Originally published by LHSS project.
Vulnerable groups. Marginalized populations. Underserved communities. These are all terms we use in global health and development, especially in program design. We mean well. We’re trying to be inclusive, to ensure our programs reach people in need, especially those who may be left out of mainstream programming. But as Shauna Caria and Anne Hayes argue in this piece for Devex, relying on these catchall terms can have a harmful unintended consequence. “Vulnerable groups” and similar terminology aggregates the needs of diverse, often excluded people and perpetuates their invisibility.
We need to be intentional. Rather than slipping in an ambiguous term, we need to analyze from the start the characteristics of the people who are excluded from our programs or may miss out on the improvements we’re working towards. Using precise language about the intended beneficiaries of our work not only contributes to sound program design, but also helps us revisit who we are trying to reach later in implementation or even evaluation. How can we hold ourselves accountable if we are not even naming who we are trying to help?
How can we hold ourselves accountable if we are not even naming who we are trying to help?
Other frequent culprits are sentences such as, “We will ensure our program reaches women, children, and other vulnerable groups.” First, these are vague statements which likely indicate no real plan to truly reach the named groups. Second, simply throwing in “women … and vulnerable groups” masks the critical power dynamics that are often the root causes of the vulnerabilities. Programs that target women and vulnerable groups on the surface, without addressing the underlying power dynamics, will not lead to sustainable change of harmful norms. While it is true in most contexts that we need to be proactive in reaching women to account for systemic and historical discrimination, only targeting women ignores the complex gender and social norms limiting their participation in the first place.
Use an intersectional approach to address complexities. Everyone has their own unique experiences, and we must consider everything and anything that can marginalize people – gender, race, class, sexual orientation, physical ability, financial means, and more. In health, different characteristics intersect to make an individual more or less susceptible to certain diseases, able to access and afford health care, and likely to receive quality, needed services.
Every context is going to be different, so there is no one term to recommend. With the LHSS Project, we try to be as specific as possible. In Colombia, we determined the specific challenges in accessing health care for Venezuelan migrants and continue to keep this central. In Jordan, LHSS is training health providers to manage COVID-19 cases among persons with disabilities. In the Dominican Republic, LHSS is improving the quality of HIV treatment and care for people of Haitian descent.
Let’s all commit to using intentional, specific language and remember that words have meaning.
LHSS is also identifying specific populations and differential strategies in the important area of COVID-19 vaccination programs. A blanket approach of trying to reach “vulnerable populations” with COVID-19 vaccines would quickly flop, as individuals have different needs, accessibility, and even hesitancies about vaccines that need consideration. In many cases, program planners probably have a sense of who they are trying to reach with vaccination, but if they don’t name these groups specifically, they may fail to tailor the vaccination campaigns appropriately to actually reach all the intended groups.
There are tools to help find the right words and narrow in on the challenges. For example, by conducting a gender analysis, practitioners can gain more specificity on the different types of vulnerabilities in the context they are working in and appropriate ways to engage the community. A gender analysis, or a gender equity and social inclusion analysis, seeks to identify, understand, and explain gaps that exist in households, communities, and countries between males and females and other intersectional identity factors. The gender analysis provides a better understanding of the unique needs of people involved in the program, including root causes of vulnerability.
We need to do better. Let’s all commit to using intentional, specific language and remember that words have meaning. Language is an important step, but only part of a process in design and implementation. Community engagement, monitoring and evaluating, and continuous learning are also critical elements. But it all starts with naming who we mean.
About the author: Samantha Law Wilde is the LHSS senior technical advisor for gender equality and social inclusion and a senior program officer with LHSS consortium partner Banyan Global.