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It was 2018 when OneWorld, a Dutch online platform for journalism, published an article with the title This is the colonial language we will no longer use (translated from Dutch). [1] The editing team argued that our language is peppered with (neo)colonial talk, condescension and above all the ‘white Western perspective’. They also argued that journalists have an extra responsibility to decolonize language. To set an example in the Dutch media landscape, OneWorld announced they would no longer use a number of words, such as ‘to empower’, ‘empowerment’, ‘ethnic’, ‘local’, ‘minorities’ and ‘developing countries’. They motivated their choices with an explanation for each word.

This extraordinary move was picked up by other media and other Dutch journalists. Columnist Asha ten Broeke wrote in De Volkskrant that OneWorld’s initiative could lead to a positive outcome, as it would make people think about taken-for-granted norms. [2] In the same newspaper, columnist Elma Drayer shared a different perspective. She wrote: “Of course, it would not hurt to take into account others’ wishes and sensitivities when it comes to language use. But to think that reality will adapt to it is wishful thinking at best, and naïve at worst”. [3] In the meantime, the words banned by OneWorld were still widely used by other media outlets.

The words were also used by me, or at least one of them. In 2018 and 2019, I was writing a book about some of my PhD research results, through a Dutch publisher. It was different from my dissertation, because it was aimed specifically at the audience of Dutch people with an interest in working or studying in the Global South. So: no academic language, no theoretical elaborations. It was meant to be practical and fun to read, while also insightful and eye-opening. I understood why ‘developing countries’ was on OneWorld’s ‘blacklist’, and while they had suggested alternatives for each word on the list, there was not yet one for ‘developing countries’. Despite OneWorld’s arguments, I decided to use the term ‘developing countries’ anyway, mainly because I wanted my message to be received and embraced by my targeted audience. I did not want to be correct in language but ineffective overall because nobody would want to read the book. I even went as far as to title the book The Third World On Your Resume, to tickle or provoke my readers, and I made an effort to, again, explain my word choice in the book.

And now it is 2022. Would I still use ‘developing countries’ in my writings today? Absolutely not. So what has changed? In me, in Dutch society, in the world? I guess I am more aware of the powerful impact that words have on reality. Both in a good way, when the right words are used, but also in a bad way, when words are used that do not reflect or do justice to what the world is really like. ‘Developed versus developing countries’ is an outdated classification system, originating among multilateral institutions in the 1960s, for transfer of resources from rich to poor countries. [4] It does not make people ask questions such as: What does it mean to be developed? How do we define potential? Or what do a developing and developed country have in common? Instead, people use the words to divide the world into two, in a way that perpetuates existing inequities. Unfortunately, the terms I use instead, such as low- and middle-income countries (LMICs), high-income countries (HICs), Global North and Global South, are controversial too, for similar and other reasons. Better alternatives are hard to find.

Reasons to change language

My choice to write and speak differently today is related to the debate in The Netherlands about Zwarte Piet and whether this is an innocent Dutch tradition or a harmful event with roots in racism. It is also linked to the rise of the Black Lives Matter movement. George Floyd’s murder in Minneapolis in the United States sparked large racial justice protests around the world. [5] Additionally, my thinking and reasoning is linked to academic debates in global health. It is linked to questions such as: Is global health truly global? Who sets the agenda? Who is not heard? Numerous scholars have written and continue to write about this, such as Themrise Khan, Seye Abimbola, Catherine Kyobutungi and Madhukar Pai with their article How we classify countries and people – and why it matters. Chanel van Zyl, Marelise Badenhorst, Susan Hanekom and Martin Heine wrote a piece specifically about the term ‘low-resource settings’ which has recently gained ground in academic global health literature. [6] The authors state that this term, as well as other proxies such as low- and middle-income countries, undermine the complexity of such settings and insinuate a level of homogeneity that is unsupported.

Lastly, my current language choices are based on developments, outside the field of global health, in the field of international development. In the Netherlands, we have Hucom, an awesome organization that works passionately towards equitable and fair humanitarian communication. Hucom’s approach is to organize awareness events in the Netherlands, one of which is an annual award ceremony for both the best and worst campaigns by Netherlands-based NGOs that work internationally. Save the Children is a frequent nominee and winner of the award for the worst ad, with campaign videos that dehumanize children by portraying them as skinny, sad and poor, without contextualizing the situation. Every year, Save the Children makes new videos and every year they end up being nominated by Hucom. In a television program about fundraising for international development, Pim Kraan, the director of Save The Children Netherlands explained why they continue to work this way: a campaign portraying positive images raises 200 euros a week, whereas a campaign saturated with negative images raises 9000 euro a week. [7]

Hucom considers these simplistic and one-sided stories, produced by organizations working in international development – either through words or images – to actually be part of the problem these organizations are trying to solve. They state on their website: “We consider representation and discourse as integral to the production of the Global South and see the communication on (the needs of) developing nations and peoples by government, industry, NGOs and the media in the Global North as part of the problem of (the failure of) international development and worldwide issues of poverty, inequality and injustice”. [8]

Does language reflect or shape the world?

Elma Drayer was quick to write that it is naïve to think that reality is not affected by language because this process started long ago, and not in a fair way. Language is part of a (historically constructed) system that perpetuates the status quo and keeps powerful countries, institutions, organizations and individuals in power. My PhD research about power dynamics and relationships between international and Cameroonian staff in a hospital in Cameroon showed that many visiting health workers engage in ‘processes of othering’ in which they – deliberately or not – distance themselves (‘us’) from others (‘them’). I agree with the scholar Harng Lu Sin who states that this can “potentially create rifts that hinder the building of strong personal relationships”. [9] In the inspiring TED Talk The Danger of a Single Story, the writer Chimamanda Ngozi Adichie shares some of her experiences with such prejudice and the effect of one-sided and simplistic stories, created by people who do not see the full story, but rather what they want to see or think they see. [10] It shows that we are not just bystanders of ‘the real world’. Through the things we see and the language we use, we actively shape and recreate it.

Processes of othering have greatly contributed to the fact that many people in the Global North do not look at people in the Global South as equals. It is widely known that feelings of superiority are not only associated with colonial and missionary medicine back in the days, but as much with the often short-term work of contemporary Global North health professionals in Global South medical settings. [11] In 2012, Teju Cole wrote about the inability of many people in the Global North to look at developments in the Global South in a nuanced way, and with respect for the efforts of people in their own lives and their efforts to improve their country. Cole wrote: “His [American/European] good heart does not always allow him to think constellationally. He does not connect the dots or see the patterns of power behind the isolated disasters. All he sees are hungry mouths, and he […] is putting food in those mouths as fast as he can”. [12] It makes me think of a quote from Kofi, a Ghanaian school boy in Akusua Abb’s Ashanti Boy, written in 1959. [13] I have read the quote many times, and I encourage all readers of this article to read it a few times to really get to the gravity of this boy’s message:

I want to do well in exams, because I want to… help everybody here. I must be a doctor, an engineer, or a lawyer to help. Now all the doctors, engineers and lawyers are Europeans, or nearly all of them, and they can’t know us and our troubles as well as we know ourselves. There are not enough of them anyway, and they always go home in the end. They don’t stay here. [Then, speaking to a European missionary:] We will get self-government one day. We will govern ourselves. Then we must have as good a government as you, and you must say ‘These are good men, as good as us, so of course, their country will soon be as good as ours and then they will be our equals.’

What strikes me most is that the boy expresses his wish for himself and his people to be independent, to be able to run his home country of Ghana without European outsiders who come and go, while at the same time he shows a deep wish for the appreciation by these Europeans for being ‘as good’ as them, and therefore being equals. One day…

The road to justice

The current visa problems in global health, hampering or even preventing travels of global health professionals from the Global South to travel to the Global North to participate in global health conferences, WHO and other meetings, are only one example that illustrates that we are far away from Kofi’s dream [14]. Another example is the way media in the Global North reported during the Covid-19 pandemic; when it turned out that people on the African continent were not dying as massively as expected by many people in the Global North, media attributed this to a ‘miracle’ rather than to expertise and experience with fighting infectious disease, in combination with good leadership. [15]

Adding up these insights leaves us with one important question: Based on the current academic and public debates about language in global health, how can we do better? First of all, let us closely look at our current language use. We cannot change our previous choices, but we can reflect upon these choices based on what we know now. Jurriën Hamer, a Dutch philosopher and lawyer, even recently wrote: “Out of fear of admitting having made the wrong choices [he refers to eating meat and flying around the world], people do not acknowledge their role in the world, and the effect of their behaviour. Society as a whole is paying the price for that”. Hamer also argues that people can reap the benefits from the sober realization that everyone makes mistakes: “We want to see our value reflected in the eyes of others. We want others to be proud of us”. [16] In this light, in the context of this human wish to be seen and acknowledged for the efforts made, I think it is even more harmful to continue with language that takes away space for others – people with the same desire but less agency – to be seen, heard and acknowledged. For their full capacity.

So what is the best way forward? What terms should be avoided? Of course, there is not one answer to that. Themrise Khan and colleagues argue, in the earlier mentioned article, that people could be more specific about the terms they use. For instance, when using ‘low-resource setting’, an explanation can be provided as to why and how a setting is low-resource and along which dimension(s). They also argue that changing language alone is not enough; it should also be about changing intentions, methodologies and practices. This is in line with what Himani Bhakuni and Seye Abimbola argue in their article on epistemic injustice in academic global health; that it is about practices related to knowledge production, use and circulation. [17]

So, does Elma Drayer have a point in saying that societal change through language is wishful thinking? Language is only one aspect of the power system, but as said, it does contribute to the construction of the world we all live in. People need be aware of this in order to use the power of language for the better. In order to learn more, I argue that people in the field of global health can also learn from organizations in other fields, such as OneWorld in journalism, Hucom and also Partos in international development. Partos is the Dutch membership body for (more than 100) organizations working in international development, and their Dream Paper Shift the Power is highly recommended. [18] Another document worth mentioning is Hucom’s most recent Communication Code. [19] The concrete recommendations for ethical communication, linked to dignity, context and nuance, can be applied to the field of global health too. At the very least, using these lessons in the field of global health – in practice, research and education – contributes to open and equitable relationships on both an individual and institutional level. At the very best, it paves the way to justice.

References

  1. Nourhussen S. Met deze koloniale taal stoppen we: OneWorld is klaar met neokoloniale woorden. OneWorld. 2018 Jun 13. Available from: https://www.oneworld.nl/lezen/politiek/met-deze-taal-stoppen-we/
  2. Ten Broeke A. Meer nadenken is altijd dubbelplus goed. De Volkskrant. 2018 July 12. Available from: https://www.volkskrant.nl/columns-opinie/meer-nadenken-is-altijd-dubbelplusgoed~b86281e6/
  3. Drayer E. Woorden zijn niet allesbepalend. Zo simpel ligt het niet, hoe graag menigeen dat ook zou willen. De Volkskrant. 2018 July 5. Available from: https://www.volkskrant.nl/columns-opinie/woorden-zijn-niet-allesbepalend-zo-simpel-ligt-het-niet-hoe-graag-menigeen-dat-ook-zou-willen~bc28b0cf/
  4. Khan T, Abimbola S, Kyobutungi C, Pai M. How we classify countries and people—and why it matters. BMJ Global Health. 2022 Jun 1;7(6):e009704.
  5. Silverstein J. The global impact of George Floyd: How Black Lives Matter protests shaped movements around the world. CBS News. 2012 Jun 4. Available from: https://www.cbsnews.com/news/george-floyd-black-lives-matter-impact/
  6. Van Zyl C, Badenhorst M, Hanekom S, Heine M. Unravelling ‘low-resource settings’: a systematic scoping review with qualitative content analysis. BMJ global health. 2021 Jun 1;6(6):e005190.
  7. 7Braam M, Van Rosmalen L. De tranentrekken: Hoe verkoop je een ramp? HUMAN VPRO Medialogica. 2020 Jul 30. Available from: https://www.vpro.nl/argos/media/kijk/kort/hoe-verkoop-je-een-ramp/de-tranentrekker.html
  8. Expertise Centre Humanitarian Communication. What is the Expertise Centre Humanitarian Communication. 2020. Available from: https://humanitairecommunicatie.nl/about/
  9. Sin HL. Volunteer tourism—“Involve me and I will learn”?. Annals of tourism research. 2009 Jul 1; 36(3):480-501.
  10. Ngozi AC. The danger of a single story. TEDGlobal. 2009. Availabe from: https://www.ted.com/talks/chimamanda_ngozi_adichie_the_danger_of_a_single_story?language=en
  11. Van de Kamp J. Behind the smiles: Relationships and power dynamics between short-term westerners and Cameroonian health workers in a hospital in rural Cameroon. University of Amsterdam DARE. 2017 Oct 31. Available from: https://dare.uva.nl/search?identifier=2a067093-7c29-4e8b-b515-31eb18662eb2
  12. Cole T. The White-Savior Industrial Complex. If we are going to interfere in the lives of others, a little due diligence is a minimum requirement. 2012, March 12. Available from: https://www.theatlantic.com/international/archive/2012/03/the-white-savior-industrial-complex/254843/
  13. Abbs A. Ashanti Boy: A Story for Young People of All Ages. Collins; 1959.
  14. Pai M. Passport and Visa Privileges in Global Health. Forbes. 2022 June 6. Available from: https://www.forbes.com/sites/madhukarpai/2022/06/06/passport-and-visa-privileges-in-global-health/
  15. Büyüm AM, Kenney C, Koris A, Mkumba L, Raveendran Y. Decolonising global health: if not now, when?. BMJ Global Health. 2020 Aug 1;5(8):e003394.
  16. Hamer J. Ons land is er zo beroerd aan toe omdat ook wij kiezers de toekomst niet serieus namen. De Volkskrant. 2022 Oct 14. Available from: https://www.volkskrant.nl/columns-opinie/ons-land-is-er-zo-beroerd-aan-toe-omdat-ook-wij-kiezers-de-toekomst-niet-serieus-namen~b6373566/
  17. Bhakuni H, Abimbola S. Epistemic injustice in academic global health. The Lancet Global Health. 2021 Oct 1; 9(10):e1465-70.
  18. Greijn H, Chanase G, Fowler A, Isooba M, Lijfering S, Sansur R, Kojo VanDyck C, De Vries G. Dream Paper: Shift the Power. Partos. 2022, Jan. Available from: https://www.partos.nl/wp-content/uploads/2022/01/Partos-Dreampaper-Shift-the-Power-v7.pdf
  19. Knowledge Centre Humanitarian Communication. Communications guide for development organisations. Knowledge Centre Humanitarian Communication. Available from: https://humanitairecommunicatie.nl/wp-content/uploads/2021/10/HuCom-Communications-Code-2021-English.pdf