The “underserved” are “undeserved”

I hate the phrase, “the underserved”. I would love to remove it from the lexicon of public health. But it appears to be here to stay, particularly in North America where there is even a journal devoted to them.

A girl with kwashiorkor during the Nigerian-Biafran War (Public Domain; Wikipedia).

On a number of occasions in public lectures I have played with the phrase using a comparison of the “undeserved” and the “underserved”. It usually takes listeners a few minutes to work out that I am not repeating myself over and over again. And if you thought I had typed the same thing twice, look again. “underserved”≠”undeserved”.

My spell-checker knows the difference. It tells me that “underserved” is a spelling error and I almost certainly mean “undeserved”, and herein lies the problem. It is not simply that these two words look and sound similar, it is that there is an unpleasant semantic connection between them. It seems to depend where you lie on the political spectrum which term you use to refer to the same group of people.

On the left, the powerless and the left-behind, those with poor access to services and care would be characterised as the underserved. On the right of politics (or a nationalist left where refugees and migrants are vilified) anyone in need, the powerless and the left-behind, those with poor access to services and care are more typically characterised as the undeserved. The same people, the same need, and the same suffering, but a more or less generous view of our social obligations.