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

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.