Blog authors: Jeffrey V Lazarus, Michael Betel, Scott Isaacs, Melina Manolas, Priya Jaisinghani on behalf of the Global Think-tank on Steatotic Liver Disease
What is the People-First Liver Charter, and why was it created?
The People-First Liver Charter is a new initiative focused on improving how language is used in liver health practice, by putting people—not diseases or assumptions about their behaviours—at the centre of communication, care, and policy.
Person-centred care recognises the person as a whole human being—not a diagnosis. When care is delivered in this way, it leads to stronger relationships with healthcare teams, which can improve health management and even lower morbidity and mortality. As such, the Charter was designed to guide clinicians, advocates, policymakers, and communities toward language that reduces stigma and supports equitable care.
Behind the effort was the Global Think-tank on Steatotic Liver Disease, a collaborative initiative designed to bring together diverse stakeholders to advance the recognition, understanding, diagnosis, and management of steatotic liver disease (formerly known as fatty liver disease)—with a particular focus on MASLD/MASH as part of the broader metabolic health threat.
How does stigma affect people living with liver conditions?
Stigma is one of the most powerful, and often overlooked, drivers of poor health outcomes.
People living with liver conditions often report discrimination in healthcare settings, social judgment, and internalised shame. These experiences can lead to:
- Avoiding screening or diagnosis,
- Disengaging from care,
- Delaying treatment until symptoms become severe, and
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Being excluded from clinical trials or support services.
The harms of stigma are greatest for people facing socioeconomic disadvantage, where liver disease is more common and often more severe. Stigma amplifies these inequities, creating a cycle in which the people most affected receive the least support.
When stigma shapes how society views a condition, it can become harder to manage—even when it doesn’t need to be. That is exactly what the Charter aims to prevent.
What language changes does the Charter recommend for healthcare professionals and policymakers?
Changing language is not cosmetic—it’s clinical. It directly affects trust, communication, and health outcomes. The People-First Liver Charter turns these insights into practical guidance, reiterating that progress, not perfection, is the aim.
It calls for six core shifts:
1. Put the person first, not their condition.
Use “person living with cirrhosis” instead of “cirrhotic person.”
2. Use neutral language, avoid overstating the severity of a condition and avert fear.
Say “person living with hepatitis C,” rather than “infected person” or “carrier.”
3. Highlight abilities over limitations.
For instance, “person managing diabetes with insulin” rather than a “poorly-controlled diabetic”.
4. Emphasise the person’s right and capacity to manage their health, bearing in mind that certain conditions may impact this capacity
Use language that reflects partnership, such as “the person engages with the treatment plan,” rather than implying obedience or failure such as “the person adheres to the treatment plan”.
5. Recognise the person as a contributing member of society, rather than as a burden, and avoid assigning blame
For instance, this involves shifting the focus from perceived individual deficits to the responsibilities of systems and communities to provide appropriate support. Use language such as ‘the person will be provided with the resources necessary to engage with their treatment plan’ rather than ‘the person requires extra support to follow their treatment plan’.
6. Use language that is understandable, consistent and precise to communicate with the person
Communication should be tailored to the individual and free from jargon. Above all, it should create space for people to ask questions without fear of judgement or stigma.
What are the broader health and socioeconomic inequities linked to liver disease?
Liver disease does not affect all communities equally. Its prevalence, severity, and outcomes are strongly shaped by social determinants of health—such as income, education, geography, employment conditions, and access to care.
People in low-income/resource settings often face:
- Higher rates of liver disease.
- More advanced disease at diagnosis.
- Limited access to screening and treatment.
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Greater exposure to stigma or discriminatory care.
These inequities reinforce each other. When health systems and public narratives imply that liver disease is a “personal responsibility issue,” people with fewer resources bear the heaviest stigma and the poorest outcomes. The Charter stresses that liver health is not an individual failing but a societal responsibility.
What further research is needed?
Despite growing interest in people-first communication, we still lack fundamental research on:
- How people-first language influences trust, engagement, and health outcomes.
- The impact of stigma-reducing communication on early diagnosis and long-term disease management.
- Effective strategies to reduce stigmatising behaviors within clinical settings.
- How different populations perceive liver-related terminology.
- Ways to address exclusion from clinical trials, especially for marginalized groups.
These are critical knowledge gaps. Without addressing them, health systems cannot fully design or measure interventions to reduce stigma or improve liver health outcomes.
How can people-patients, advocates, clinicians—get involved in implementing the Charter’s principles?
The People-First Liver Charter is not a document to read once—it’s a framework to practice in everyday interactions. Everyone in the liver health community has a role:
People living with liver conditions
- Share experiences to guide the development of better language and care models.
- Participate in patient advisory groups or advocacy networks.
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Provide feedback to healthcare teams on what feels respectful and what does not.
Clinicians and healthcare teams
- Integrate people-first language into consultations, presentations, medical notes, and patient-facing materials.
- Call out stigmatising language when it appears in clinical environments.
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Support shared decision-making and build communication skills into routine care.
Advocates and community organisations
- Use the Charter as a foundation for campaigns, training, and public education.
- Promote narratives that highlight dignity, capability, and community responsibility.
- Endorse the Charter
Policymakers and health leaders
- Ensure national liver health strategies incorporate people-first principles.
- Fund research on stigma, communication, and equity.
- Standardise person-centred communication in healthcare guidelines.
Take the needed actions to turn the tide on liver disease.