Inclusive Language Guide

Diverse colors, shapes and mediums in this colorful abstract created in response to summer of 2020

Inclusive language puts our humanity at the center; it allows everyone to feel recognized, valued, invited and motivated to contribute at their highest level. To become an anti-racist institution, OHSU must take concrete action to change our culture and the experiences of OHSU members and stakeholders. If our words but not our deeds change, we have failed. Yet learning about and using respectful, identity-affirming language is key to creating a welcoming environment that is antiracist and embraces diversity as a whole.

The OHSU Inclusive Language Guide is intended as an evolving tool to help OHSU members learn about and use inclusive language in institutional communications, patient care (including chart notes), instruction and presentations around descriptors of:

Race and ethnicity
Immigration status
Gender and sexual orientation
Ability (including physical, mental and chronological attributes)

This guide is a direct response to requests from many OHSU members in the wake of President Danny Jacobs’ June 2020 proclamation that OHSU will work to dismantle systemic racism. Campus leaders in diversity, equity and inclusion and in communications convened a six-person, diverse, cross-institutional Inclusive Language Project Team. (See appendix)

The team surveyed the employee resource groups and other campus affinity groups, including students and trainees, to make the case for and shape the guide’s content. In all, 272 OHSU members responded to the survey. They expressed strong agreement that a guide is needed to better focus and achieve the aspirations of respect for all. Moreover, with their insights and feedback, the guide became a unique reflection of OHSU, its members and what it means to a diverse range of individuals to feel seen and respected.

“I love the idea of having an OHSU standard for how to identify race and ethnicity,” said one survey respondent. “It will make me feel better about my employment at OHSU to have this attention on respect and diversity.”

It will take time to update language across platforms and software applications such as Epic and Oracle. Often, change related to gender and race will require conversations with vendors and the evolution of government descriptors. In some instances, arriving at standard descriptors is not possible given the diversity of human identity and the imprecision and evolution of descriptors. But OHSU members have made clear that education and guidance where possible is needed.

Principles

The goal of using inclusive language is not transactional – it is not about getting it right or wrong as much as it is about a paradigm shift.

Like the saying that history is written by the victors, discourse tends to be dominated by the majority point of view in any given situation. In general, discourse in American society has tended to center the experience of people who are white, heterosexual and cisgender (their gender identity matches their sex assigned at birth), setting this experience up at the norm and everything else as an exception or deviation. By contrast, acknowledging and affirming difference from the outset shifts to the premise of honoring and inviting multiple perspectives, and celebrating rather than suppressing diversity.

The intention of this guide is not to be prescriptive as much as instructive. The more we understand about language, descriptors and their meanings, the more we can be intentional about how we speak and the impact of our words. To develop this guide, we used insights from survey participants combined with scholarly and journalistic sources to offer the following principles to help you think about word choice:

Identity is personal

Every individual has the right to describe themselves as they wish. One survey respondent said, “As a fat person, I’m offended by the word obese, as many fat people are. Many fat people reclaim the word ‘fat.’” Among people who fit the U.S. Census description of Hispanic (descending from a Spanish-speaking country), diversity — and the ways individuals describe themselves — is vast. This guide offers insight on general terms that does not supersede how individuals choose to describe themselves.

Respect

Not everyone wants to share their identity. If you are leading a group or setting the stage in a conversation, create space for people to show up as they are to the extent that they wish to. A survey respondent said, “We need to allow people at the individual level to choose whether they wish to disclose their individual identities. Respect for privacy is important.”

Ask

When interacting with people for the first time, describe your intention to use respectful language and ask, “How do wish for me to refer to you?” One survey respondent suggested, “When caring for a patient who is from a culture or group you are unfamiliar with, you must ask them how you can make them feel safe and respected.”

Sharing how you wish to be addressed is one way to establish a dialogue in a group setting: “Welcome to our class. I’m Dr. Neville. My pronouns are she/her/ hers. I identify as Jamaican; it’s where my parents are from. I grew up in Seattle. I’d welcome knowing how each of you would like to be addressed or anything else you would like us to know so that we can honor our diversity and refer to each other respectfully. But what you choose to share now or in the future is up to you, and if you wish to share information privately with me, that’s also OK. I just want everyone to feel invited to be who they are in this class.”

Be specific

We often hide behind vague words or generalizations when we are uncomfortable, such as using the word “diverse” to refer to people who are not white and heterosexual. But this is incorrect. Diverse refers to two or more people who are different from one another. Diverse is not defined as a person or people who are different from you, as if you are the norm and they are diverse.

If referring to a wide spectrum of nonwhite people and specifying race is relevant, you might say, “people of color and/or individuals who identify with other underrepresented groups” (if, in fact, they are underrepresented, such as in medicine or science). Or if you know the specific makeup of a group, you could just be specific.

As one of the survey respondents said, “Since I have switched to saying what I mean rather than hiding behind vague terms, I have been much more effective in building relationships and making necessary points about how to move forward in issues that surround race.” Another said, “Use clear, unambiguous language.”

…acknowledging and affirming difference from the outset shifts to the premise of honoring and inviting multiple perspectives, and celebrating rather than suppressing diversity.

Be thoughtful and intentional

When is it even appropriate to call out a person’s race or physical or mental attributes? We recommend being thoughtful. In a chart note, for example, one provider suggested including race and other such personal attributes in the social history but not in an introductory statement about a patient where such attributes can trigger bias. So rather than introducing the patient as a 25-year-old, Black woman, you would instead include her race in the social history because we know that a patient’s race is a social determinant of health

Be kind and affirming

People-first language

We are all people with various attributes - a person who lives with mental illness, a person who is gay or heterosexual. It is generally advised not to lead with the attribute, as if that attribute defines the whole person – such as, a mentally ill person or an undocumented person. However, there are exceptions. Accepted terminology for individuals of transgender experience may include a transgender person, transgender woman or transgender man (the gender the person has transitioned to). “Identity-first” language leads with a defining attribute. In the Deaf community, for example, “Deaf person” is acceptable. People on the autism spectrum often call themselves autistic people. Always, when in doubt, ask how a person refers to themselves or, for general usage, use people-first language but be open to correction.

It is generally advised not to lead with the attribute, as if that attribute defines the whole person – such as, a mentally ill person or an undocumented person.

Avoid labels

Instead of “addict” use, “a person with a substance use disorder.” Instead of labeling a patient “noncompliant” in a chart note, say “did not complete treatment” or “stopped taking medication.” When we label people, it is as if that word wholly and forever defines them; it can also trigger biases in others. As people, our attributes can change over time. A person with a substance use disorder may simultaneously be a person in recovery.

Use asset- not deficit-based language

The goal is to focus on strengths. Here are examples from the grant-writing world:

Asset based	Deficit based
Our mission is to amplify the voices in our community.	Our mission is to give voice to the voiceless.
The communities we partner with are strong and powerful.	The communities we serve are strong and powerful.
Youth in our community are our future. We must invest in them as leaders.	We provide youth with jobs in order to prevent them from committing crimes.

Intellectual humility

Acknowledging that you understand the importance of, and intend to use, respectful language shows and invites humility. At the same time, avoid burdening others with your learning curve. So rather than, “I’m really trying to use inclusive language, but sometimes I mess up, so cut me some slack,” try, “I’m learning more about inclusive language and will try hard to get it right. Thank you for your patience.

Gender neutral language

“You guys,” or “ladies and gentleman,” can be “you all” or “folks” or “welcome to all!” to include individuals who identify as transgender or nonbinary. This is equally important in other areas where gendered language prevails. “Pregnant people or person,” for example, rather than “pregnant women or woman.” Other examples may include “parent(s)” instead of “mother(s) and father(s)” or “sibling” instead of “sister” or brother” or “chair” instead of “chairman.” In clinical realms, gender-neutral language can also be used when referring to anatomy or parts of the body.

Capitalization

OHSU uses the Associated Press Style Guide on communications platforms. The AP’s thoughtful attention to evolving language has inspired continued confidence in this tool.

Black

In summer 2020, the AP began capitalizing Black in a racial, ethnic or cultural sense, conveying an essential and shared sense of history, identity and community among people who identify as Black, including those in the African diaspora and within Africa. The lowercase black refers to the color, not a person.

Indigenous

Capitalized when referring to original inhabitants of a place. These two decisions align with long-standing capitalization of distinct racial and ethnic identifiers such as Latino, Asian American and Native American or American Indian.

brown

The AP does not capitalize “brown” as in “brown people,” as it is a broad and imprecise term unless capitalized in a direct quote. Interpretations of what the term includes vary widely and many people find “brown people” offensive or demeaning.

white

The AP continues to lowercase the term white in racial, ethnic and cultural senses. The AP reasons that white people generally do not share the same history and culture, or the experience of being discriminated against because of skin color. The AP agrees that white people’s skin color plays into systemic injustices. But capitalizing the term, as is done by white supremacists, risks subtly conveying legitimacy to such beliefs. The AP acknowledges that some view this decision as inconsistent or discriminatory. Others say capitalizing the term could pull white people more fully into discussions of race and equality. The AP plans to track how thought evolves and periodically review the decision.

Race and ethnicity

The following is intended to educate about descriptors of race and ethnicity to assist in choosing respectful and affirming language when referring to individuals and groups in a general sense:

Broad terms referencing individuals/groups

BIPOC

Stands for Black, Indigenous and People of Color. Some individuals and groups have embraced this descriptor, while others feel alienated or unacknowledged by it. “People of color” is also widely used, but some point out that white is also a color, don’t wish to be defined by their skin color or find the phrase othering. Others note that BIPOC centers race/ethnicity, not gender or other forms of diversity. In general, when desiring to refer broadly to racial or ethnic groups other than white, non-Hispanic, this guide recommends “Black, Indigenous, Hispanic, Asian and other people of color” as a broad term and the use of more specific descriptors when those are known or relevant.

This guide recommends “Black, Indigenous, Hispanic, Asian and other people of color” as a broad term and the use of more specific descriptors when those are known or relevant.

Underrepresented

The general phrase “underrepresented” or “members of underrepresented groups” is appropriate and is especially preferred when you can be specific and accurate. For example: Black students and/or transgender students are “underrepresented in medicine” or “underrepresented in dentistry.” An appropriate reference would be, “A goal of the scholarships is to provide financial support to students identifying with under-represented groups.” Note:

Not all individuals of color are under-represented in the health professions. Individuals who identify as Asian (a large, diverse category) are not underrepresented in medicine, for example. This does not mean that they don’t experience racism or discrimination. And, several Asian subgroups, such as Pacific Islander, are underrepresented in medicine.
The term “minority” (or “underrepresented minority”) centers people in the majority, usually white people, and doesn’t account for the fact that in some groupings, “minorities” are in fact in the majority. (Some prefer the term “minoritized,” to reflect the active subordination of a group of people; yet others feel that the term is insulting, implying a lack of agency among individuals to which it is applied.)

Underrepresented: The general phrase “underrepresented” or “members of underrepresented groups” is appropriate and is especially preferred when you can be specific and accurate.

Specific terms for specific groups

Term
Definition

American Indian or Alaska Native

“American Indian or Alaska Native” (AI/AN) includes all individuals who identify with any of the original peoples of North America and who maintain tribal affiliation or community attachment. Oregon has nine recognized tribes. Indigenous people use a range of words to describe themselves and prefer various descriptors to be used by others. Some say American Indian or Native American, though both are white European constructs. Most identify with their specific nation, such as a member of the Navajo Nation. Respectful, general terms are Indigenous people or First People. Learn more. (See Mesoamerican Indigenous people under Hispanic/Latino/Latinx.)

Arab and Arabian

Arab is an umbrella term for a pan-ethnic group of people, composed of many ethnicities. Generally, and even more so presently, Arabs descend from member nations of the Arab League, 22 nations and territories formed in 1945. However, there are people who live in Arab countries who do not consider themselves Arabs, such as the Kurds.

Arabs are also not necessarily Arabians. Arabians are people from the countries of the Arabian Peninsula. The Arabian Peninsula is now home to Arabic peoples, so you could say that Arabians are Arabs, but not all Arabs are Arabians, since many live off of the peninsula. The Arab peoples are united by an identity of a shared culture and history.

Most Arabs speak Arabic, which is a language and not meant to refer to the people, though you could say “Arabic-speaking people.” (See also Middle Easterner.)

Asian

An individual who identifies with one or more nationalities or ethnic groups originating in the Far East, Southeast Asia or the Indian subcontinent.

Black/African American

The most inclusive term is Black people, denoting a shared sense of identity and experience in this country related to skin color and not narrowing by the gender “men” or “women.” Black people trace their origins to many countries, languages and ethnicities.

African American is technically accurate for individuals and groups who identify as Americans and trace their ancestry to Africa. Afro-Caribbean American denotes people who identify as Americans and trace their ancestry to both Africa and the Caribbean. Caribbean American denotes those who identify as American and solely with Caribbean ancestry. There are many other variations.

An African is a person of African descent. Africans may be various races. Some do not identify with Black or African American culture.

Middle Easterner

A person or a descendant from the Middle East. The Middle Eastern countries are: Bahrain, Cyprus, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Northern Cyprus, Oman, Palestine, Qatar, Saudi Arabia, Syria, Turkey, United Arab Emirates, and Yemen. Afghanistan and Pakistan, are not included in the Middle East. These nations, as well as Algeria, Libya, Tunisia, and even Djibouti and Somalia, have been referred to as part of the Greater Middle East.

Native Hawaiian

An individual who is Native Hawaiian or is a descendant. They are the aboriginal Polynesian people of the Hawaiian Islanders and/or their descendants.

Pacific Islander

An individual who identifies or descends from the Pacific Islands or ancestry. The three major sub-regions include Micronesia, Melanesia and Polynesia. A U.S. Census term, referring to one of eight groups — Fijian, Guamanian, Hawaiian, Northern Mariana Islander, Palauan, Samoan, Tahitian, and Tonga Pilipino.

Persian

Persian can refer to people of Iran and a language. But, when referring to people, Persians are Iranians who speak the Persian language (Farsi). The term Persian people historically meant “from Persis,” which is around Pars, Iran, north of the Persian Gulf. With this definition, not all Iranians are Persians, but all Persians are Iranians, nationally.

However, some now designate Persian people as a pan-ethnic group (like the Arab people). If unclear, describe someone from Iran as Iranian. Also, many Iranians use “Persian” to make a locational, rather than an ethnic, distinction. So there may be non-Persian people (who don’t speak Farsi) whom Iranians deem Persian, as they come from the Persian region. Learn more at teachmideast.com.

Roma, Romany, Romani

The Roma or Romani (also spelled Romany) are a traditionally itinerant ethnic group. Oregon has a large Roma community. They are often called Gypsies, but this is a term with negative connotations of illegal activity, and many Roma do not identify with it. Romany (with a y) usually refers specifically to Romanichals, the native Romani subgroup in England. Learn more about Oregon Roma history.

Russians and Russian Old Believers

It is appropriate to use the phrase “a person from Russia” to refer to people (regardless of religion) who hail from this country. But coming from Russia can be different from identifying ethnically as Russian. Russia, like China, is home to many ethnicities, such as Chechan or Tatar. “He comes from Russia” is appropriate, but “he is Russian” may be inaccurate. A subset identifies as Russian Orthodox Old Believers (starovery). They are descendants of medieval Russians who refused to adopt the mid-17th century church reforms, viewing them as sacrilegious. Therefore, the Old Believers are also referred to as Old Ritualists (staroobryadtsy). Many Russian Old Believers live in Oregon. Learn more about Old Believers in Oregon.

Hispanic or Latino/Latina/Latinx

Hispanic, which includes descendants of all Spanish-speaking countries, or Latino/Latina/Latinx or Latino/Latinx referring to people of Latin American heritage, are acceptable broad descriptors. The latter represents masculine (Latino), feminine (Latina) and nonbinary (Latinx). Learn more:

Latino

Definition

Generally refers to geography, namely from Latin America, which is any place in the Americas that speaks a language descending from a Latin romance language. Includes below the U.S., the Caribbean and Brazil.

History

Latino was recorded as early as the 1940s in the U.S. and ultimately shortened from the Spanish Latinoamericano, or Latin American. The U.S. Census introduced the term Latino in 2000 and the term Hispanic 20 years earlier.

Commentaries

Hispanic and Latino can be viewed as interchangeable terms to describe the ethnicity and heritage of a population that makes up nearly 20 percent of the United States population.

Hispanic

Definition

Describes a person who has lineage to a Spanish speaking country, or whose heritage derives from it. It is not a prerequisite to speak Spanish. Includes Spain but excludes Brazil where Portuguese is spoken.

History

Hispanic refers to Spain and its people on the Iberian Peninsula. Hispanic derives from the Latin Hispānicus, the source of the name Spain. First recorded in English in the late 1500s. Hispanic reflects the imperialist history of Spain as a European colonizer in Latin America.

Commentaries

During the Civil Rights Movement, there was a cry to recognize U.S. Mexican, Puerto Rican and Cuban populations. The term Hispanic was adopted as a federal heritage category introduced in the 1980 U.S. Census. The term caught on, with support of Spanish language TV and became a more broadly accepted label.

Latinx

Definition

A term used to describe individuals who are of/or relate to Latin American origin or descent. This term is a gender-neutral or nonbinary alternative to Latino or Latina. Listen to pronunciation.

(Latine is also an emerging gender-neutral descriptor.)

History

A new, gender-neutral, pan-ethnic label, Latinx, has emerged as an alternative to describe Hispanics/Latinos. Latinx has been around since 2004 but became better known after the 2016 Pulse nightclub shooting in Orlando, Florida. This term tends to be used more by younger people and those identifying as LGBTQ.

Commentaries

The Pew Research Center National Survey found that one in four U.S. Hispanics/ Latinos have heard of Latinx but only 3 percent use it. Some call it linguistic imperialism — English policing the Spanish language; Latinx does not correspond with Spanish grammar or conventional speech. The Real Academia Española, preserver of the Spanish language, rejected the term. Merriam-Webster added it in 2018.

Mexican American, Chicana, Cubano/a, Guatemalteca/o, Puerto Rican, Dominican, Dominicano, Dominicana, Puertorriqueño, etc.

Definition

Personalismo – Personalization in Latino culture implies setting trust to establish relationships.

History

Personalized – Individuals tend to identify or be influenced by their origin, roots, and/or heritage to Spain or a Latin American country.

Commentaries

Many first acknowledge their roots of origin prior to selecting Hispanic or Latino. Soy Mexicana, Soy Otomi, Soy Domicano.

Mesoamerican Indigenous

Definition

A term used to describe Indigenous people from Mexico and Central America.

History

The Historical Linguistics of Native America notes more than 125 languages native to Mesoamerica. Language families include: Mesoamerica are Mayan, Mixe-Zoquean, Otomanguean, Tequistlatecan, Totonacan, Uto-Aztecan, and Xinkan. Not all speak Spanish.

Commentaries

Societies that flourished more than 1,000 years before the Spanish colonization of the Americas. Mesoamerican Indian/Indigenous cultures have a common origin in the pre-Columbian civilizations.

Latino

Definition

A term used to describe Indigenous people from Mexico and Central America.

History

Commentaries

Societies that flourished more than 1,000 years before the Spanish colonization of the Americas. Mesoamerican Indian/Indigenous cultures have a common origin in the pre-Columbian civilizations.

*The Spanish language also uses pronouns el, ella, ellos, nosotros and formal and informal language—tú y usted.

Immigration status and language proficiency

Just as American language has tended to center on the white experience, descriptors of immigration status tend to center on and affirm people with citizenship. They tend to dehumanize, criminalize and/or vilify those without citizenship. This diverts attention from the circumstances that led them to leave their countries and from the barriers to legitimacy they’ve encountered in the U.S., and puts the “blame” solely on the individual or family. Inclusive language around immigration status affirms and acknowledges the legitimacy of everyone as human beings:

Immigration status

Rather than referring to residents who are not citizens with such dehumanizing terms as alien or illegal alien or simply illegal, the word “undocumented” is advised, ideally:

• The person or family is undocumented, not they are an undocumented family.
• Or, the person or family lacks documentation; or lacks a path to citizenship.

Language proficiency

She speaks English as a second language is viewed as inadequate in that people may speak more than two languages.

Emerging bilingual is equally limiting and English language learner is paternalistic.

Preferred: She speaks English in addition to other languages, or she speaks Spanish and is learning English, or Spanish or Japanese or Russian, etc. is her first language.

Glossary of terms

Term
Definition

U.S. citizens

People who were born in the U.S. or who have become “naturalized” after being permanent residents. Entitled to receive every benefit as other every U.S. citizen.

Permanent or conditional residents

Legal permanent residents (LPRs) are those who have a “green card.” A green card holder, or lawful permanent resident, has authorization to permanently live and work in the United States. Green card holders have all the benefits of U.S. citizenship except voting.

Non-immigrants

People in this category are in the country legally but only on a temporary basis. Examples:

Students (F-1 visa)
Business visitors or tourists (B1/B2 visas)
Fiancées (K-1 visa)
Individuals granted temporary protected status

Undocumented

People who are in the U.S. without permission are undocumented either because they overstayed a legal temporary visa or they entered the U.S. without going through a port of entry. They are not authorized to work or access public benefits. People who are undocumented risk being deported. This creates a highly stressful and unstable living situation.

Full listing of terms for immigration glossary

Sex, gender, gender identity and sexual orientation

Sex is a label — most often male or female — that you’re assigned at birth based on your genitals and chromosomes. It goes on your birth certificate. Sex diversity also includes intersex. This is an umbrella term to describe people born with chromosomes, hormones and/or anatomy that is not typically male or female. Intersex people can be any gender, including transgender or gender nonbinary.

Gender is a social and legal status and a set of expectations from society about behaviors, characteristics and thoughts. Each culture has standards about the way that people should behave based on their gender, also generally masculine and feminine.

Gender identity is how you feel inside and how you express your gender through your clothing, behavior and personal appearance. It’s a feeling that begins very early in life.

Sexual orientation is an inherent or immutable enduring emotional, romantic or sexual attraction to other people. Sexual orientation is not the same as, and is independent of, gender identity.

Broad references

The most inclusive general reference is LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minorities). LGBTQ is also widely used.

Glossary and respectful language tips

Sexual orientation

Asexual: A person who does not experience sexual attraction.
Bisexual: A person emotionally, romantically or sexually attracted to more than one sex, gender or gender identity though not necessarily simultaneously, in the same way or to the same degree. Sometimes used interchangeably with pansexual.
Gay: A person who is emotionally, romantically or sexually attracted to members of the same gender. Men, women and non-binary people may use this term to describe themselves.
Lesbian: A woman who is emotionally, romantically or sexually attracted to other women. Women and non-binary people may use this term to describe themselves.

Gender identity

AFAB and AMAB: Acronyms for assigned female at birth and assigned male at birth.
Agender: A general term to describe someone who has no gender.
Ally: Any non-LGBTQ person who helps or supports an LGBTQ person or the LGBTQ community; also used in the context of race, as in “white ally” to people of color, or, “white accomplice.”
Assigned gender: The gender a person is identified as at birth, usually based on their anatomy.
Cisgender: People who identify with their assigned gender. From the Latin prefix cis-, which means “on this side of,” as opposed to trans-, which means “on the other side of.”
Gender-affirming surgery: Any surgery that changes a person’s body to align with the person’s gender identity. This may involve chest reconstruction (commonly called top surgery), genital reconstruction (also called bottom surgery) and other physical changes.
Gender dysphoria: A person’s deep dissatisfaction, anxiety or distress about the disparity between their gender identity and assigned gender. Not all transgender people have dysphoria.
Gender expression: The external ways in which people show their gender. This could be through their name, pronouns, appearance, voice, mannerisms and other means. Transgender people’s gender expression often matches their gender identity. But gender expression doesn’t always fit society’s defined roles.
Gender fluid: This means having a gender identity that changes — long term, day to day or on any other timeline.
Gender identity: A person’s inner sense of their gender, whether it’s male, female, a combination of both, fluid or neither. Transgender people’s gender identity is different from the gender they were assigned at birth. Your gender identity may not be obvious to other people.
Gender nonconforming: A descriptive term for people whose gender identity or expression doesn’t fit traditional male and female roles and behavior. It doesn’t necessarily mean transgender. For example, someone who was assigned male at birth and who identifies as male but whose gender expression does not fit traditional male roles may consider themselves gender nonconforming but not transgender.
Genderqueer: Another term for gender nonconforming.
Intersex: This is an umbrella term to describe people born with chromosomes, hormones and/or anatomy that is not typically male or female. Intersex people can be any gender, including transgender or gender nonbinary.
Multigender: Identifying as two or more genders. People who identify as two genders may call themselves bigender.
Nonbinary: Anyone who identifies as neither male nor female. Some nonbinary people consider themselves transgender; others do not.
Transgender: An umbrella term to describe people whose gender identity or gender expression is different from the gender they were assigned at birth. Not all transgender people change their bodies with hormones or surgery, and not all match their gender identity with their gender expression. Transgender is sometimes shortened to trans. Neither is used as a noun.
Transition: The process of aligning gender expression with gender identity. Transition is different for every transgender person. Some make social changes, such as using a different name and pronouns, or wearing different clothes. Some use hormone therapy to change themselves physically and emotionally. Others choose surgery. Many choose a combination. Transitioning may be public, including telling family, friends and co-workers. It may include changing your name and gender on legal documents. Or it may be private.

Terms to avoid

Most of the time, a person’s gender is irrelevant. If it is relevant with a transgender person, there are ways to be respectful. Terms vary by region, ever-evolving language and other factors. In some cases, a person may find that one of the following terms best describes their experience. But in general, these terms are outdated, and we avoid them.

Biological male/female, born a man/woman: Considered derogatory. Use “assigned male/female at birth” or “designated male/female at birth.”
Gender identity disorder: This is an obsolete medical and psychological term for gender dysphoria.
Hermaphrodite: Outdated, offensive term for intersex.
MTF and FTM: Old acronyms for male-to-female and female-to-male. Transgender woman and transgender man are generally accepted terms instead.
Preferred name, preferred pronoun: Like anyone, a transgender person’s name and pronouns are what they call themselves, not what they prefer to be called. For the same reason, avoid “real name."
Pre-operative, post-operative W: Whether a transgender person has had gender-affirming surgery may have nothing to do with transitioning. It’s usually an invasion of privacy to describe someone in such terms.
Sex-change operation: Many transgender people who have surgery — and not all do — see themselves as affirming their gender, not changing it. Gender-affirming surgery is preferred.
Sexual orientation: This refers to a person’s romantic or sexual attraction to others. It is not the same as gender identity.
Tranny: Offensive to most transgender people, even though some use it to describe themselves.
Transgendered: Incorrect adjective for transgender, the same as saying someone is “maled” or “femaled.”
Transsexual: An older adjective for people who have changed, or want to change, their bodies to align with their gender identity. Some transgender people use the word to describe themselves, but many do not.

Best practices

If you’re unsure what name or pronoun someone uses, politely ask. It’s usually OK to ask: “What pronouns do you use?” Remember, it’s not what pronouns they “prefer.”

Do your best to use someone’s name and pronouns consistently, even if you knew the person by another name.

Acknowledge any language mistakes you make and how it may make the person feel.

Talking about a transgender person’s previous identity is called deadnaming. It’s disrespectful. If you don’t know how to refer to someone in the past, ask. If the person doesn’t want to discuss it, respect that.

Learn more

Human Rights Coalition

University of Maryland Lesbian, Gay, Bisexual & Transgender Equity Center

Glossary of LGBT terms - National LGBT Health Education Center | en español

How to Be Human: Talking to People Who Are Transgender or Nonbinary - Healthline.com

Understanding Transgender People: The Basics - National Center for Transgender Equality

Standards of Care Version 7: Glossary - World Professional Association for Transgender Health (scroll to Page 95 for glossary)

Glossary of Terms - Human Rights Campaign

Glossary of Terms – Transgender, Gay and Lesbian Alliance Against Defamation

The Radical Copyeditor’s Style Guide for Writing About Transgender People

Ability, physical, mental and chronological attributes

Following is a glossary promoting language around ability and physical, mental and chronological attributes. The Community of People with Disabilities is by definition inclusive and intersectional. At the request of OHSU members, we have also added a segment on body weight and age.

Respectful language

Term
Definition

Ableism

Discrimination in favor of people who are able-bodied. “After your meeting, will you run down to my office to pick up the documents?”

Able-bodied

A person without a physical disability.

Ageism

Discrimination based on age – usually negatively stereotyping older adults or the aging process but also patronizing or underestimating the abilities of younger people. Learn more on Wikipedia.

Autism spectrum disorder

A complex developmental condition that involves persistent challenges in social interaction, speech and nonverbal communication, and restricted/repetitive behaviors. The effects and severity differ in each person. Preferred general language is a person with autism spectrum disorder or a person on the autism spectrum, but many in this community refer to themselves as autistic people. (See above reference in the Principles section to people-first versus identity-first language)

Autism spectrum disorder now includes the neurodevelopmental disorder called Asperger’s syndrome, named for the German pediatrician Hans Asperger. Dr. Asperger played a pioneering role in the understanding of autism during the 1930s and 1940s, but has been proven, in recent years, to have used the designation to deem some children as intelligent and others as unfit, signing the paperwork for them to go to a Nazi hospital where children were euthanized.

Body weight

People of higher weight experience discrimination and stigma as a result of living in a larger body. A 2020 review analyzed 33 studies related to people’s preferences around weightrelated terminology. It identified the terms obese and fat as the least acceptable among study participants (Puhl, 2020). However, some people of higher weight have reclaimed the term “fat” and self-identify this way (Meadows & Daníelsdóttir, 2016). If a person of higher weight encourages you to describe them as fat, then it is appropriate to do as asked, otherwise “higher weight” or “larger body” are preferred.

This does not change the recommendation to avoid using the term to describe someone unless encouraged to do so by that person.

Deaf person

A person who is part of the Deaf community. The Deaf community has its own culture, language(s). See the Diversity Style Guide for more information.

Hard of hearing

A phrase used to describe a person usually with mild to moderate hearing loss.

Hidden/invisible disability

A non-obvious/hidden/invisible condition that substantially limits one or more major life activities, including people with non-obvious visual or auditory disabilities or repetitive strain injury. Learn more about hidden/invisible disabilities.

Neurodiverse

An adjective most often used to describe autistic people or other people who have neurologically atypical patterns of thought or behavior.

Neurotypical

An adjective used to describe people who have typical developmental, intellectual and cognitive abilities. Generally used in contrast with people who are neurodiverse.

Obvious disability

A manifestation of the body that indicates some type of disability.

Person with a disability/people with disabilities

This represents person-first language; see the person, not the disability. Widely, but not universally used in the community for people with disabilities. For example, Deaf people and autistic (neurodiverse people) prefer the respective adjectives to proceed the word people. People with disabilities are not all the same.

Sanism (mentalism)

A type of discrimination and oppression against a mental trait or condition a person has or is judged to have. The discrimination/oppression often occurs through common phrases, i.e.; “crazy talk,” “mental case,” “lunatic,” “wacky,” “nuts,” etc.

Substance use disorder

A disease that affects a person’s brain and behavior and leads to an inability to control the use of a legal or illegal medication or drug. Use instead of “addicted to drugs” or “drug addict.”

Best practices

Do not try to diagnose or define a person in casual conversation. Examples: That person is on the spectrum. That person is bipolar.

When first meeting a person with a visible disability, don’t lead with, What happened to you? Why do you walk like that? Why are you in a wheelchair? Get to know a person before, if ever, asking about their disability. If a person shares their experience, it is OK to draw them out if they seem to want to talk about it or to just say, Thank you for sharing that with me.

Avoid trying to relate to a person with a disability by referring to people you know. Examples: Hey, (my sister) (my friend) is (in a wheelchair) (blind) (deaf), etc.; There was a kid at my daughter’s school who … Such statements are natural associations occurring in your head but can come across as presumptuous, as if you know what it’s like to be them. If a person with a disability brings up their disability, it is fine to talk about it, but stay within scope. Example, if a person shares that they have a spinal cord injury, you should not jump to a deeply personal question such as how do they get dressed or use the restroom. Stay within the scope that the person introduces.

Don’t start conversations with false flattery. Examples: I couldn’t do what do. You are an inspiration. Start conversations like you would with a person who does not have a visible disability; talk about the weather, parking, coffee or simply, “How’s it going?

Terms to avoid

Abelist language

Amp/amputee
Cripple, crippled
Diabetic
Gimp
Handicapped
Invalid
Lame
Spaz
The Spectrum/on the spectrum
Wheelchair-bound, or confined to a wheelchair (wheelchairs are mobility tools, and people are not stuck in them)
Hearing impaired is a less favored term in the deaf/hard-of-hearing community as the word impaired can have negative connotations and focuses on what a person can't do.

Sanist language

Addict, addicted
Bipolar
Crazy
Deranged
Drug addict
Drug baby
Handicapped
Idiot
Imbecile
Insane
Invalid
Lunatic
Manic
Maniac
Nuts
Opioid addict
Retarded and variants including words with prefixes attached to -tard.
Weird

Glossary of terms and definitions

Term
Definition

Accessibility: The extent to which a facility is readily approachable and usable by individuals with disabilities, particularly such areas as the residence halls, classrooms, and public areas.
Age-ism: Prejudiced thoughts and discriminatory actions based on differences in age; usually that of younger persons against older.
Ally: Someone who makes the commitment and effort to recognize their privilege (based on gender, class, race, sexual identity, etc.) and work in solidarity with oppressed groups in the struggle for justice, understanding that it is in their own interest to end all forms of oppression, even those that they may benefit from in concrete ways.
Anti-racist: An anti-racist is a person supporting antiracist policy through their actions or expressing antiracist ideas. This includes the expression or ideas that racial groups are equals and do not need developing, and supporting policies that reduce racial inequity.
Anti-Black: The Council for Democratizing Education defines anti-Blackness as being a two-part formation that both voids Blackness of value, while systematically marginalizing Black people and their issues. The first form of anti-Blackness is overt racism. Beneath this anti-Black racism is the covert structural and systemic racism, which categorically predetermines the socioeconomic status of Blacks in this country. The structure is held in place by anti-Black policies, institutions, and ideologies.
Active bystander: Someone who intervenes to stop, assist or constructively address inappropriate or harmful behavior, language or situations.
Bias: A subjective opinion, preference, prejudice, or inclination, often formed without reasonable justification that influences the ability of an individual or group to evaluate a situation objectively or accurately.
Brave space: Honors and invites full engagement from individuals who are vulnerable while also setting the expectation that there could be an oppressive moment that the facilitator and allies have a responsibility to address.
Bystander: Someone who witnesses or is made aware of behavior, language, or situations that are or could be inappropriate or harmful to the community.
Color blind: The belief in treating everyone “equally” by treating everyone the same; based on the presumption that differences are by definition bad or problematic, and therefore best ignored (i.e., “I don’t see race, gender, etc.”).
Color-ism: A form of prejudice or discrimination in which people are treated differently based on the social meanings attached to skin color.
Cultural competence: The ability to interact effectively with people of different cultures, more of a learned/taught condition.
Cultural humility: An interpersonal stance that is open to individuals and communities of varying cultures, in relation to aspects of the cultural identity most important to the person. Cultural humility can include a life-long commitment to self-critique about differences in culture and a commitment to be aware of and actively mitigate power imbalances between cultures.
Cultural white privilege: A set of dominant cultural assumptions about what is good, normal or appropriate that reflects Western European white worldviews and dismisses or demonizes other worldviews.
Discrimination: Actions based on conscious or unconscious prejudice that favor one group over others in the provision of goods, services or opportunities. The unequal treatment of members of various groups based on race, gender, social class, sexual orientation, physical ability, religion, and/or other categories.
Equality: Treating everyone the same way, often while assuming that everyone also starts out on equal footing or with the same opportunities.
Equity: Working toward fair outcomes for people or groups by treating them in ways that address their unique advantages or barriers.
Hate crime: Hate crime legislation often defines a hate crime as a crime motivated by the actual or perceived race, color, religion, national origin, ethnicity, gender, disability, or sexual orientation of any person.
Inclusion: The act of creating involvement, environments and empowerment in which any individual or group can be and feel welcomed, respected, supported, and valued to fully participate. An inclusive and welcoming climate with equal access to opportunities and resources embrace differences and offers respect in words and actions for all people.
Individual racism: Beliefs, attitudes, and action of individuals that support or perpetuate racism in a conscious and unconscious ways.
Interpersonal racism: Slurs, biases, or hateful works and actions.
Institutional racism: Institutional racism refers specifically to the ways in which institutional policies and practices create different outcomes for different racial groups. The institutional policies may never mention any racial group, but their effect is to create advantages for whites, oppression, and disadvantage for people from groups classified as people of color.
Karen: Slang for a white woman who is extremely aware of her privilege and uses it as a weapon against individuals who identify with minoritized groups.
Ken: Slang for white male who is extremely aware of his privilege and uses it as a weapon against individuals who identify with minoritized groups.
Micro-aggressions: Commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory racial slights. These messages may be sent verbally, (“You speak good English”), non-verbally (clutching one’s purse more tightly around people from certain race/ethnicity) or environmentally (symbols like the confederate flag or using Native American mascots). Such communications are usually outside the level of conscious awareness of perpetrators.
Micro-insults: Verbal and nonverbal communications that subtly convey rudeness and insensitivity and demean a person’s racial heritage or identity. An example is an employee who asks a colleague of color how she got her job, implying she may have landed it through an affirmative action or quota system.
Micro-invalidation: Communications that subtly exclude negate or nullify the thoughts, feelings or experiential reality of a person of color. For instance, white individuals often ask Asian-Americans where they were born, conveying the message that they are perpetual foreigners in their own land.
Model minority: Refers to a minority ethnic, racial, or religious group whose members achieve a higher degree of success than the population average. This success is typically measured in income, education, and related factors such as low crime rate and high family stability.
Privilege: Unearned social power accorded by the formal and informal institutions of society to ALL members of a dominant group.
Racist: One who is supporting a racist policy through their actions or interaction or expressing a racist idea.
Racial profiling: The use of race or ethnicity as grounds for suspecting someone of having committed an offense.
Safe space: Refers to an environment in which everyone feels comfortable expressing themselves and participating fully, without fear of attack, ridicule or denial of experience.
Structural white privilege: A system of white domination that creates and maintains belief systems that make current racial advantages and disadvantages seem normal. The system includes powerful incentives for maintaining white privilege and its consequences, and powerful negative consequences for trying to interrupt white privilege or reduce its consequences in meaningful ways. The system includes internal and external manifestations at the individual, interpersonal, cultural and institutional levels.
System of oppression: Conscious and unconscious, non-random, and organized harassment, discrimination, exploitation, discrimination, prejudice and other forms of unequal treatment that impact different groups.
Token-ism: Hiring or seeking to have representation such as a few women and/or racial or ethnic minority persons to appear inclusive while remaining mono-cultural.
Unconscious bias (implicit bias): Social stereotypes about certain groups of people that individuals form outside their own conscious awareness. Everyone holds unconscious beliefs about various social and identity groups, and these biases stem from one’s tendency to organize social worlds by categorizing.
Whiteness: A broad social construction that embraces the white culture, history, ideology, racialization, expressions, and economic, experiences, epistemology, and emotions and behaviors and nonetheless reaps material, political, economic, and structural benefits for those socially deemed white.
White fragility: A state in which even a minimum amount of racial stress becomes intolerable [for white people], triggering a range of defensive moves. These moves include the outward display of emotions such as anger, fear, and guilt, and behaviors such as argumentation, silence, and leaving the stress-inducing situation. These behaviors, in turn, function to reinstate white racial equilibrium.
White privilege: As a member of the dominant group, a white person may have greater access or availability to resources because of being white in the U.S. Life may be structured around not having to daily think about skin color and the questions, looks, and hurdles that individuals of color endure and overcome. White privilege may be less recognizable to some white people because of gender, age, sexual orientation, economic class or physical or mental ability, but it remains a reality because of one’s membership in the white dominant group.
White supremacy: White supremacy is a historically based, institutionally perpetuated system of exploitation and oppression of continents, nations and individuals of color by white individuals and nations of the European continent for the purpose of maintaining and defending a system of wealth, power and privilege.

Appendix

Inclusive Language Project team members

The team was convened in late summer 2020 and completed this guide that December.

Co-Chair Erin Hoover Barnett, B.A., Director of Communications, OHSU School of Medicine

Co-Chair Leslie Garcia, M.P.A., Assistant Chief Diversity Officer , OHSU School of Medicine

Rosemarie Hemmings, Ph.D., LCSW, Director of Social Work, Assistant Professor of Community Dentistry, OHSU School of Dentistry

Ian Jaquiss, J.D., Interim Coordinator, Americans with Disabilities Act, OHSU Department of Affirmative Action and Equal Opportunity (AAEO)

Octaviano Merecias, M.A., MBT Lead Diversity Trainer, OHSU Center for Diversity and Inclusion

Amy Penkin, M.S.W., LCSW, Program Supervisor, OHSU Transgender Health Program

Survey

The Inclusive Language Project Team distributed a survey in September 2020 to stakeholder groups to help shape the guide. Stakeholders were defined as individuals active in campus affinity groups and/or who may have lived experience important to reflect in this guide as well as individuals and teams whose work includes purview over language used at OHSU, such as the OHSU Digital Engagement Team, which sets the tone for language on the OHSU website.

More than 270 people responded to the survey, from the following groups: