Communication in healthcare and science education is critical in order to convey ideas and thoughts. Inclusive language is part of the backbone for the effective sharing of ideas, knowledge, and sentiments especially in science education and healthcare settings. (Canfield and Menezes).  In the context of this pathology resource, the goal is to update many of the historical words that describe human anatomy, various conditions and pathologies, and indeed people in general, that are outdated and/or are derogatory.  It is critically necessary to adopt language that not only better reflects current scientific knowledge but that is also both acceptable and not hurtful to individuals or groups of people.  Use of inclusive language is respectful, and free from stereotypes, prejudices, and phrasing that either intentionally or unintentionally promotes the discrimination or exclusion of others.

Diversity in Science

It is important to provide safe and welcoming spaces to all people in all realms of our society.  It is obvious that ideas and contributions from a diverse group of people is beneficial to the workplace, to the community and to science in general.  Diversity produces better science (Nature), creativity, innovation, and makes for a better world to live in.  Therefore, diversity should always be promoted, encouraged, and celebrated!  This requires having an open and accepting mindset, the willingness to broaden world views, and accept the responsibility to educate ourselves – Just like in science!  This guide will give you an introduction to some important terms used in science that can sometimes be exclusive, misleading, or incorrect and provide you with alternate words and perspectives to view other people, cultures, and science.

Goal of this Language Guide 

The goal of this guide is to serve as a reference for the authors writing the book, for the teachers and professors using this book in their classrooms, and for the students who are learning about pathophysiology as well as future career paths.  After reading this guide, users will be able to communicate what they have learned about human pathophysiology in an inclusive and culturally sensitive way.  Additionally, readers should have increased courage in becoming advocates for inclusion, as well as have an increased curiousity in learning more about inclusive language in all walks of life.  Although this inclusive language guide is not exhaustive, it is meant to be a starting point.

This Guide is a Living Document and is subject to Revisions and Improvements

Note: As culture changes, language changes as well. Therefore, this guide will be reviewed periodically to ensure the appropriate and correct terms are included and changed as needed.  Please note, some of the preferential terms used in this guide are based primarily on Canadian culture and may be different in other countries.

Sex (Biological Sex)

The sex (biological sex) assigned at birth is most often based on external genitalia.  However biological sex of an entire human is based on defining many contributing characteristics such as chromosomal makeup (with genetic test), genitalia, internal reproductive organ development, hormone levels and gene expression levels.  Often sex is described using the binary of male and female, however the contributing factors can vary widely leading to a sliding scale (or continuum) of contributing factors (Fig. 1, Cools, et. al., 2018).

It is likely obvious, that humans are also not identical in traits other than primary and secondary sexual characteristics.  Height, hair colour, facial features, interests, and personalities vary from person to person.  In a similar manner, not all biological (XY) males or biological (XX) females are identical in their primary and secondary sexual characteristics and reproductive organ development.  Additionally, it should not be surprising that many individuals do not develop and fit into these two binary categories of male and female.

Male (Biological Male, Assigned Male at Birth, AMAB):  

The inheritance of XY chromosomes most often gives rise to the internal and external organs associated with a biological male.  In the past, in the English language, the binary nouns boy, boys, man and men, as well as the binary pronouns he, him and his have been used to correlate to the biological male sex.  The more current uses of nouns (boy(s), man, and men) and pronouns (he, him, his) is discussed later.  Currently, within the fields of human anatomy and health care, the terms male, biological male, and assigned male at birth (AMAB) are used to refer to the presumable inheritance of XY sex chromosomes and the development of the primary and secondary reproductive structures associated with the biological male sex.

Female (Biological Female, Assigned Female at Birth AFAB): 

The inheritance of XX chromosomes most often gives rise to the internal and external organs associated with a biological female.  In the past, in English, the binary nouns girl, girls, woman and women, as well as the binary pronouns she, her and hers have been used to correlate to the biological female sex.  The more current uses of nouns (girl(s), woman, and women) and pronouns (she, her, hers) is discussed later.  Currently, within the fields of human anatomy and health care, the terms female, biological female, and assigned female at birth (AFAB) are used to refer to the presumable inheritance of XX sex chromosomes and the development of the primary and secondary reproductive structures associated with the biological female sex.

Intersex and Differences of Sex Development (DSD): 

As with other human phenotypes (e.g., height, hair colour), a person’s genotype (e.g. XX or XY) does not necessarily correlate with the physical traits and anatomy that is expressed.  The term intersex is used when a person’s chromosomal makeup (e.g., XX or XY) does not match the traditional biological sex characteristics of male or female expressed.  It is estimated that ~1.7% of people are born intersex, and may or may not be aware, depending on whether any medical testing has been necessary, most often for unrelated health concerns.  Please note that as reported by Griffiths (2018), “Terms such as intersex, pseudohermaphroditism, hermaphroditism, sex reversal, and gender based diagnostic labels are particularly controversial. These terms are perceived as potentially pejorative by patients, and can be confusing to practitioners and parents alike.  As such, the phrase Differences of Sex Development DSD) has been adapted in the literature to describe in utero and congenital conditions affecting human sexual determination and development.  This being said, personal preference should be respected as to whether a person chooses to use the words intersex or DSD or other when referring to themselves.

Turner’s Syndrome and Klinefelter’s Syndrome: 

It should be noted that it is still unclear within the scientific community (and community in general) as to whether individuals that have sex chromosome differences, for example, X0 Turner’s syndrome or XXY Klinefelter’s syndrome fall into the categories of intersex or DSD.  Both syndromes present with impaired or incomplete growth and development (that can affect sexual organ systems).  It is deemed, that the most respectful way to treat patients, is on a case-by-case basis, as each case can be very different in presentation as well as needs.  For example, Turner’s syndrome most often presents as biological female, though may have incomplete ovarian development.  Klinefelter’s syndrome can include gynecomastia (male breast enlargement), smaller than average testes that do produce testosterone, though exhibit aspermatogenesis.  Again, it is important to follow a person’s wish as to whether they would like to be referred to as male, female, intersex, or other.

Endocrine Disorders: 

In addition to different sex chromosome genotypes that influence both the development and maturation of sexual organs, there are also hormone and growth factor levels to consider.  Some endocrine (hormonal) disorders can result in the development of characteristics that are opposite to the sex chromosome genotype of that individual (e.g. congenital adrenal hyperplasia).  Again, it is important not to assume that a person would like to be referred to as male, female, man, woman etc. Always listen and follow the wishes of the person involved.

Figure 1 illustrates the known chromosomal differences that can contribute to differences of sex development.

Cools, M., Nordenström, A., Robeva, R. et al. Caring for individuals with a difference of sex development (DSD): a Consensus Statement. Nat Rev Endocrinol 14, 415–429 (2018). https://doi.org/10.1038/s41574-018-0010-8

Gender:

Gender is a very different term than sex (or biological sex).  Therefore, the word gender is not interchangeable with sex.  Gender is a social construct that describes behaviours, roles and appearances.  Individuals can choose to express and identify with any category(ies) of gender (UBC Equity and Inclusion Office, Canadian and BC Human Rights Codes).   The nouns she, girl, woman, he, boy and man are used to relay a person’s gender identity which may or may not reflect with their assigned sex at birth.  Likewise the pronouns his, him, her, hers are used to express a person’s identity.  Some individuals prefer to have the pronouns they and them used, in which case it is important to use they/them respectfully.  In the cases in which one does not know how an individual would like to be addressed, their name and the pronouns, they or them are recommended.

Gender Identity:  Gender-identity is a deep sense of feeling as to how one feels about themselves in terms of whether they view themselves as a boy, man, girl, woman or as a gender-neutral, gender-fluid, agender, gender-nonconforming, or gender-queer, etc.

Agender:  A term individuals may use if they do not identify as being either man or a woman. Specifically, a person may see themselves as both a man and a woman or neither.

Bigender:  Individuals may describe themselves as bigender if they view themselves as sometimes a man and sometimes a woman.

Cisgender:  The term used when the biological sex assigned at birth aligns with gender identity.

Dead Name:  The term used to refer to the name assigned at birth that a person no longer uses, most often as they do not identify with the gender associated with the birth name.

Feminine, Femininity:  Femininity is a social construct that has a set of attributes that are dependent on culture and historical time frame.  This set of attributes can involve: expected manner of dress, physical appearance, behaviours, personality traits, roles in society, career choices, duties, responsibilities, and participation in specific sports/games, and can reflect societal treatment of individuals that do exhibit feminine qualities.

Gender Affirming:  When someone correctly uses terms that do align with a person’s gender (e.g. correct pronouns, correct salutation, or newly adopted name in place of dead name).

Gender Expansive:  The term used by an individual that identifies with a wide and flexible range of gender.

Gender Expression:  Gender expression refers to how a person chooses to express their gender (e.g. behaviour, clothing, body language, make-up, hair style, etc.).

Gender Fluid:  Someone who describes themselves as gender fluid, feels they do not have a fixed gender associated with their identity. (may use multiple different pronouns ie (they/she).

Genderfree or Genderless:  A term individuals may use to describe themselves, if they do not identify as being either man or a woman.

Gender Non-conforming:  A person may describe themselves as gender non-conforming if they express themselves in a manner that is not limited to a gender binary.  At times a person that identifies as trans will also identify themselves as gender non-conforming.

Genderqueer:  Genderqueer is a term someone may use to describe themselves if they are non-binary.  They may also identify as agender, genderless, genderfluid, pangender, transgender, or another gender identity.

Indigqueer:  The term used by an individual who is Indigenous and queer and would like to emphasize both identities.

Masculine, Masculinity:  Masculinity is a social construct that has a set of attributes that are dependent on culture and historical time frame.  This set of attributes can involve: expected manner of dress, physical appearance, behaviours, personality traits, roles in society, career choices, duties, responsibilities, and participation in specific sports/games, and can reflect societal treatment of individuals that do exhibit masculine qualities.

Misgender:  When someone mistakenly uses a term that does not align with a person’s gender (e.g. the wrong pronouns, wrong salutation, or dead name).

Non-Binary:  Individuals who do not identify with either of the genders in the gender binary (man/boy or woman/girl).  Modernly use they/them pronouns but may also use neo pronouns (e.g. ey/em/eir/eirs, ne/nem/nir/nirs, ve/ver/vis, xe/xem/xyr, ze/hir/zir/hir/zir/hirs/zirs).

Pangender:  A gender identify that is not made up of one gender, but rather multiple gender identities at once.

Preferred Gender Pronouns:  Pronouns are chosen by an individual and often reflect their gender identity.   Gender Pronouns include: they/them/theirs, she/her/hers, he/him/his as well as neo pronouns mentioned earlier: (ey/em/eir/eirs, ne/nem/nir/nirs, ve/ver/vis, xe/xem/xyr, ze/hir/zir/hir/zir/hirs/zirs etc.) Please note this list is not exhaustive.

Transgender:  Describes someone whose gender identity is expressed differently than others who have their same sex assigned at birth.

Trans man:  A person that was assigned female at birth, who identifies as a man.

Trans woman:  A person that was assigned male at birth, who identifies as a woman.

Transition:  This term is used at times to describe the process of a person making changes to align with the gender that they identify with.  These changes can involve: clothing, hairstyle, name (which may include legal identification changes to passport, birth certificate, driver’s license etc.), pronouns, hormone therapy, and gender affirming surgeries, etc.

Sexuality (Sexual Orientation):  The term sexuality describes one’s sexual/romantic attraction to another person.  Defined below are the sexual identities represented by the acronym 2SLGBTQIA+.  Please note that the following terms are considered outdated or offensive and are no longer used:  homosexual, transvestite, transgendered, and transexual.  All sexual identities may not be defined below, for more information on other sexual identities please refer to the “additional resources” section at the end of the guide.  Please note that the term “sexual preference” is no longer used when referring to sexual orientation, as most people would argue that their sexual orientation is not a choice or preference, but is something that is inherent within themselves.

2SLGBTQIA+:  Acronym defining, Two-Spirt, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Plus

Asexual:  A person may describe themselves as asexual if they do not experience sexual attraction to individuals of any gender.

Aromantic:  A person describes themselves as aromantic if they do not experience romantic attraction to anyone.

Bisexual:  Someone who is romantically or sexually attracted to people of two or more genders; most often to people of their own gender as well as people of another gender(s).

Gay:  Male-identifying individuals (men or trans men) who are romantically/sexually attracted to other male-identifying individuals (men or trans men).  ‘Gay’ can be used to refer to a woman or trans woman who is attracted to other women or trans women.  However, the term gay is more commonly use to refer to men or trans men who are romantically/sexually attracted to other men or trans men.

Heterosexual:  Someone who is attracted to people who are not the same gender as themselves.

Lesbian:  Female-identifying individuals (women or trans women) who are romantically or sexually attracted to other female-identifying individuals (women or trans women).

Pansexual:  Someone who is romantically or sexually attracted to people regardless of gender; at times they may refer to themselves as gender-indifferent.

Plus:  Members of the community who’s gender or sexual orientation is not represented in the acronym, 2SLGBTQIA+.

Queer:  An umbrella term used to describe sexual identities, other than heterosexual. Sometimes the Q in 2SLGBTQIA+ can be for ‘questioning’.   Queer was at one time used as a slur, though some individuals/communities have reclaimed this term.

Questioning:  Questioning is a term used by individuals that are exploring their sexual identity, sexual orientation and/or gender.

Two Spirit (2S):  Includes Indigenous LGBTQIA identifying individuals only.  This term is used rather than the western labels of gay, lesbian or transgender in order to honour Indigenous history and heritage.

First Note:  It is important to allow someone to choose their own gender and sexuality terminology and then use that terminology yourself.  While some of the terms are similar, one term may resonate with an individual more than another or represent their identity more accurately.  As such, with respect to themselves, a person may prefer to be referenced by specific pronouns (e.g. he, she, they) which correlate with their gender or sexual identity, rather than their biological sex.  It is important to respect a person’s choices and use the terms that they prefer.

Second Note:  Biological sex can sometimes be an indicating factor for diagnosis.  With this in mind we recognize that the majority of people would not have received a genetic test to determine what their sex chromosome makeup is.  Within this textbook, use of the words:  female, biological female, AFAB, male, biological male, and AMAB will refer to reproductive structures and organs that are present on this person.   At times the sex chromosome genotype may be given to convey this information.

Example:

 Eg. Alexis Smith (he/him) who is an 88 year old has broken his hip.

Patient History: AFAB, XX, no hormone therapy

“XX chromosomes” indicates the genetic component to the question.

“Alexis Smith (he/him)” indicates the individual’s gender and identity.

 AFAB and XX chromosomes in this example would indicate a susceptibility to osteoporosis of biological females due to lower levels of sex hormone expression (estrogen) post-menopause.  Osteoporosis and age are leading risk factors for hip fractures. These factors are helpful in determining cause and treatment of the hip fracture.

Anatomical and Reproductive Care Terms –  specific examples:

Informal Occasion and Introductions:  At times, a person may introduce themselves or their friends/family/acquaintances with titles (e.g. Mr. and Mrs.) that are already known to be acceptable/desired by that person.  In this case, continued use of those titles is considered respectful.

Example 1:  “Hi Mom, this is my hockey coach, Dave.  “Hi Dave, good to meet you.”

Formal Occasions and Introductions:  For individuals who are not known personally to you, and you have not been introduced, instead of guessing, it would be better for you to introduce yourself and then remember how a person introduces themselves to you.

Example 1:  “Hello my name is Mr. Drobowitz, DJ’s father, good to meet you.”  “Hello, I’m Mr. Jackson, the Grade 11 English Teacher here at MSS”.  “Hello, Mr. Jackson, you can call me Mike…”

It is recommended that the titles (e.g.  Mr., Mrs., etc.) are continued to be used when a person has chosen this as their own preferred way to be addressed.  This may reflect the degree of professional setting and/or level of respect and/or familiarity that is desired.  For example, if the principal of a school has introduced herself as Mrs. Jones, it is best practice to always address her using that title (Mrs. Jones).  Another example may be a person that introduces himself as the “Duke of Sussex, but you can call me William”, in which case you are free to and expected to address him by his first name of William.

Situations that lack Introductions:  In the case when introductions do not occur, it is best practice to use eliminate the use of titles (e..g. Mr., Sir, Master, Mrs., Miss, Ms., Madam, and Ma’am) for individuals who are not known personally to you.  The use of these terms is tied to a set of social assumptions including sexuality, gender, and socio-economic status, that are not necessarily accurate nor desired by the person that is being referred to.  The titles Mrs. and Miss have the added inappropriate assumption of a person being married or single, and choosing to identify and be labelled as such.

For example, consider the following scenarios:

1. “This patient’s chart reads, First Name: Abdue, Last Name: Santiago”. “OK, can your write down, Abdue Santiago’s hematocrit level is now 40.3%, and hemoglobin levels are back to normal too at 14.4 grams/dL.”  “The doctor will be ready shortly, can you go send in Abdue from the waiting room?”  …. “Abdue the doctor will see you now”.

2. At a restaurant, the server’s name tag states the name Norma James. It wouldn’t be appropriate to guess their preferred title and say “Miss James can I get a water refill?”  It would be more polite to say “Can I please get a water refill when you have a minute?

3. Another example that is not appropriate is: “Hi Sid, this must be your wife, Mrs. Jenkins?”  It would be wrong on 3 levels: to assume that the terms wife or Mrs. or Sid’s last name was adopted by his spouse/partner.

Professionals Titles:  When considering professional titles (e.g. Dr., Professor, Judge, Chancellor), again, it is best practice to address this person by their title, until they let you know that the formality can be dropped or an alternate is preferred.

For example, consider the following scenarios:

1. “Dr. Martin will see you now.”  “Hello Dr. Martin.”   “Hello, my name is Dr. Martin and what brings you in today”  “Hi Dr. Martin, I’m here about my foot…”

2. “Hello class, my name is Professor Boucher, but you can call me Dr. B” “Hi Dr. B do you have office hours tomorrow?”

Breast feeding:  Consider using the term “Chest feeding” to include transgender and non-binary people.  Again, it is best to use the term that the individual uses themselves.

Breast cancer:  This type of cancer affects everyone and thus the term should be reflective of who it is affecting.  For some transgender, non-binary, binary, or gender-neutral people, the term “breast” may contribute to gender dysphoria.  Using the term “chest cancer” or “cancer of the mammary tissue” “male breast cancer” may be preferred by some people.  In which case terms such as “chest examination” may be preferred by the patient instead of “breast examination”.  For example, “Jake came in and presented with breast cancer but prefers to call it chest cancer.”  Jake’s last chest examination was performed on Feb. 2. (Apicha Community Health Center)

Perinatal care unit: 

Consider using this term instead of maternity care unit, for delivery of care after birth of infant.

Ageism is discrimination based on someone’s age and is partly based on many stereotypes.  It is important to know that age does not necessarily mean that a person has:  memory loss, frailty, hearing loss, vision loss, cognitive loss, lack of interest in certain recreational activities, etc.  Additionally, age doesn’t mean a need for certain types of food, exercise, entertainment, occupation, work hours, clothing, hair-styles, etc.

Here are suggestions as to more up-to-date terms to use to offset ageism:

What to call someone who takes care of an older adult?

A general name could be care giver or support person.  Please note that the term care taker is not preferred in Canada as it is often used to refer to a person taking care of a building, zoo animals, or cemeteries.

If there is a closer known relationship you could use that. Ie. “Sandra’s daughter, Megan, comes daily to help her with her medication”.

Note: “Elderly” is indicative of the abuse that this population faces which can involve isolation, financial abuse, emotional abuse, physical and systematic abuse.  The term “older adult” is broader and does not allude to this abuse. (National Senior Strategy).  Unfortunately, abuse of older adults is a very real situation and must be reported immediately to the police and/or social services.  Please see this resource for more information:  Canadian Network for the Prevention of Elder Abuse

Ableism is defined as discrimination against people with (visible or invisible) disabilities. Both the BC and Canada Human Rights Codes have laws to protect people from being mistreated due to their disability.  Disabilities may be physical or mental, visible or non-visible.  Disabilities can occur at any time during a person’s life and some disabilities may temporary, chronic, sporadic, and may progressively worsen with time.  The 2006 Participation and Activity Limitation Survey found that 4.4 million people (1 in 7) in Canada have a disability.  Disabilities may be painful, and/or affect mobility.  Some disabilities are more treatable than others.  Some disabilities have no visible or outwardly apparent signs or symptoms.

Ableism contributes to the stigma that people with disabilities need ‘special treatment’ whereas instead people with disabilities need inclusive accommodations.  To prevent ableism, consider the diverse abilities someone has and how one can support them rather than how to control them.

Determine which terminology a person prefers – some individuals may choose Person-First Language others may choose Identity-First Language.  Also some individual may view themselves as having a disability and other individuals do not view themselves as having a disability.  Be sure to respect their choices for language with this in mind.

In general:   Be careful of using terms and phrases such as: “special”, “courageous”, “overcome a disability”, “suffering with”

Here are suggestions as to more up-to-date terms to use:

 Neurodiversity:

Refers to the fact that there is no “normal brain” rather, vast differences that can be found across a large spectrum used to describe the function of the brain. (Queens University Faculty of Health Sciences and Queens University EDI Office).  Please note that neurodivergent is a non-medical term, to describe the differences in brain development and is often used in the context of autism spectrum disorder, attention deficit hyperactivity disorder, or dyslexia (NIH 2023).  Other conditions that are sometimes described in this manner are: Asperger’s syndrome, Down syndrome, dyscalculia, dysgraphia, dyspraxia, intellectual disabilities, bipolar disorder, obsessive-compulsive disorder, Prader-Willi syndrome, sensory processing disorders, social anxiety disorder, Tourette syndrome, and Williams syndrome (Cleveland Clinic 2023, Doyle 2020).  Neurodiversity is a term that is used to focus on positive aspects of different ways of thinking, learning and behaving, rather than focusing on any associated disabilities (NIH 2023).

Note: The R- word, “retard” was historically used in the medical system as “mental-retardation” to describe cognitive delay specifically in people with intellectual disabilities.  The term has since shifted to becoming offensive and derogatory in everyday language.  The R-word now incorrectly associates intellectual disabilities with being stupid or dumb and is predominantly used in language today to make jokes.  Nevertheless, the R-word should not be used in any sort of language since as long as it is used, people with intellectual disabilities will continue to be excluded and mistreated. (Spread The Word Inclusion)

Sizeism is defined as discrimination and mistreatment based on someone’s size (height, weight, shape, and/or body composition, and/or fitness level) (NIH Office of EDI).

Weight Measurements:

Body Mass Index (BMI):  Is a measure of total body mass, not a person’s body fat and should only be used to define “obesity” (BMI >30) in a medical sense as fluctuates with different demographic factors which makes it difficult to draw conclusions over the general population without consideration for these factors (Volger, Vetter and Dougherty).

Note: In a social context the term, obesity, draws conclusions of being unmotivated, lazy, lacks self-care, etc.  This may or may not be true and therefore should not be used to describe an individual outside of the BMI context.  Being obese is a description of one’s total body mass, not one’s individual identity and therefore should be a medicalized term rather than a description of one’s social and cultural identity.  Instead of the term “obesity”, one can use “unhealthy body weight” or “weight” to describe someone’s weight if necessary (Volger, Vetter and Dougherty). 

Eating Disorders:

Examples of eating disorders may include anorexia nervosa, bulimia nervosa, binge eating disorder or avoidant and restrictive food intake disorder (National Eating Disorder Information Centre).

Definitions:  Anorexia Nervosa Vs Anorexia:

‘Anorexia Nervosa’ is a potentially life-threatening eating disorder that is associated with fear of weight gain and heightened concerns of body image.

‘Anorexia’ is a term that is used to describe someone experiencing short-term loss of appetite, which can be a symptom of many diseases (e.g. cold, flu, food poisoning) and sometimes a side-effect of treatments (e.g. A patient undergoing chemotherapy frequently experiences nausea and anorexia).

Skin colour, Ethnicity, Place of Origin, and Immigration/Refugee Status

As mentioned earlier, both the Canadian Human Rights Act and BC Human Rights Code prohibit a person being discriminated against based on: race, national or ethnic origin, colour, political beliefs, religion, age, sex, sexual orientation, gender identity or expression, marital status, family status, genetic characteristics, disability (mental or physical) and conviction for an offence for which a pardon has been granted.

Words are powerful and it important to utilize inclusive language in all settings to ensure everyone feels, welcome and respected.   Inclusive language is part of ensuring that biases, prejudices, and mistreatment of minority groups is stopped completely.   Laws, codes, hiring and recruiting practices, providing equitable opportunities in education, employment, housing, etc. should be used to encourage and support diversity within communities and the subsequent successes that diversity brings to a population.

In the field of science, we have learned that humans are 99.9% genetically identical (NIH Genome Research 2023).  We have also learned that human qualities (e.g. intellect, personality, skills, beliefs, talents, etc.) do not correlate with human size, shape, skin tone, ethnicity, hair/eye colour, marital status, place of origin, gender, or sexual identity.  Inherently, we know that a person cannot and should not be judged by their appearance.

In health care settings, frequently physical examinations of patients are required in order to provide an accurate diagnosis and prescribed treatments.

In doing so, being mindful and intentional with inclusive language is encouraged.

In all settings it is important to remember that inappropriate assumptions about people can lead to the use of certain words, tones, questions and/or phrases that come across as hostile.  As mentioned earlier, most of the time, microaggressions are unintended and occur due to the unconscious biases, that all humans hold based on societal backgrounds in which they were raised.  Most often, microaggressions, discrimination, and prejudices are directed against minorities within the population.

Best Practice:  Before referring to, or asking, about someone’s skin colour, ethnicity, place of origin, political or religious beliefs or immigration/refugee status, ask yourself the following questions:

1. Why am I referring to or asking about a person’s skin colour, ethnicity, place of origin, political or religious beliefs or immigration’s status?
2. What are my intentions?  Is this any of my business?  Why does it matter?
3. Am I sounding prejudiced?  Does this sound like a microaggression?
4. Am I making assumptions about a person?

It is important to be conscious of how powerful words can be and how hostile pointing out someone’s differences can be to that person.

As mentioned earlier, languages have evolved significantly over time, so it’s important to do a review of terminology and traditional names and stay up to date in order to facilitate and build good relationships that are filled with respect and understanding.

Terminology to Describe – Definitions

Aboriginal:  While this term is common in Australia, it is not the preferred term in Canada. In Canada, the name, Aboriginal Peoples, was given to the First Nations, Inuit and Métis Peoples by the government in section 35 of the Canadian Constitution.

Culture:  Encompasses the similarities amongst groups of individuals that come from a common background.  Some categories of culture may include but are not limited to geography, beliefs, values, preferred sports, music, food, language, etc.

Colonization:  is the act of settling within and obtaining control over an Indigenous population or area without consent or permission.  Colonization involves imposing cultural views, language, economic and social structures, religions, laws, education systems, and policies that favour the colonizers (Government of Canada).

Decolonization:  involves the act of learning about and understanding Indigenous history and interactions with non-Indigenous peoples, particularly in association with the Truth and Reconciliation Commission Report and Call to Action.  As stated by BC’s Office of the Human Rights Commissioner, “decolonization is the dismantling of the process by which one nation asserts and establishes is domination and control over another nation’s land, people and culture”.  Decolonization is the process of undoing the oppression and subjugation of Indigenous peoples.  Decolonization involves the working toward a new reality that honours Indigenous perspectives, culture and peoples (BC’s Office of the Human Rights Commissioner).

Equity-deserving group member:  “Equity-seeking groups are communities that face significant collective challenges in participating in society. This marginalization could be created by attitudinal, historic, social and environmental barriers based on age, ethnicity, disability, economic status, gender, nationality, race, sexual orientation and transgender status, etc. Equity-seeking groups are those that identify barriers to equal access, opportunities and resources due to disadvantage and discrimination and actively seek social justice and reparation”.  (Canada Council for the Arts, 2023)

Ethnicity:  “term for the ethnic group to which people belong. Usually, it refers to group identity based on culture, religion, traditions, and customs” (Oxford Reference, 2023).

Ethnic Origin:  refers to the ethnic or cultural origins of a person’s distant ancestors (i.e. more distant than a grandparent).

Human Race:  refers to all people, considered together as a group.

IBPOC:  Acronym for “Indigenous, Black, People Of Colour” created to provide visibility and recognition to often minoritized groups of individuals. (Please note, the acronym BIPOC was developed in the USA, and in Canada, the acronym IBPOC is preferred in most places, as the Indigenous peoples were the first humans to populate North America (UBC).

Indigenous:  A collective term describing the original people occupying a land and their descendants. This includes many different groups, some example of these groups include: First Nations, Metis, and Inuit.  Note: Not all Indigenous people will prefer to be described the same way. It is important to mirror people’s language when they talk about themselves or ask them how they identify if you are unsure and need to know. (First Nations and Indigenous Studies at UBC) 

Immigrant:  A person who has by their own choice, applied for and been accepted by a country to settle within in that country. Please note the term Alien is problematic.

Inuit:  Describes people who live in the far North of Canada that also identify as Indigenous.

Marginalized Peoples:  is used to refer to peoples that have not been treated equitably.  People that have been not been given the same opportunities/resources in society.  This term can refer to peoples that have been oppressed unfairly based on race, gender, sexuality, ethnicity, religious/political beliefs, and/or social class.

Métis:  Refers to a collection of cultures and identities resulting from the coming together of Indigenous and European peoples in what is now Canada.

Native:  This term generally means, to have originated from a specific place. In the United States, “Native American” is commonly used to describe Indigenous people. “Native” is not preferred in Canada.

Place of Origin:  The country in which a person, born outside of Canada, last resided before immigrating to Canada (Statistics Canada, 2023)

Refugee:  A persecuted person forced to flee from their homeland

Race:  Originally used to describe the colour of skin, has since gained additional meanings in the social context.  The word race has negative connotations, as historically it has been used to relay prejudices and invoke discrimination.  Historically, the word race has been used to imply that there are subspecies of humans.  It is a word that has been used to segregate, divide, and mistreat peoples.  Additionally, the word race has been used to form assumptions about place of birth, economic status, religion, illnesses, etc. and should not be used to determine such information (Lei and Bodenhausen).

Racialized Person/Group/Minority:  A person or group of people that has/is being discriminated against based on skin colour, origin, religion, language etc. (The Canadian Encyclopedia, 2023)

Systemic Racism:  The process by which racialized groups are victims of a system that has led to being regarded negatively without just cause, abuse, mistreatment, and/or deprivation of opportunities, etc. (The Canadian Encyclopedia, 2023)

Here are suggestions as to more up-to-date terms:

(Adapted from:  A Guide for Inclusive Language, Western University Equity Diversity and Inclusivity)

Diversity:  Recognizes the different and unique societal backgrounds that shapes everyone’s identities and recognizes how these differences may affect each individual’s life.

Inclusion:  Fosters an environment where everyone feels safe, supported, and respected while also ensuring everyone has an opportunity to achieve success.

Minoritized Group:  A group in society that does not exhibit the dominant traits of others, are often devalued and given less resources. Previously, the term “minority group” was used. The term has been changed to represent the active role society has in creating a lower societal status (DiAngelo and Sensory).

Intersectionality:  Encompasses all aspects of an individual at once. Aspects may include, ethnicity, gender, sexuality, culture, religion, socio-economic status, etc. Intersectionality considers no part alone but rather collectively as a unique composition of how all parts form a whole individual. Therefore, no one individual is exactly the same as another.  Also, it may be that a person has one or more minoritized characteristics (e.g. ethnicity, skin colour, sexuality, socio-economic status, etc.) that may have lead them to being treated more poorly and having fewer opportunities.  Combined minoritized traits can have lead to even poorer treatment.  In order to mitigate this, it is certainly important to be conscious of these occurrences and to make every effort to ensure inclusivity and equity are instilled into every facet of today’s society.

Note: Some societal information (ethnicity, gender, religion, sexuality, etc.) that would be present in a real situation may or may not be provided in the textbook, depending on it’s relevance to the ailment being discussed.  This is intended to encourage diagnosis and understanding in a professional manner – from the accurate reading and writing of patient history, family history, analysis of medical diagnostic imaging and lab tests, signs and symptoms, physical examinations as necessary, and with current research in mind – rather than societal stereotypes, skin colour, last names, and non-medical characteristics/behaviours that are not associated with disease/disorder/illness being discussed (e.g. hairstyles, clothing, speech mannerisms, clothing, etc.).  Skin tone and last names are not a reliable way to ascertain ancestry and possible genetic susceptibilities – be sure to do the proper medical examination and testing that is required for an accurate diagnosis.