The RACP is facing an internal push to ban the word ‘vulnerable’ from its official vocabulary, with public health physicians arguing the term is vague and becoming anachronistic.

The limbic is still seeking details, although the RACP announced last week its council had received a proposal from the Australasian Faculty of Public Health to “remove the term from college documents”, but had instead elected to conduct an information campaign for members.

It appears the motion was raised some time ago and exactly how the language would have been revised is unclear, as is precisely which college materials would have been impacted.

And ultimately, the proposal was rejected amid objections from the Chapter of Community Child Health.

Nevertheless, the term remains problematic and should be avoided, says Dr Stephanie Munari, a public health registrar based out of the Burnet Institute in Melbourne.

“As words convey concepts and shape world views, it is imperative that we use precise and transparent language in the various roles we undertake,” she wrote in an RACP Quarterly article (linked here) on behalf of the public health faculty.

“Whether we observe the effects or not, the language we employ each day can have immense ramifications on the lives of those around us.”

Power imbalance

In the piece, written in collaboration with the faculty’s policy and advocacy committee, she said ‘vulnerable’ was a word of convenience that suffered the major flaw of being indiscriminate and vague.

It was also “deficit language”, implying an “inherent inadequacy” that could “create or reinforce a power imbalance between the labeller and the labelled”, Dr Munari added.

“Instead, we should use language that precisely and transparently identifies the underlying problem at hand, resisting temptation to label a population or group ‘vulnerable’,” she said.

“By adopting this approach, the true nature of the situation can be unveiled and targeted solutions better conceptualised and applied.”

“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.”

But in a rebuttal published alongside Dr Munari’s paper, representatives of the Chapter of Community Child Health argued there was still a place for the term.

They said ‘vulnerable’ was well understood as representing groups at higher risk of poor health due to a range of socioeconomic and other barriers, as well limitations due to illness or disability.

“The term ‘vulnerable children’ is widely used because it is a summary term that highlights children who are at risk because of their life circumstances,” the authors added.

“It incorporates children who have been traumatised by their adverse experiences before or after birth, or who have pathophysiological or neurodevelopmental conditions that make them susceptible to doing poorly.”

“We do acknowledge that using the term to describe patients or their families (particularly in formal correspondence) is not acceptable; however, it remains useful when describing population groups. We support the move to using positive framing, but believe there is still a place for using ‘vulnerable’ within the college.”

Controversial

Whether the push will go any further is unclear, although the council released a communique after its meeting in October 2020 which said it was “exploring the use of the term” with other college bodies and its senior leadership team.

“Council members agree that rethinking the term vulnerable could become controversial for a range of reasons, but that using clear and consistent language among physicians and the wider industry is key to correct messaging and communication,” the communique said.

“Further discussion and consultation will occur.”

But it appears that those hoping to eliminate the word may be fighting a losing battle, with a PubMed search showing its use has increased steadily in medical literature, appearing in a record 21,764 papers last year.

This compared to 18,367 hits for the word in 2020 and just 6,013 in 2010, according to the database.