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

ABSTRACT

The word ‘vulnerable’ is frequently used in public health research and practice. We use critical discourse analysis to explore the use of this term in articles published between January 2015 and January 2018 in the American Journal of Public Health and the Canadian Journal of Public Health. We find that terms such as ‘vulnerable groups’ are often vaguely defined or undefined, requiring the reader to ‘fill in the blanks’ as to who is vulnerable, why they are vulnerable, and what they are vulnerable to. Where terms such as ‘vulnerable groups’ are applied with some specificity, they are used as proxies for a wide range of groups, conditions and situations. Often, groups are constituted as inherently vulnerable, as authors imply that even if policies and processes change, group vulnerability will remain. Notably, populations and groups in power – and therefore responsible for generating structural vulnerability – are rarely examined. In our experience, researchers often use the word ‘vulnerable’ strategically to attract resources, policy interest and public concern. At the same time, we propose that the vagueness associated with terms such as ‘vulnerable’ conceals the structural nature of public health problems. We conclude that this vagueness can serve the political function of obscuring power relationships and limiting discussion of transformational change.

KEYWORDS:

• Vulnerable groups
• vulnerable populations
• public health
• critical discourse analysis

Author contributions

All authors worked together to conceptualize this article and identify relevant supporting literature. AS Katz was primarily responsible for writing, with contributions from all authors. AS Katz, ME Morton Ninomiya, M Firestone and BJ Hardy reviewed articles and undertook the initial stages of data analysis. BJ Hardy and ME Morton Ninomiya reviewed further analysis done by AS Katz. All authors refined and edited the final version for submission. All authors worked together to respond to peer reviewer input and complete a revision.

Acknowledgements

We thank past and present members of the Centre Talks Committee from the Centre for Urban Health Solutions at St. Michael’s Hospital for their collective contributions to the conceptualization of this article. In particular, we thank Jennisha Wilson, Tatiana Aratangy, Anjana Aery and Ben Brisbois for sharing insights, knowledge and inspiration early in the process. We thank Carolyn Ziegler from the Health Sciences Library at St. Michael’s Hospital for her enormous help in identifying relevant literature and for her input and ideas. We thank Patricia O’Campo and Arjumand Siddiqi for the ideas shared during their presentations at the 2 May 2017 Centre Talks session at St. Michael’s Hospital, ‘Racialization, health care and health care research,’ which provided critical insights that helped to shape this article. We thank Stephen Hwang and Patricia O’Campo for their support throughout this process. Finally, we thank the anonymous peer reviewers, whose input significantly influenced the final manuscript. We are grateful to them for their careful reading, and for sharing their knowledge with us.

Disclosure statement

No potential conflict of interest was reported by the authors.

supplementary material

Supplemental data for this article can be accessed here.