Meaning of Public health: Lost in jargon

“I work in the field of public health,” as the first author introduced herself to a family friend, she was asked, “What exactly is public health?” The author fumbled to give a relatable response and said, “Well, it’s immunisation…vaccination and a lot of other practices or services that impact the general health of people.” The difficulty in conveying what public health means in simple language made us think about why something like health that matters to everyone – be it childbirth, food, nutrition, or health care – should be so difficult to explain? Why do we struggle to explain the wider canvas of public health that includes preventive, promotive, and rehabilitative aspects to the very ‘public’ that it is meant for? ‘Public health’ should evoke a sense of collective ownership because it means the health of people, i.e., the health of all of us. But it seems to have evolved as a ‘technical field’ that remains the prerogative of experts.

The linguistic expressions of well-being, illness and healing used by public health practitioners are critical because they have the potential to create people’s sense of collective ownership and belongingness to the field. This vocabulary and everyday expressions make public health tangible, unlike clinical medicine which often remains exclusive and exclusionary as a large section of people struggle to relate to medical jargon. The use of technical terms, names and abbreviations of diseases, therapies and programmes seems to have shrunken the space for sharing our health experiences with healthcare providers without using such non-medical jargon and abbreviations.

Similarly, the space for expressing our well-being in a non-medical language has also shrunk in the case of public health. Public health actors including village-level health workers are socialised (in fact, expected to do so) to adopt a technical language. As one of the grassroots health workers shared, “ANC se jude bahut saare kaam hote hai. VHND karna hota hai, ANC visit karke hum IFA tablet dete hai, BP aur HB check karvaate hai. VHIR ka avlokan karke due list update karne me bhi madad karte hai,” (“There is a lot of work related to ANC. We need to conduct VHND, give IFA tablets during the ANC visits, check BP and HB. We also help in updating the list in VHIR”), one wonders if these acronyms are taking a life of their own and legitimize this technocratic language. Does the use of these terms (ANC, PNC, HB, IFA, VHND etc.) create more disconnect between the ‘public’ and ‘health’? Canadian physician and one of the founding members of Johns Hopkins Hospital, Sir William Osler, once said, “From the standpoint of medicine as art for the prevention and cure of disease, the man who translates the hieroglyphics of science into the plain language of healing is certainly the most useful.” While it is crucial to translate such hieroglyphics of science into plain language in clinical care, public health at its core imagination is supposed to create space for everyone to share their health-related needs, ideas of well-being and healthcare choices using the vocabulary that they feel comfortable with. The imagination of community-based approaches, primary care and accountability structures in the health care delivery system entail collaborative, inclusive, and participatory ways of improving people’s health. This would be possible only if the vocabulary used by various public health actors is non-technocratic and non-intimidating.

As new illnesses and diseases are emerging, the public health field seems to have accepted the linguistic hegemony of medical jargon. Added to this, more recently, public health seems to be operating under the shadow of acronyms and abbreviations of public health policies and programmes. Does the essence of what ‘taking care during pregnancy’ evokes get captured by technocratic acronyms, such as ANC/PNC used by practitioners? Are we able to convey the ‘commonness’ of common mental disorders when a patient gets labelled as having a ‘CMD’ not only on their prescription but also in conversations around care provision among stakeholders including families? If the field of public health continues to use technocratic terms in everyday use, it is likely to lead to a further distancing of people from a field that matters to everyone; more so, for those who already find it difficult to read and comprehend such language.

We need to think of ways in which public health can become a field that is inclusive of diverse vocabularies and expressions and uses a language that brings people into the folds of public health. While such efforts are underway in clinical practice through improving health communication approaches and as ‘narrative medicine’ as a field is actively trying to change clinical interviewing by incorporating patients’ experiences, such efforts have bypassed public health.

Since public health is, after all, what we eat, where we live, how we connect with others, the air we breathe, and how and when we seek care that promotes health and well-being, a glossary that accommodates the everyday terms and experiences across contexts and inclusive of expressions in local languages can be the first step in the direction to demystify it.

 

Mukta Gundi and Arima Mishra are faculty at Azim Premji University.

 

(The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views or the positions of the organisation they represent.)