Hard to reach, or not being reached?

I’ve lost count of how many times I’ve sat in a meeting, read a report or listened to a conversation and heard the same phrase.

Hard to reach.

It’s said about the families who don’t attend. The parents who don’t respond. The young people who don’t participate. It’s said casually, often kindly, and almost always without a second thought.

And it needs to be challenged.

When we talk about “hard-to-reach communities”, we are often talking about minority ethnic communities, refugee communities and young people. These include groups disproportionately affected by drowning, and they are the very communities Bold Waters engages with every day.

So when I hear that they are hard to reach, I have to ask: hard to reach for whom?

The problem begins before the conversation does

Language shapes the approach before the conversation even begins.

When we describe people as hard to reach, we have already suggested where the difficulty sits. It sits with them. Their willingness. Their interest. Their readiness to engage.

Our own assumptions can remain comfortably out of view.

Then the explanation sometimes goes further: “They don’t want to be reached.”

That is a considerable claim to make about somebody you have not connected with.

Have they said that? Have they expressed a wish to be left out? Or have we taken an unsuccessful attempt to engage them and turned it into a judgement about what they want?

“We haven’t reached them” describes our experience. “They don’t want to be reached” claims to describe theirs.

Somewhere between those two statements, responsibility changes hands.

A label that has outlasted the evidence against it

Public health researchers have been challenging “hard to reach” for more than thirty years. Across that work, a recurring concern is that the label can reflect the assumptions and limitations of those doing the reaching, rather than an inherent quality of the people being described. Its meaning shifts with the organisation using it, while very different communities are grouped beneath the same description (Freimuth & Mettger, 1990; Flanagan & Hancock, 2010; Aliyas et al., 2023).

Research by Aliyas et al. (2023) in Montreal makes this distinction tangible. The researchers explored difficulties involving families from low-income neighbourhoods, including recently arrived immigrant families, in public health research. When they changed their recruitment approach, they received twice as many responses in roughly a tenth of the time.

The families had not suddenly become more willing to engage. The researchers had found a better way to connect with them. That led them to question whether these communities were “hard to reach”, or whether they had simply not been reaching them.

The distinction is important. An approach that does not work tells us something about that approach. It does not give us permission to define a whole community by its failure.

The CDC’s health communication guidance now recommends replacing “hard-to-reach populations” with wording that specifies the service or resource by which people are underserved. The relationship with provision becomes visible, rather than the difficulty being attached to people themselves (CDC, n.d.).

Yet the phrase persists. Familiarity has made it sound factual.

What we mistake for unwillingness

How does someone engage with an issue they do not know exists?

How do they recognise that a conversation concerns them if they never see their lives reflected in it?

How do they respond to information they have not encountered, cannot understand or do not realise applies to their family?

These questions matter because awareness, understanding, opportunity and motivation are different things. Research on healthcare access and behaviour recognises that people must be able to identify a need and have the capability and opportunity to respond. Wanting to act does not automatically make action possible (Levesque et al., 2013; Michie et al., 2011).

But “they don’t want to engage” folds all of those distinctions into one judgement.

Not knowing becomes not caring. Not participating becomes not wanting to participate. Our absence from someone’s life becomes their resistance to our presence.

That applies to teenagers too. Young people’s absence from a particular initiative does not establish that they cannot be engaged, or that they have no concern for their own safety. It establishes that they were absent from that initiative.

We should be careful about how much meaning we place on an empty chair.

The words do not stay on the page

The concern extends beyond whether a phrase sounds respectful. Descriptions can affect what professionals think and do.

In medicine, Goddu et al. (2018) examined how the wording of a patient’s notes influenced the clinicians who read them. Medical students and residents received descriptions of the same hypothetical patient. Those exposed to stigmatising language developed more negative attitudes; which was reflective in less favourable treatment.

That study demonstrated something relevant to any professional setting: language can carry judgement from one person to another and influence decisions before a relationship has begun.

A phrase in a report can become an assumption in a meeting. An assumption in a meeting can become the explanation for why a project did not connect.

Eventually, people are responding to the description of a community rather than the community itself.

When the stakes are children’s lives

Nobody wants their child to drown. Yet the families and young people described as hard to reach include those disproportionately affected by drowning.

Black children have more than three times the drowning death rate of White children. Children in the most deprived areas face more than twice the rate of those in the least deprived. Teenagers are among those most at risk, and social care involvement features in seven in ten child drowning cases where that history was known (NCMD, 2026).

These figures tell us who is experiencing harm. They do not tell us that those families care less or that those young people are unwilling to engage.

A parent who has not responded to water safety messaging has not told us they are indifferent to whether their child comes home. A teenager who has not participated has not told us they have no interest in their own safety.

We cannot make those judgements for them.

Whose voices are part of the conversation?

Communities are often discussed without their voices being present. Organisations rooted in those communities are not always included either. Their absence matters when explanations for their supposed lack of engagement are being accepted as fact.

The same applies to language. Information being available does not mean it is accessible to everyone it concerns. Research on healthcare and water safety shows that barriers to understanding matter, and that knowledge can improve when an educational approach changes (Al Shamsi et al., 2020; Shibata et al., 2026).

People cannot respond to information they have not understood, or recognise themselves in a conversation that has never included them. Their silence does not explain why the connection is missing.

Just because one organisation has not made a connection does not mean that connection cannot be made. It raises a question about who is best placed to make it, and whose experience is missing when we decide that it cannot be done.

At Bold Waters, and in other organisations like ours, we are part of the communities so often described as hard to reach. Yet here we are, already leading the work.

That contradiction should give us pause.

By Melona Headley, Founder and CEO of Bold Waters

References

Aliyas, Z., Collins, P. A., Chrun-Tremblay, S., Bayram, T., & Frohlich, K. L. (2023). “Hard-To-Reach” or Hardly Reaching? Critical Reflections on Engaging Diverse Residents From Low Socio-Economic Status Neighborhoods in Public Health Research. International Journal of Public Health, 67, 1605296.

Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of Language Barriers for Healthcare: A Systematic Review. Oman Medical Journal, 35(2), e122.

CDC. (n.d.). Preferred Terms for Select Population Groups & Communities.

Flanagan, S. M., & Hancock, B. (2010). “Reaching the hard to reach”: Lessons learned from the voluntary and community sector. A qualitative study. BMC Health Services Research, 10, 92.

Freimuth, V. S., & Mettger, W. (1990). Is There a Hard-to-Reach Audience? Public Health Reports, 105(3), 232–238.

Goddu, A. P., et al. (2018). Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. Journal of General Internal Medicine, 33, 685–691. See also the published correction.

Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.

National Child Mortality Database. (2026). Child drowning deaths 2019–2025.

Shibata, M., et al. (2026). Public Health Promotion Through Language Learning: Improving Migrants’ Australian Beach Safety Knowledge Through a Reading Exercise for English Language Proficiency Tests. Health Promotion Journal of Australia, 37(1), e70132.