Table 1

Selected dichotomous terminologies used in global health and development, their likely origins and concerns

TermOrigins and key referencesConcerns
Rich versus poor countries (or resource rich vs resource limited)Origins unclearWho gets to define who is rich and who is poor?
Some countries might be poor in financial resources, but rich in other dimensions (eg, expertise, culture and other resources).
LMICs are automatically equated with ‘resource-limited’, and this ignores the reality that even the richest countries have resource-limited populations (due to neglect and racism).
Developed versus developing countriesClassification system originating among multilateral institutions in the 1960s, for transfer of resources from rich to poor countries.21An outdated concept. The idea of ‘developed’ implies that countries so labelled have reached their most potential, and that there is only one way to be developed. How do we define potential, and what does it mean to be developed?
Advanced versus emerging economiesThe International Monetary Fund (IMF)22A more sophisticated form of ‘developed vs developing countries’ or ‘rich vs poor countries’, but the implications remain the same.
First World versus Third WorldTheoretical, post-WW2 classification developed by Alfred Sauvey in 1952.23 Supported by Marxist theorists based on social and economic hierarchies at that moment in history.Racist in its implications as the ‘Third world’ signifies a backwardness as compared with others. The disappearance of the ‘Second world’ as an equally used term also exposes an intentional gap between the two.
Old World versus New World16th century term, where the Americas were ‘discovered’ and called the New World, as compared with Africa, Asia and Europe (called Old World)24Archaic term that has little relevance today
High-income countries (HICs) versus low and middle-income countries (LMICs)World Bank classification for lending based on GNP per capita.25The methodology is clear, but ‘LMICs’ is a very heterogeneous group; and the dichotomy between HIC and LMIC says little that is useful. Also many countries graduate into higher categories. Only a small percentage of the world’s population lives in LICs, while LMICs is an enormous fraction that is very diverse. Even the distinction of upper and lower middle-income country does little to nuance the categorisation. In addition, people from supposedly ‘low income' countries may not be happy to see their countries described using such terms?
Global North versus Global SouthAlso known as The Brandt Line (figure 1).26 Post-cold war IMF/structural adjustment period, 1980sThere are no negative connotations, but geographically this is not accurate. Australia and New Zealand are technically in the Southern hemisphere (and also not in the ‘West’), while countries like Singapore and UAE which are classified as South are also classified as high-income countries. What these divisions indicate, is the ‘whiteness’ of wealth, including aid, given these nations are predominately white, while everyone else is not. But in addition to these very weak geographical and racial divides, there are many countries in the South, that are increasingly at par with rich Northern countries, like India, China and Brazil.
The West versus the East (including vs the Rest or the Orient)A distinction that began with geographical connotations but evolved in the 1800s into an ideological and hegemonic sociopolitical distinction about values.27The terms ‘West’ and ‘Western’ are geographically inaccurate, insofar as Latin America (which is in the Western hemisphere) is not typically deemed part of the West, and Australia and New Zealand (which are not in the Western hemisphere) are seen as part of the West. The values that are touted as exclusively Western—for example, freedom, liberty, tolerance, rationality, democracy equality, individualism, science, etc—are inherently human values that are not unique to Europeans and their descendants elsewhere.28 However, the terms West and Western remain useful for describing the hegemony that the West has cultivated over the Rest.
The Majority World versus Minority WorldThe Majority World denotes those countries combined which hold most of the world’s population.29The term is often deliberately used to remind the West that these countries outnumber them. While there are no negative connotations, most people in the Western world do not appreciate being referred to as the ‘minority’ as it implies that they are—or ought to be—less powerful due to being fewer in number.
Rosling’s four levels of incomeInstead of dichotomising countries based on economic level, Rosling19 proposed four levels: level 1 is made up of people who earn less than US$2 a day and live in extreme poverty. At level 2, people earn between US$2 and US$8 a day. Level 3 is made up of people who live on between US$8 and US$32 per day. The richest billion people on earth live at level 4, with income more than US$32 a day.This might be better than dichotomous categories, and the terms do not (yet) have negative connotations.
WEIRD: Western, educated, industrialized, rich and democratic (WEIRD) nationsAcronym invented by some social psychologists30 who were concerned that behavioural scientists often publish big claims about human behaviour based on samples drawn entirely from WEIRD societies.How do we define ‘industrialized’ or ‘rich’ or even ‘democratic’?
BIPOC versus whiteOriginating in early 2010s largely as a response to increasing racial discrimination in North America against non-white origins.31Implying racial origins only for a specific set of groups, all contained as one; that white is not a colour.
Beneficiaries versus providersPerpetuated by the aid industry; exact origins unclear.4 16Denotes that people ‘benefit’ from the wealth ‘provided’ to them by the rich. There is much evidence to show that this is not always the case. ‘Beneficiaries’ are often a numerical target attached to a ‘project’. The more the beneficiaries, the greater the credit to the ‘providers’.
Local versus internationalPerpetuated by the aid industry; exact origins unclear.17 18International is often used, implicitly, to refer to organisations in the North/West (eg, to publish in an international journal is to publish in a Northern/Western journal). In that sense ‘local’ often has derogatory connotations (eg, a local working in their ‘poor’ country is juxtaposed with and considered inferior to the ‘expat’ or international expert from a rich country).
Core versus peripheryImmanual Wallerstien’s World Systems Theory was developed to classify global division of labour in 1970s.32 A theoretical analogy created to understand countries of high skills and power at the core and countries of low skill at the periphery.An old theoretical concept which is still used in academia to discuss the North and South.
  • *Origins are not always clear or attributable to a specific person or group.

  • BIPOC, Black Indigenous and People of Color.