After the Associated Press Stylebook made the startling decision in April to shift from “health care” to “healthcare,” it set off a fierce debate not only in the STAT newsroom, where we use a lightly modified version of AP style, but among our readers.
As STAT’s director of editorial operations and a longtime copy editor, I consulted with my colleagues and also asked for readers’ help. The fight over a single space, which has raged for years, might look a little silly from the outside, and maybe it is. But it’s taken on perhaps outsize importance, and many people, including me, have strong feelings on the matter.
After much deliberation, STAT has decided to continue to use “health care” (two words) and remain consistent with how we’ve written it since our founding more than a decade ago.
While usage can sometimes change from two words to one over time (see the stylebook’s move this year to “daycare” and “childcare”), we feel that “health care” is an exception. Writing “health care” as two words puts more of an emphasis on the two distinct concepts. And it signals that there are many types of care (which are also not written as a compound word) — for example, prenatal care, medical care, and cardiac care.
The health care industry itself has largely moved toward using “healthcare,” as many of our readers who work in the field pointed out. But our style is motivated by encompassing not only the business side of health care but the patient focus as well.
When we asked for our readers’ help in making the call, we received an overwhelming and spirited response. Out of 210 votes, around 60% of people were in favor of “healthcare.” To some, it was an issue of grammar or linguistics. To others it was more of a philosophical argument — or simply common sense that the word should be written one way instead of another. For many, the word holds a different meaning when spelled as one word or two.
STAT is not a democracy, but the responses both for and against making the change helped sharpen my thinking. Here’s a collection of what our readers had to say:
In favor of ‘health care’
“The AP style mavens have yet again yielded to ‘usage’ as justification for making a change, and cited industry usage to boot. Therein lies part of the problem; the term health care has much broader application than in business. … To call it ‘healthcare’ is plain wrong. Of course, I hate to think that during nearly four years as an editor at STAT I wasted time inserting a space between ‘health’ and ‘care.’” — Karen Pennar
“I’m a physician and have always bristled at compressing it into one word, even as I have on occasion succumbed to using ‘healthcare.’ There are many kinds of care. Attending to health is one of them.” — Carole Allen
“‘Health care’ should be two words. As I said in a recent STAT article about ethical objections to the use of the word ‘provider’ to describe clinicians, language is important and certain business terms in health care turn patients into economic abstractions.” — Lois Snyder Sulmasy
“I’ve been a copy editor for almost 30 years, and I’m tired of having to learn new things. Please let my brain have this one small thing, as a treat.” — Katherine Dillinger
“Health care is the type of care medical professionals provide. Healthcare is a sector of the economy, a commodity.” — Daniel Bryant
“We don’t use ‘medicalcare’…….or ‘pediatriccare’………or ‘GIcare’…or ‘heartcare’……It is two words!” — Grendel Burrell
“‘Health’ modifies ‘care.’ There are many types of care. ‘Healthcare’ commodifies the term. Grammar is thrown off with one word.” — Mary Patrick
“I feel like [‘health care’] gives more emphasis to the health part. If it’s one word and you’re writing about mental health, is it ‘mental healthcare’? To me somehow that lessens the ‘mental health’ part of ‘mental health care.’ I don’t know, one word just gives me the ick.” — Terri Robinson
“Please keep using ‘health care’ as two words. I’m a federal employee enforcing federal health care laws. Federal law consistently uses the term ‘health care’ over ‘healthcare.’” — C Lorden
“When we lose the space between ‘health’ and ‘care,’ we lose the distinction between these two vital concepts. ‘Healthcare’ is shorthand for a vast industry. ‘Health care’ is a more flexible and expansive term that connects us to the human beings at the heart of this work: the people with health needs, and the people who care for them. Listen, you already use the Oxford comma. What’s one more deviation from AP style?” — Andrew Shih
In favor of ‘healthcare’
“It’s a distinct concept that we often talk about! Not just about the care of health, it’s the industry, the complex, the providers — the term includes all.” — Lynne Cotter
“‘Healthcare.’ I say this as a former AP staffer and now current health writer. Politicians, industry leaders and others went to one word years ago and it looks ridiculous when we have a statement with ‘healthcare’ in the quote and it’s one word and yet in the story it’s ‘health care.’” — Terri Langford
“For 20 years I was a ‘health care’ guy, but now I’m the CEO [of a company] that uses ‘Healthcare’ in our name. So I’m contractually obligated to say ‘Bravo, AP!’” — Shawn Gremminger
“From the perspective of someone who works in policy communication, I think ‘healthcare’ (one word) better reflects the usage of the word as it relates to a system/sector/industry, rather than simply the act of caring for health.” — Conor McGrath
“Faster with no loss of meaning / value — one less character / space.” — Stephen Kahane
“I think it’s always better to use one word instead of two, where possible. The same with ‘childcare.’” — Kathleen Harriman
“Linguistically the shift to ‘healthcare’ follows the pattern of ‘babysitter.’ First those were two words, ‘baby sitter.’ Then came hyphenation: ‘baby-sitter.’ Finally we settled on ‘babysitter.’ Sticking with two words is like trying to hold back the tide.” — Alma Colclasure
“‘Healthcare’ is the norm in popular usage. Anything else seems hopelessly out of date. And this is from a person who still puts two spaces after a period!” — Tia Goss
“For eight years, I was an in-house editor and marketer for a regional health plan that scrupulously maintained the style preference of ‘health care’ — two words. A few years back, I created the editorial style guide for my current employer, a nonprofit nutrition services provider. My recommendation: ‘healthcare,’ one word. I’ve come to the conclusion that striking that fussy little space is the least we can do to bring this unwieldy, monstrous monolith of an industry down to size.” — James Flaherty
“We must change with the times, you stodgy journalists. 🙂 Also, it works better with healthcare-associated infections.” — Jim Wappes