As a medical copywriter, I’ve written a lot of health-related articles and documents over the past six years or so and one thing I’ve found is that often the most time-consuming part of the job is not the research and fact-checking, but the agonising over how to make that copy inclusive.
Look up any info about pregnancy, breast cancer, prostate health, or other typically gendered health topics and you’ll likely find a bunch of assumptions about the people affected by those issues.
“So what?” you might ask, and it’s a fair question, given that the majority of people who experience pregnancy are straight cisgender women who intend to be parents and are in a relationship with a straight, cisgender man. And, again, most people who develop breast cancer are cis women, while most people with a prostate are cis men.
Why make my life more difficult than it has to be, and run the risk of irking (or even losing) clients by consciously avoiding gendered terms in the copy I write?
Well, the short answer is, because a little bit of difficulty on my part is nothing compared to the daily microaggressions experienced by transgender folks, intersex folks, those who are genderqueer, and others who just don’t fall into the gender binary or the simple male/female sex categories.
OK, so that wasn’t a short answer.
Why use one word when you can get paid to use 70, right?
Just kidding. (No one’s paying me to write this, sadly.)
To clarify, I don’t have a huge problem with articles with snappy titles like, “5 top tips for moms-to-be,” or, “6 Things Every Woman Should Know About Losing Weight After Pregnancy” or, “17 reasons why men get man boobs.” Actually, that last one would give me pause.
These articles have a specific audience in mind and can be useful to that audience. They may be annoying, dismissive, and even downright offensive to people who don’t identify as cisgender or straight, or who are sick of weight-loss articles, but the information in these pieces isn’t necessary for good health and can be passed over in favour of more inclusive publications that are much less clickbaity.
My problem is more with the websites and leaflets and such that purport to be authoritative guides on specific ailments or health issues but that totally fail to recognise the difference between sex and gender, can’t comprehend anything beyond a heteronormative ‘traditional’ family model, and also make the assumption that it’s perfectly fine to write about the average mortality rate, incidence of a disease, or testing done without mentioning the huge disparities between different socioeconomic groups, races, ethnicities, genders, and so forth.
The problem with averages and generalisations
I came across an example recently of the type of problems that can be caused by a lack of specificity and inclusivity in medical copywriting. When reviewing a medical article for a major website, I noticed a statistic regarding the frequency with which women (all assumed cis gender) get their recommended mammograms. A single figure (a percentage) was given in the article, but I knew that this was unlikely to tell the whole story, given that cis gender lesbians and cisgender bisexual women are more likely to die from breast cancer than straight cis women. Sure enough, lesbians and bisexual women are less likely to get routine mammograms, according to the U.S. Department of Health.
I also figured there were probably some differences between people living in the U.S. with a decent household income and people living in poverty. Sure enough, digging into the stats shows that cis women in the lowest percentile for income access recommended mammograms at a significantly lower rate than average (about 42% vs. around 66% for 2013). With a little more digging, it may be possible to find stats on the uptake of mammograms in people who don’t identify as straight cis women.
Inclusivity means more than just gender and sexual orientation
Although I’ve focused largely on issues of gender and sexual orientation so far in this post, it’s also important to realise that medical copy can be alarmingly whitewashed and ableist.
Consider, for example, that some medical conditions are much more common in black people than in white people. African Americans are 1.7 times more likely to have diabetes than non-Hispanic white people. Thus, the use of averages for many common diseases can be horribly misleading. Sometimes this difference is because of genetic factors, sometimes because of issues around accessing good health care, and sometimes it is a complex interplay of these two things and a host of other factors.
While white people still make up the majority of the U.S. population, and most of the online publications we read in North America are written with a U.S. audience in mind, making general statements about health without mentioning significant differences in risk between races can make that health information woefully inaccurate. In almost all cases there is no intent to mislead the reader, but the use of such statistics could offer a false sense of security to people who actually have a much higher risk of a particular condition.
We could also get into the problematic lack of diversity in medical studies and what that means for cis women and anyone who isn’t white, but that’s a whole other issue.
How do we write inclusively?
Where does this leave us, as medical copywriters, bloggers, or just as general readers of health info on the internet?
Well, for one thing, I think we all need to be more cognisant of diversity when we write, more sceptical of ‘trusted’ sources of medical information, and more forthright (in a diplomatic and helpful way) with clients who just don’t get how a man could be pregnant or a woman could have a prostate, for example.
In order to make writing inclusive medical copy a little easier, I’ve started compiling useful phrases or substitutions for commonly used terms. I’ve also begun forming a list of things to watch out for when reviewing medical articles. Some of these things include:
The Fosters – a TV show that demonstrates the diversity of family.
- When discussing breast cancer, don’t assume all patients are cis women.
- When discussing prostate health, don’t assume all patients are cis men.
- When discussing pregnancy, avoid the assumption that the person who is pregnant is a woman and/or intends to be a parent – they may be trans*, genderqueer, a surrogate, or may intend for the child to be adopted or fostered.
- Don’t assume a person giving birth to a child has a male partner – use ‘birth partner(s)’ instead.
- When talking about children’s health, avoid the word ‘parent’ – use caregiver instead or rephrase to avoid the need for such words.
- When an article refers to a doctor or nurse, check for pronoun use – is there an assumption the doctor is a man and the nurse a woman?
- Look for use of gendered partner terms, such as “men and their wives” or “a doctor and his wife” or “a mom might want to ask her partner if he can watch the kids while she takes some time to herself.”
- Don’t assume that a person has just one romantic or sexual partner – say “A patient with epilepsy may find it helpful to let their partner(s) know about their condition and what to do in the event of a seizure.”
- Avoid assuming that a person with a partner or partners of the same sex and/or gender identifies as gay or as a lesbian – bisexual erasure and trans* erasure is an unfortunate by-product (no pun intended!) of some efforts to make medical copy more inclusive.
- Be cautious over the use of the word ‘queer’ – this term has been reclaimed in some parts of the world, but remains an offensive term in many other parts and is often considered an ‘in-group’ term (i.e., ‘out-group’ use may be viewed as pejorative).
It’s also good practice to use people-first terminology, saying “a person with epilepsy” or “a person with diabetes” rather than “epileptic” or “diabetic,” for example.
Basically, practice being mindful of any assumptions you are making in your writing in regard to gender and sexual orientation, as well as race and disability, or any other pattern, grouping, or categorisation.
Resources on inclusive language
Sadly, there’s very little in the way of comprehensive guidance for medical writers, or writers in general, who want to ensure their copy is inclusive. Some resources that I have tracked down include:
- This Inclusive Language Guide from the National LGBTI Health Alliance of Australia focuses on “Respecting people of intersex, trans and gender diverse experience.” (The best resource I’ve found online so far.)
- This Queen’s University inclusive language guide to talking about gender, race, and disability.
- This article from the UK Government looks at inclusivity in health communications as it pertains to people living with disabilities.
- This handout on gender-inclusive language completely ignores the existence of people who are genderqueer, but it does offer some useful advice, including noting that, “Perhaps the best test for gender-inclusive language is to imagine a diverse group of people reading your paper. Would each reader feel respected?”
The lists and links above are by no means exhaustive, nor is my current practice as inclusive as I’d like it to be. There are some issues around sex that make it difficult to talk about sex-specific health conditions. For example, some males do not have a prostate, and some females do not have ovaries. In these cases, I do tend to err on the side of probabilities and use the biological terms (male and female) in place of gendered terms (men and women), but will use phrases such as ‘people who are post-menopausal’ if it seems appropriate.
Even the terms ‘male’ and ‘female’ are problematic as some people who are assigned these terms at birth or who identify as male or female later in life can differ from the standard model for these biological terms. For example, it doesn’t necessarily make sense to try to diagnose or treat a transgender person according to their biological sex assigned at birth, especially where that person is taking or has used hormone therapy.
Health can be a very sensitive topic even for people who don’t face barriers due to their gender, race, socioeconomic status, or sexual orientation. This is why it’s so important to make the effort to create inclusive resources that don’t add to general anxiety about discussing health and well being. Sadly, few medical students receive training to help them communicate effectively with all patients, and fewer still learn anything about health issues affecting trans* folks. There are some signs of change, however. For example, these medical students are helping to raise awareness of the importance of inclusive practice at the University of Alberta and more widely.
I am adamant about writing people-first medical copy that is inclusive, accurate, and helpful, and while I’ve learnt a lot in these past six years, I’ve still got a long way to go. I also recognise that just as language conventions change, so does society, so we’re always going to be encountering new challenges. So, if you have also run up against this issue and have something to share, please do. I would love to learn from others in the field, and to hear from readers who have found great accessible sources or who have examples of people doing medical copywriting well!
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