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Views & Reviews Live from London

Mind your language

BMJ 2008; 337 doi: (Published 15 October 2008) Cite this as: BMJ 2008;337:a2111
  1. Deborah Cohen, features editor, BMJ
  1. dcohen{at}

    “Rather than improving their response capacity and anticipating new challenges, health systems seem to be drifting from one short-term priority to another, increasingly fragmented and without a clear sense of direction.” This is from the World Health Organization’s world health report for 2008, Primary Health Care: Now More Than Ever, published this week (see News, doi:10.1136/bmj.a2109). This snappy quote appeared in a press release specifically designed to grab an editor’s attention. And grab my attention it did—for all the wrong reasons. It highlighted a current personal annoyance: global healthspeak. I’ve come to loathe it.

    Without wanting to sound too much like a beauty pageant candidate, I very much care about global health and neglected diseases. In fact it’s the reason I studied medicine in the first place.

    But I can’t help wondering whether all the jargon is really helpful other than communicating with other global health devotees—and I’m not sure that if you tested a random sample they would be able to accurately define its meaning. Let’s give it a go: civil society, grassroots, engagement, scaling up, actors and players . . . the list goes on.

    What’s the problem, you may well ask. Medicine is replete with acronyms and jargon, with one of the worst offenders being public health, as a study earlier this year showed (Public Health doi:10.1016/j.puhe.2008.05.012). But the problem for global health is that the proponents want to be heard and to push their issues higher up the political agenda—they want to “engage.” At best, global health jargon obfuscates important messages and sounds cliched; at worst it appears elitist and cliquey—something probably worth avoiding if you’re trying to better the lot of people at the bottom of the pile.

    I have a little game I play when I go to conferences and workshops in the global health “arena.” It’s rather imaginatively called “Insert the issue.” While listening to participants unleash their rhetoric I try to work out how many different issues the said speech could apply to. The language is often flabby and imprecise, giving messages without saying much at all. It could literally apply to anything. (At this point I’d like to add that there are some remarkable campaigners who refuse to play the game, and as an arrogant native English speaker I allow for those who are able to converse in what is often their fifth language.)

    Inevitably there’s someone who will say—in all seriousness—that civil society needs to be engaged to ensure that health systems can be scaled up. If someone could tell me what this means in plain English I’d be most grateful. My problem with global healthspeak isn’t the content, it’s the delivery. That global health deserves a platform and investment is without question. But while the message might be strong, perhaps the language needs to change.


    Cite this as: BMJ 2008;337:a2111

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