Language guide

Preferred: A person experiencing addiction; a person with a substance use disorder; people who use drugs or alcohol, where this is the relevant description.

These labels can define a person by a health condition or behaviour and may reinforce stigma. Use the most precise description available and do not assume that all substance use constitutes addiction or a substance use disorder.

Polydrug use

Preferred: Use of more than one drug or substance; polydrug use, followed by a plain English explanation.

Polydrug use means using more than one drug or substance, either at the same time or within a period in which their effects may interact.

There is no single term preferred by every autistic person. Many autistic adults prefer identity-first language, such as “autistic person”, while others prefer person-first language, such as “person with autism”.

We will normally write “autistic” and “autism” with a lower-case “a”, in line with our general writing style. We recognise that some people use a capital “A” to express identity or community and will respect this where it is an individual or organisation’s chosen usage.

Our understanding of autism continues to develop. Current NHS England guidance describes a shift away from a deficit-based approach towards understanding autism through a neurodiversity lens.

Where possible, we will use the language preferred by the individual or group. In general Suffolk Public Health writing, we will use:

• autistic person or autistic people
• autistic child, young person or adult
• person or people with autism where this reflects an individual preference or source terminology
• autism when referring to the condition or subject generally.

Use instead of "challenging behaviour", when someone acts in a way that could hurt themselves or someone else. More information can be found on the NHS website.

Behaviour may communicate distress, discomfort, pain, fear, unmet need, sensory overload or difficulty communicating. The wording should not imply that the person is the problem.

“Behaviour that challenges services” may be appropriate when the context is specifically about how services respond. If there is an immediate risk of harm, describe the behaviour and risk clearly rather than relying on a general label.

An unpaid carer is someone who provides unpaid help or support to a family member, partner, friend or other person who could not manage without that support because of illness, disability, frailty, mental ill health, addiction or another support need.

Use “unpaid carer” where it is necessary to distinguish the role from paid care workers or care professionals. In contexts where the meaning is already clear, “carer” may be sufficient.

A parent carer is a parent or guardian who provides additional care to a child or young person because of illness, disability or additional needs.

A young carer is a child or young person who provides care or support to another person. A young adult carer is generally a young adult who continues to have caring responsibilities.

Some people do not identify with the term “carer”, even where their circumstances meet a formal definition. Where possible, reflect how people describe their own relationships and responsibilities.

More information: NHS England – Who is Considered a Carer?

We will generally use “children in care” rather than “looked-after children” in narrative writing.

“Looked-after children” is a statutory and administrative term and may need to be retained when referring to legislation, official statistics, service definitions or named indicators.

If an acronym is genuinely needed, write the term in full first. Avoid using different acronyms such as CiC, CLA and LAC interchangeably, as this reduces clarity.

Use “children with a social worker” when this accurately describes the population or measure.

Do not use the term as a substitute for all children receiving support from children’s social care. Some children may receive support without having an allocated social worker. 

If using an official measure, definition or dataset, explain who is included. Avoid using the acronym CWSW unless it appears repeatedly and is necessary for the intended audience.

Communities are diverse. Avoid writing as though one person or organisation can represent an entire community.

Preferred:

• people from Muslim communities
• representatives from local Gypsy and Traveller communities
• participants from LGBTQ+ communities.

Avoid where possible:

• the Muslim community
• the disabled community

unless referring to a specific, defined community that uses that description.

Do not assume that people who share one characteristic have the same experiences, views or needs.

Preferred term: Co-occurring mental ill health and substance use; co-occurring mental health and substance use conditions, where diagnosed conditions are meant.

Avoid where possible: Dual diagnosis, unless this is the formal name of a service, pathway or source definition.

“Dual diagnosis” is used inconsistently. It may refer to co-occurring mental illness and substance use, or to other combinations of conditions. Use a precise description and explain which experiences or conditions are included.

Use “co-occurring” rather than “co-existing” where the conditions or experiences occur during the same period but may fluctuate over time.

Use the full name of a council on first mention. An acronym may be used later if it appears frequently and is clear to the intended audience.

Upper Tier Local Authority (UTLA)

• Suffolk County Council

District & borough councils / Lower-Tier Local Authorities (LTLAs) 

• Babergh District Council
• East Suffolk Council
• Ipswich Borough Council
• Mid Suffolk District Council
• West Suffolk Council

There are also town and parish councils.

Use “district and borough councils” or “lower-tier local authorities” where the distinction is relevant.

There is no single form of language preferred by everyone.

“Disabled people” reflects the social model of disability, which recognises that people are disabled by barriers in society as well as by the effects of an impairment or health condition.

“People with disabilities”, “people with impairments” or “people with health conditions” may be appropriate where these are preferred by individuals or better describe the subject.

Use “wheelchair user” rather than “wheelchair-bound”. Wheelchairs provide mobility and independence.

Do not assume that everyone with a long-term condition or impairment identifies as disabled. Where possible, ask people how they wish to be described.

When reporting data, retain the definition used by the source and explain it where necessary. Legal, survey and service definitions of disability may differ.

The English Indices of Deprivation are a collection of area-level measures. The Index of Multiple Deprivation is the overall relative measure within that collection.

Use:

• English Indices of Deprivation or Indices of Deprivation when referring to the full release
• Index of Multiple Deprivation when referring specifically to the overall index
• IMD only after writing “Index of Multiple Deprivation” in full.

Do not use IoD and IMD as interchangeable terms.

State the relevant edition or year and avoid describing an area as having “become more deprived” based only on a change in national rank. The measures are relative, and changes in rank may reflect changes elsewhere as well as changes in the local area.

Ethnicity and race are related but are not interchangeable in every context. We will use the term that accurately reflects the question, dataset, evidence or experience being described.

Ethnicity is self-defined and may relate to culture, ancestry, identity, history, language, religion, nationality and other factors. Race is a socially constructed concept but remains relevant when discussing racism, racialisation, discrimination and inequalities.

We will not replace “race” with “ethnicity” where doing so would weaken or obscure a discussion of racism or racial inequality.

Wherever possible, we will:

• name specific ethnic groups rather than use a broad collective label
• use the classifications and wording recorded in the source data
• make clear when categories have been combined for analytical reasons
• avoid treating any ethnic group as homogeneous
• capitalise the names of ethnic groups, such as Black, White, Asian and Mixed or Multiple ethnic groups
• use people-centred descriptions.

Examples include:

• people in the Pakistani ethnic group
• babies in the White British ethnic group
• adults in Mixed or Multiple ethnic groups.

Ethnic minority groups

Use “ethnic minority groups” only where it is necessary and appropriate to refer collectively to people from ethnic groups other than the specified majority group.

“Ethnic minority groups” is usually preferable to “ethnic minorities” because it emphasises that several distinct groups are included.

Be clear about the reference population. In England, “ethnic minority groups” is sometimes used to mean all groups other than White British, including White minority ethnic groups. The meaning may differ in another geographic or analytical context.

Avoid as collective labels:

• BAME
• BME

These terms can combine very different populations, position one group as the default and conceal important differences in experiences and outcomes.

The Government Statistical Service recommends that people choose their own answer to questions about ethnic group because ethnicity means different things to different people

Use “health behaviours” when referring to actions that may influence health, such as smoking, alcohol use, physical activity or diet.

Avoid using “lifestyle” as a catch-all explanation for health outcomes. “Lifestyle” can imply that behaviours are freely chosen and shaped only by individual motivation.

Where relevant, recognise that behaviours are influenced by factors including income, housing, employment, education, commercial environments, transport, social norms, trauma, stress and access to services.

Health inequalities are avoidable, unfair and systematic differences in health between different groups of people.

Use “health inequalities” where differences are linked to unequal social, economic or environmental circumstances, the distribution of power and resources, discrimination, or differences in access to services and support.

Not every difference in health is necessarily an inequality. Where the evidence only demonstrates variation, use neutral language such as:

• difference
• variation
• gap
• disparity

Avoid implying that people or communities are responsible for the inequalities they experience.

Where possible, describe:

• which groups are being compared
• the measure used
• the size and direction of the difference
• whether the difference is statistically supported
• whether a causal explanation is established or only suggested

Inclusion health is an umbrella term used to describe people who experience some of the most severe health inequalities and significant barriers to accessing services.

Depending on the purpose and source, this may include:

• people experiencing homelessness
• people who sleep rough
• vulnerable migrants, refugees and people seeking asylum
• Gypsy, Roma and Traveller communities
• people involved in sex work
• people in contact with the criminal justice system
• people experiencing multiple disadvantage.

“Inclusion health groups” is a broad administrative and public health term, not necessarily an identity used by individuals.

Where possible, name the specific population being discussed. Do not assume that all inclusion health groups have the same experiences, needs or outcomes.

People with a learning disability

Use “people with a learning disability” rather than “the learning disabled”.

A learning disability affects the way a person understands information and learns new skills and may affect independent living. Experiences and support needs vary considerably.

Use the singular phrase “a learning disability” when following established UK terminology. However, retain different wording where it is part of a source definition or reflects an individual’s preference.

Learning difficulty

A learning difficulty is not the same as a learning disability.

Learning difficulties may affect a particular area of learning or information processing, such as dyslexia, and do not necessarily affect general intellectual ability.

Do not use “learning difficulty” as a softer substitute for “learning disability”. Use the term that accurately describes the person, population, evidence or service.

Intellectual disability

“Intellectual disability” is commonly used in international evidence and diagnostic literature. When using such evidence, retain the source terminology and explain that the broadly corresponding UK term is “learning disability”, while recognising that definitions may not be identical.

Mental health is part of everyone’s health. It includes emotional, psychological and social wellbeing and is not simply the absence of mental illness.

Use:

• mental health when referring to mental health generally
• poor mental health or mental ill health when describing adverse mental health experiences that may not involve a diagnosed condition
• mental health condition or mental illness where this accurately reflects a diagnosed or clinically recognised condition
• people experiencing mental ill health where the experience is relevant and the terminology is supported by the evidence.

Do not assume that “mental illness” is always permanent or that everyone experiencing poor mental health requires medical intervention. Where appropriate, distinguish between mental wellbeing, distress, symptoms, diagnosed conditions and severe mental illness.

Retain formal terms such as “common mental health problem” or “serious mental illness” when these form part of an official definition, measure, service or published evidence base. Explain them where necessary.

Neurodiversity refers to the natural diversity of human minds and ways of thinking, learning, communicating and experiencing the world. It includes everyone.

A neurodivergent person is someone whose mind functions in ways that differ significantly from dominant social expectations or what is generally described as neurotypical.

Neurodivergence may include autism, attention deficit hyperactivity disorder (ADHD), dyslexia, dyspraxia, dyscalculia, Tourette syndrome and learning disability. There is no universally agreed or definitive list.

Use “neurodivergent people” when a collective description is necessary and relevant. Wherever possible, name the specific population or experience being discussed, as the term covers people with very different strengths, barriers and support needs.

A group can be neurodiverse because it includes people with different neurotypes. An individual is more accurately described as neurodivergent or neurotypical.

Do not assume that every neurodivergent person identifies as disabled. Do not minimise the disabling barriers, health inequalities or support needs that some people experience.

Use clear, precise age descriptions.

Preferred:

• people aged 65 and over
• adults aged 18 to 64
• children aged under 16
• people in later life, where a broad non-statistical description is appropriate.

Do not use “older people” as though it describes one homogeneous population. Where age matters, specify the age group.

Avoid descriptions suggesting that ageing itself is necessarily a burden, crisis or period of decline.

Preferred: People experiencing homelessness; people who are homeless, where this is the individual’s preferred wording.

Avoid where possible: The homeless.

Homelessness is an experience and should not be used as a noun that defines a group of people.

Homelessness includes more than sleeping rough. Depending on the source definition, it may include temporary accommodation, sofa surfing, insecure accommodation and other situations where a person does not have a safe and settled home.

People sleeping rough

Use “people sleeping rough” when referring specifically to people sleeping outside or in places not designed for habitation.

Do not use “rough sleepers” as a general synonym for everyone experiencing homelessness.

Housing insecurity

Use “housing insecurity” when referring to difficulties such as unstable, unsafe, unaffordable or insecure accommodation. Do not assume this is equivalent to statutory homelessness unless the relevant definition is met.

Preferred: People experiencing multiple disadvantage; people facing multiple disadvantage.

Avoid as a general label: People with complex needs; complex people.

Multiple disadvantage describes the experience of two or more forms of disadvantage that interact and can make it harder to access support. These may include homelessness, contact with the criminal justice system, substance use, mental ill health, domestic abuse, poverty or trauma.

The complexity often lies in people’s circumstances and in the way systems and services are organised, rather than within the person.

Do not assume that everyone experiencing one of these issues experiences multiple disadvantage. Define which experiences are included in the evidence, programme or dataset being discussed.

The term “severe and multiple disadvantage” may be retained where it is the formal wording used by a particular programme or evidence source.

Use “people experiencing poverty” or a more specific description such as “people living in households below the relative income threshold”.

Do not use poverty and deprivation interchangeably. Poverty generally concerns insufficient economic resources, while deprivation may cover a wider range of unmet material and social needs.

Preferred: People living in the most deprived areas or neighbourhoods; areas experiencing higher levels of deprivation.

Avoid: Deprived people; poor areas, unless specifically discussing income poverty.

Area-level deprivation measures describe neighbourhoods, not every individual living within them. Not everyone living in a more deprived area experiences deprivation, and some people experiencing poverty live in less deprived areas.

When using the Index of Multiple Deprivation, state clearly that it is an area-based relative measure. Avoid implying that it measures an individual person’s circumstances.

Preferred: People living with overweight or obesity; people with obesity.

Avoid where possible: Obese people; the obese; sufferers; language implying that body weight is solely the result of personal choice or willpower.

Person-first terminology can reduce stigma, but preferences differ. When referring to an individual, use the language they prefer.

Focus on health and wellbeing rather than appearance. Avoid stigmatising images, unnecessary photographs of bodies without faces, or imagery that reinforces stereotypes.

If reporting a clinical or statistical category, explain how it was defined and measured. Do not assume that body mass index alone provides a complete assessment of an individual’s health.

Sex, gender and gender identity are distinct concepts.

We will usually use “sex” when data were collected using sex categories, and “gender” or “gender identity” when the source specifically asked about those concepts.

We will use established terms such as “gender pay gap” where they have a recognised meaning.

If data collection is unclear, do not guess whether a variable represents sex or gender. State the limitation.

Gender identity 

Gender identity describes a person’s internal sense of their gender. It is different from sex and sexual orientation.

Sexual orientation describes a person’s emotional, romantic or sexual attraction to other people. It is distinct from sex and gender identity.

Use “sexual orientation” when referring to the characteristic or to data collected about it. Do not automatically substitute “sexual identity” or “sexuality”, as these terms may have different meanings depending on context.

When reporting data, use the categories recorded by the source and explain any grouping or limitations. People may use a wider range of words to describe themselves than are included in a statistical classification.

We may use LGBT+ or LGBTQ+ where it is necessary and appropriate to refer collectively to people with different sexual orientations and gender identities. Define the acronym on first use and avoid assuming that everyone included has the same experiences or needs.

Use lower case for general descriptions such as lesbian, gay and bisexual unless the word begins a sentence or appears in a formal title.

Where possible, use the terminology preferred by the people or communities concerned.

Use “socioeconomic position” or “socioeconomic circumstances” where describing the combination of social and economic factors affecting people’s lives.

Avoid “low socioeconomic status” unless this is the established terminology used in the source. If retained, define how status was measured.

Use: Died by suicide; death by suicide.

Avoid:

• committed suicide
• successful or unsuccessful suicide
• completed suicide
• failed suicide attempt
• suicide epidemic.

“Committed suicide” can suggest criminality. “Successful”, “unsuccessful” and “failed” can frame a death or survival as an achievement or failure.

Use “suspected suicide” where the cause of death has not been formally determined. Do not state that a person died by suicide before this has been established by the appropriate process.

Avoid unnecessary details about methods or locations, sensational language, speculation about a single cause, and descriptions suggesting that suicide was inevitable, quick, painless or a solution.

Where content discusses suicide in a public-facing format, consider whether it should include information about sources of support.

Self-harm

Use “self-harm” rather than “deliberate self-harm”. The word “deliberate” can appear blaming and does not add useful meaning.

Avoid assuming that all self-harm involves suicidal intent. Where the distinction is important, report what the evidence or person says rather than inferring intention.

Where Suffolk is used it refers to the Upper Tier Local Authority (UTLA) area. 

Underrepresented

Use “underrepresented” when a group is represented less than expected in data, research, consultation, employment, leadership, service use or another defined setting.

State where the group is underrepresented and, where possible, compared with what. A community is not inherently underrepresented in every context.

Underserved

Use “underserved” where services, systems or resources do not adequately meet a population’s needs.

Where possible, specify the service or need concerned, for example:

People underserved by routine dental services.

“Underserved” puts attention on the adequacy and accessibility of provision rather than implying a deficit within the population.

Seldom heard

Use cautiously. If used, make clear that organisations or decision-makers have not adequately heard or included people’s views.

More direct alternatives may include:

• people whose views are not well represented
• communities not effectively reached by the consultation
• people facing barriers to participation.

Avoid

Avoid “hard to reach” as a description of people or communities. It can suggest that the difficulty lies with the population rather than with the accessibility, relevance or design of the engagement approach.

Where possible, name the barrier:

• people not reached through online engagement
• people facing language barriers
• residents who are not registered with a GP
• people excluded by the time or location of meetings.

We will use this for well-being. To be consistent, and to simplify and remove the hyphen.

Use:

• associated with
• linked with
• correlated with

where evidence shows a relationship but does not establish that one factor causes another.

Use “causes”, “leads to” or “results in” only where the evidence supports a causal conclusion.

Observational data can identify patterns and associations but often cannot determine why the pattern exists.

Use “estimated” where a figure is modelled, projected or based on survey estimates rather than a direct count.

Do not present an estimate as though it is an exact number. Include uncertainty or confidence intervals where these materially affect interpretation.

Use “number” for things that can be counted, such as people, cases or admissions.

Use “amount” for quantities that are not counted as separate items, such as funding or time.

A percentage or proportion describes part of a whole. A rate relates events or cases to a population and usually includes a specified period.

Do not call every percentage a rate.

Examples:

• Percentage: 56.9% of people estimated to have dementia had a recorded diagnosis.
• Rate: 412 hospital admissions per 100,000 population per year.
• Count: 370 hospital admissions.

Check the source definition before deciding which term to use.

Prevalence describes the number or proportion of people with a condition in a population at a particular time or during a specified period.

Incidence describes new cases or events arising during a specified period.

Do not use prevalence as a general synonym for frequency.

Use “risk” only where the measure and study design support that description.

Odds and risk are not interchangeable. If reporting an odds ratio, call it an odds ratio unless a reliable source has translated it appropriately.

Use “statistically significant” only where an appropriate statistical test, comparison or source assessment supports it.

Do not use “significant” to mean both statistically supported and large or important.

Alternatives include:

• substantial
• marked
• important
• meaningful
• statistically significant.

State which meaning is intended.

Do not interpret “not statistically significantly different” as proof that two values are the same.

Preferred wording includes:

• the difference was not statistically significant
• the published comparison did not identify evidence of a difference
• the values were statistically similar, where this is the source’s published classification.