Inclusive Language

Remove Today’s Stereotypes

There are many terms to avoid (many of them are considered slurs) or to include when writing or editing stories. Even when preferable terms are suggested, they should not be used except when germane to the story. Usually, you should identify everyone, or no one, by race, sex, age, and so on.

ASK THE SOURCE: Generally, the best way to determine whether a term is prejudicial is to ask the person(s) it covers. For instance, many members of tribes object to the term Indian, although some groups retain it. Many prefer being identified by tribal name; some prefer the term Native American or American Indian. Ask the person her or his preference. That’s the only way to ensure accuracy.

ELIMINATE LABELS: Labels stereotype people, annoy audiences and are out of date as language shifts to modernize. Stereotyping all people in a group as acting or being like all others in that group only blinds us to individuals’ possibilities and characteristics. Expecting every white male to be like all white males is just as racist and sexist as expecting all black females to be like all other black females.

DROP RACE, SEX, AGE OR DISABILITY TAGS: Don’t provide someone’s racial, ethnic, or religious background; sex or sexual orientation; or age or disability unless it’s relevant to the particular story. The days of the “she’s a college profess, but she’s black” story were naïve because they showed a white-press prejudice. That lack of understanding will push your audience away. 

PAY ATTENTION: Remember: Fair, objective language cannot be determined solely by popular usage or rules in books that can have the effect of freezing current understanding. Language changes daily as it responds to an increasingly global culture that changes at an accelerating speed.

The constant revision of language is not easy, as seen by arguments over acceptable and unacceptable language in a globally interdependent society. The controversy over terms are “politically correct” will grow as the world slouches toward multilevel multiculturalism.

Inclusive Language, AMA Manual of Style

JAMA and the Archives Journals avoid the use of language that impacts bias against persons or groups on the basis of sex, race or ethnicity, age, physical or mental disability, or sexual orientation. The careful writer avoids generalizations and stereotypes and is specific when choosing words to describe people.

Sex/Gender: Sex refers to the biological characteristics of males and females. Gender includes more than sex and serves as a cultural indicator of a person’s personal and social identity. An important consideration when referring to sex is the level of specificity required: specify sex when it is relevant. Choose sex-neutral terms that avoid bias, suit the material under discussion, and do not intrude on the reader’s attention. 

Personal Pronouns: Avoid sex-specific pronouns in cases in which sex specificity is irrelevant. Do not use common-gender “pronouns” (e.g., “s/he,” “shem,” “shim”). Reword the sentence to use a singular or plural pronoun that is not sex-specific, a neutral noun equivalent, or a change of voice; or use “he or she” (“him or her,” “his or hers, “they or theirs”).

Avoid: The physician and his office staff can do much to alleviate a patient’s nervousness.  Preferred: Physicians and their office staff can do much to alleviate a patient’s nervousness. (plural) The physician and the office staff can do much to alleviate a patient’s nervousness. (neutral, noun equivalent)

Avoid: Everyone must allocate their time effectively. Preferred: One must allocate one’s time effectively. (singular) People must allocate their time effectively. (plural) Time must be allocated effectively. (change to passive voice) Note: In an effort to avoid both sex-specific pronouns and awkward sentence structure, some writers use plural pronouns with singular, indefinite antecedents (e.g., Everyone allocates their time [note singular verb and “their” instead of “his or her”]) particularly in informal writing. Editors of JAMA and the Archives Journals prefer that agreement in number be maintained in formal scientific writing.

Avoid: One must allocate their time. Everyone must allocate their time. Preferred: One must allocate one’s time. One must allocate time. Everyone must allocate time

Race/Ethnicity: Race is defined as “a category of humankind that shares certain distinctive physical traits.” Ethnicity relates to “groups of people classed according to common racial, national, tribal, religious, linguistic, or cultural origin or background.”

Like gender, race and ethnicity are cultural constructs, but they can have biological implications. Caution must be used when the race concept is described in health-related research. Some have argued that the race concept should be abandoned, on the basis of the scientific evidence that human races per se do not exist. Others argue for retaining the term but limiting its applications to the social, as opposed to the biological realm. 

A person’s genetic heritage can convey certain biological and therefore medically related predispositions (e.g., cystic fibrosis in persons of Northern European descent, lactose intolerance in persons with Chinese or Japanese ancestry, Tay-Sachs disease in persons with Jewish Eastern European ancestry, sickle cell disease seen primarily in persons of West African descent).

Specifying persons’ race or ethnicity can provide information about the generalizability of the results of a specific study. However, because many people in ethnically diverse countries such as the United States, Canada, and some European, South American, and Asian national have mixed heritage, a racial or ethnic distinction should not be considered absolute, and it is often based on a person’s self-designation. 

JAMA and several of the Archives Journals indicate the following in their instructions for authors:

If race and/or ethnicity is reported, indicate who classified individuals as to race/ethnicity, the classifications, and whether the options were defined by the investigator or the participant. Explain why race and/or ethnicity was assessed in the study. See also Winker MA. Measuring race and ethnicity—who and how? JAMA. 2004;292(13):1612–1614.

When the mention of race or ethnicity is relevant to an understanding of scientific information, be sensitive to the designations that individuals or groups prefer. Be aware also that preferences may change and that individuals within a group may disagree about the most appropriate designation. For rems such as white, black, and African American, manuscript editors should follow author usage. 

Exception: Caucasian is sometimes used to indicate white but is technically specific for people from the Caucasus region in Eurasia and thus should be avoided. 

In the United States, the term African American may be preferred to black (note, however, that this term should be allowed only for US citizens of African descent). A hyphen is not used in either the noun or adjectival form.

In reference to persons indigenous to North America (and their descendants), American Indian is generally preferred to the broader term Native American, which is also acceptable but also includes (by US government designation) Hawaiian, Samoan, Guamanian, and Alaskan natives. Whenever possible, specify the nation or peoples (e.g., Navajo, Nez Perce, Iroquois, Inuit). 

Hispanic and Latino are broad terms that may be used to designate Spanish-speaking persons as well as those descended from the Spanish-speaking people of Mexico, South and Central America, and the Caribbean. However, the terms are not interchangeable, since Latino is understood by some to exclude those of Mexican or Caribbean ancestry. In either case, these terms should not be used in noun form, and when possible, a more specific term (e.g., Mexican, Mexican American, Latin American, Cuban, Cuban American, Puerto Rican) should be used.

Similarly, Asian persons may wish to be described according to their country or geographic area of origin, e.g., Chinese, Indian, Japanese, Sri Lankan. Note that Asian and Asian American (Chinese and Chinese American, and so on) are not equivalent or interchangeable. Do not use Oriental or Orientals. 

Note: Avoid using “non-”(e.g., “white and non-white participants”), which is a nonspecific “convenience” grouping and label. Such a “category” may be oversimplified and misleading, even incorrect. Occasionally, however, one sees these categorizations used for comparison in data analysis. In such cases, the author should be queried. Multiracial and people of color are sometimes used in part to address the heterogeneous ethnic background of many people. 

Age: Discrimination based on age (young or old) is ageism. Because the term elderly connotes a stereotype, avoid using it as a noun. When referring to the entire population of elderly persons, use of the elderly may be appropriate (as in the impact of prescription drug costs on the elderly, for example). Otherwise, terms such as older persons, older people elderly patients, geriatric patients, older adults, older patients, aging adults, persons 65 years and older, or the older population are preferred. 

Note: In studies that involve human beings, age should always be given specifically. Researchers in geriatrics may use defined terms for older age group, e.g., young-old (usually defined as 60 or 65–70 or so years) and old-old (80 years and older).

            Adultism is a form of ageism in which children and adolescents are discounted.

Disabilities: According to the Americans with Disabilities Act, “a disability exists when an individual has any physical or psychological illness that ‘substantially limits’ a major life activity, such as walking, learning, breathing, working, or participating in community events.

Avoid labeling (and thus equating) people with their disabilities or diseases (e.g., the blind, schizophrenics, epileptics). Instead, put the person first. Avoid describing persons as victims or with other emotional terms that suggest helplessness (afflicted with, suffering from, stricken with, maimed). Avoid euphemistic descriptors such as physically challenged or special.

AVOID	PREFERRED
The disabled, the handicapped	Persons with a disability
Disabled child, mentally ill person, retarded person	Child with a disability, person with mental illness, person with intellectual disability, person with intellectual disability (mental retardation)
diabetics	Persons with diabetes, study participants in the diabetes group, diabetic patients
asthmatics	Children with asthma, asthma group, asthmatic child
epileptic	Person affected by epilepsy, person with epilepsy, epileptic patient
AIDS victim, stroke victim	Person with AIDS, person who had a stroke
Crippled, lame, deformed	Physically disabled
Deaf	Deaf persons, deaf adults, deaf culture or community
Confined (bound) to a wheelchair	Uses a wheelchair

Avoid metaphors that may be inappropriate and insensitive (blind to the truth, deaf to the request). For similar reasons, some publications avoid the term double-blinded when referring to a study’s methodology. Note: Some manuscripts use certain phrases many times, and changing, for example, “AIDS patients” to persons with AIDS” at every occurrence may result in awkward and stilted text. In such cases, the adjectival form may be used