going to write about a serious health issue with horrific and potentially fatal consequences, tell the reader what you are talking about.

GBV victim — (victim of Gender-Based Violence) A friend mentioned this addition, to the shame of healthwriterZambia who wishes she had thought of it first. “How about battered wife?” my friend suggests, instead. A perfect example of how Alphabet Soup robs issues worth talking about of their meaning.

IPT — (intermittent preventive treatment or intermittent presumptive treatment) Part of the problem with this acronym, is that the words it stands for vary according to who you ask. Both refer to giving anti-malaria medicine to all pregnant women who can get it, to keep mother and child from getting a potentially fatal and debilitating illness. With malaria one of the leading causes of maternal and child death, why pass on a chance to spell out what needs to be done to prevent it?

ITNs — (insecticide-treated nets) This is far from the most egregious of the Alphabet Soup servings, but it is still pointless and even potentially misleading. When a government or NGO representative discusses the distribution of X number of “ITNs” it sounds like an end to malaria amongst the beneficiaries can’t be far away. Using words instead can make the situation clearer. If readers understand that what is being distributed are nets to hang over beds they may also more readily grasp the potential limitations of that solution — in places where people sleep outside and have nowhere to hang the nets from, for example.

MDG (Millenium Development Goals) — Too often we read about gruesome situations, ones that we wouldn’t wish on our worst enemies — children dying of treatable illnesses, women dying in childbirth for want of trained attendants, the spread of preventable diseases — only to have the depiction end with the thought that if the lapses allowing those tragedies to happen aren’t fixed, the country in question will fail to meet MDG _______ (fill in the blank). This, whether you mean well or not is the trivialization of human life. Better to say that in addition to the misery depicted, the country in question has set a goal that current policies render run counter to. MDG is, once again, a cruel shorthand for something much bigger that your readers can relate to.

NTD(s) — (Neglected Tropical Diseases) This one exemplifies the opportunity lost when using letters instead of words. If these diseases have been neglected in research and funding — which is what the neglect usually refers to — chances are that public awareness efforts of those diseases, or the fact that the term “NTD” has been coined to group them, is low. The words here convey an important topic that can give a dedicated health reporter countless opportunities to tell valuable stories. The letters convey further neglect.

OVC (orphans and vulnerable children) – Tell me when you meet an invulnerable child. How about “orphans and children living in extreme poverty.” Or even:”Orphans and children like four-year-old _________, whose mother leaves her in the care of her six-year brother while she struggles to earn enough for the family to eat every few days.” Again, people are reading these words and you are writing about people. Why not remind people whose life is at stake when we are writing about programs or research?

PLWHA (people living with HIV/AIDS) – I never thought I would have to add this one until I saw it in an alphabet-soup-ridden story recently. It speaks for itself. If you are writing about people, take the trouble to spell it out.

PMTCT (Prevention of Mother To Child Transmission) — The problem here is how this worthy goal is — or isn’t acheived. Preventing women of child-bearing age from becoming infected? Helping women living with HIV prevent unintended pregnancies? Preventing transmission from a mother living with HIV to her child before or after birth? Too often the term PMTCT is used without clarification, or without examining the effectiveness of addressing only one or two parts of that equation. Finally, it has been suggested that a better term would be “Prevention of Parent to Child Transmission,” as it is not until prospective parents of both genders know their status that this viscious cycle of the epidemic can be effectively addressed.

TC (Testing and Counseling) — I am told this is the new, two-letter abbreviation for VCT (below). This would be a relief, as it doesn’t call stop me mid-sentence to wonder if IVCT (involuntary counseling and testing) is going to be the next big acronym to confuse our readers. But it is just as much of a waste of space. Testing for the virus that leads to AIDS, and the appropriate counseling that should accompany that testing, are the most important components to conquering this epidemic until science steps in with something better. We should never pass on an opportunity to draw attention to that.

VCT (voluntary counseling and testing) or, “getting tested for the virus that leads to AIDS” – while usually fewer words is better this is too important a concept to reduce to an acronym.

Obfuscating phrases . . .

” . . . he said, in a speech read for him by . . .”

If someone “says” something, the words come out of that person’s mouth. That person is present, and can then answer a question that may be raised by those words. But too often reporters writing stories from the transcripts of speeches don’t ask those questions — or have the opportunity to ask them — because the author of the speech being reported isn’t actually there. It would be good to make that clearer from the start: “a government spokesperson said today that . . . ” followed by “he was reading a speech from . . .” Then, ask the questions raised by the speech. The answers could always provide a good follow-up story.

” ______________, the HIV capital of . . . ”

Unlike most words, acronyms and phrases on this list I think this term is used to sharpen, rather than blunt the emotional impact of data. A Health Desk participant sent it in withthe mention that it was used in a newspaper commentary by a Zambian HIV activist to describe Livingstone. While the irony intended in using the term to describe a place that is also, inarguably Zambia’s tourism capital, clearer ways to show that irony exist. Say it so many words — what are the numbers, how do they compare to other places that have less money coming in, and what does this say about the nature of the epidemic. What the drivers of the epidemic are in place with exceptionally high rates, can be eclipsed by this breezy phrase, however unintentionally. In the meantime, the label can damage a community that already is struggling with a debilitating public health threat. So look up the data, and say, “_______ struggles with the rates of new HIV diagnoses in the nation.” and then talk about some of the other distinctions of the place. That will be more informative, and less damaging. Incidentally, the link posted here is to the Zambia Demographic Health Survey, which gives HIV prevalence data by province rather than district (with Southern Province showing the third highest rates). Another reason to be careful before you call anyplace that is not the seat of government a “capital” without numbers to clarify.