Vagueness, power and public health: use of ‘vulnerable‘ in public health literature

Unpacking vulnerability: towards language that advances understanding and resolution of social inequities in public health

“…Our attention was drawn to an important recent paper published in the journal Critical Public Health, which discusses the use (and misuse) of the word "vulnerable" in public health research and practice (Katz, Hardy, Firestone, Lofters, & Morton-Ninomiya, 2019). We commend these authors for contributing a timely paper that calls attention to the role of language in what we regard as the longstanding challenge of downstream drift in public health research (e.g., Baum & Fisher, 2014;Baum & Sanders, 2011;Carey, Malbon, Crammond, Pescud, & Baker, 2016).…”

“…Using critical discourse analysis, Katz et al (2019) explored articles that used the term "vulnerable" and highlighted examples-within both journals-of papers where phrases such as "vulnerable groups" or "vulnerable populations" were defined vaguely, or not at all. In such circumstances, the authors argue, the reader is left to "'fill in the blanks' as to who is vulnerable, why they are vulnerable, and what they are vulnerable to."…”

“…In such circumstances, the authors argue, the reader is left to "'fill in the blanks' as to who is vulnerable, why they are vulnerable, and what they are vulnerable to." This in turn can have the effect of obscuring systemic and structural causes of inequity, including the role of power, and can perpetuate a focus on mechanisms and interventions that are downstream in orientation (Katz et al, 2019).…”

“…Yet, as Katz et al (2019) demonstrate, simplistic and problematic use of the concept of vulnerability persists. Why?…”

“…One of Katz et al's (2019) important findings was that, among the articles they explored, "few papers examined the flip side of 'vulnerable populations'the individuals and groups that are not considered to be vulnerable"; moreover, they identified that "While researchers often describe the policy landscapes, legislation and processes that lead to poor health outcomes, they do not generally examine the individuals and groups enacting policy decisions, or the factors that incentivize, enable, connect and facilitate the individuals and groups producing vulnerability" (italics added). Indeed, there are many examples of research funding competitions focused on "vulnerable" populations (e.g., NIH , 2019; University of Calgary, 2019); why aren't funding calls in public health instead organized around political structures, and those who create and perpetuate inequity?…”