Stigma as a Cause of Population Health Inequalities
Although more research is needed, emerging evidence indicates that stigma meets all of the criteria to be considered a fundamental cause of health inequalities. Stigma (1) influences several physical and mental health outcomes that affect millions of people in the United States through multiple mechanisms, (2) disrupts or inhibits access to multiple resources—structural, interpersonal, and psychological—that could otherwise be used to avoid or minimize poor health, and (3) enables the creation of new, evolving mechanisms that ensure the reproduction of health inequalities among members of socially disadvantaged populations. Failure to consider stigma in theoretical and statistical models not only leads to an underappreciation of the social factors that produce poor health but can also undermine the efficacy of public health interventions.
Inequalities between stigmatized and nonstigmatized groups are by no means inevitable, but the power differentials inherent in stigma create substantial obstacles that make the reduction of health disparities especially challenging. In particular, the production of intervening mechanisms that perpetuate health inequities among the stigmatized often goes undetected. The engine producing inequality is therefore frequently unrecognized or misunderstood and requires multiple fields of inquiry to expose it, including interdisciplinary research from such diverse fields as anthropology, psychology, sociology, epidemiology, and biology. This requires a concerted effort on the part of funding agencies, including the National Institutes of Health, to provide the necessary resources to ensure that such research is conducted. Overcoming barriers to adequate funding is essential because the production of knowledge—a resource fundamental to health—is regularly thwarted by stigma. The dearth of scientific resources devoted to lesbian, gay, bisexual, and transgender health, for example, is well documented and has prevented the dissemination of health information to health professionals and to sexual minority individuals themselves, further perpetuating health disparities. The recent Institute of Medicine report on health disparities in this population represents a particularly important and noteworthy corrective to this trend.
Research suggests that greater attention needs to be paid to stigma as a social determinant of population health and that such an approach is likely to generate novel insights into documented patterns of population health. Stigma exerts a more pervasive impact on population health than previous research suggests, and we offer here a framework to synthesize research on multiple pathways linking stigma to health inequalities, along with several avenues for future research, including data sets that can be used to evaluate the role of stigma as a driver of population health. We hope our work contributes to transformative research that will lead to improved health among the stigmatized.
Conclusions
Although more research is needed, emerging evidence indicates that stigma meets all of the criteria to be considered a fundamental cause of health inequalities. Stigma (1) influences several physical and mental health outcomes that affect millions of people in the United States through multiple mechanisms, (2) disrupts or inhibits access to multiple resources—structural, interpersonal, and psychological—that could otherwise be used to avoid or minimize poor health, and (3) enables the creation of new, evolving mechanisms that ensure the reproduction of health inequalities among members of socially disadvantaged populations. Failure to consider stigma in theoretical and statistical models not only leads to an underappreciation of the social factors that produce poor health but can also undermine the efficacy of public health interventions.
Inequalities between stigmatized and nonstigmatized groups are by no means inevitable, but the power differentials inherent in stigma create substantial obstacles that make the reduction of health disparities especially challenging. In particular, the production of intervening mechanisms that perpetuate health inequities among the stigmatized often goes undetected. The engine producing inequality is therefore frequently unrecognized or misunderstood and requires multiple fields of inquiry to expose it, including interdisciplinary research from such diverse fields as anthropology, psychology, sociology, epidemiology, and biology. This requires a concerted effort on the part of funding agencies, including the National Institutes of Health, to provide the necessary resources to ensure that such research is conducted. Overcoming barriers to adequate funding is essential because the production of knowledge—a resource fundamental to health—is regularly thwarted by stigma. The dearth of scientific resources devoted to lesbian, gay, bisexual, and transgender health, for example, is well documented and has prevented the dissemination of health information to health professionals and to sexual minority individuals themselves, further perpetuating health disparities. The recent Institute of Medicine report on health disparities in this population represents a particularly important and noteworthy corrective to this trend.
Research suggests that greater attention needs to be paid to stigma as a social determinant of population health and that such an approach is likely to generate novel insights into documented patterns of population health. Stigma exerts a more pervasive impact on population health than previous research suggests, and we offer here a framework to synthesize research on multiple pathways linking stigma to health inequalities, along with several avenues for future research, including data sets that can be used to evaluate the role of stigma as a driver of population health. We hope our work contributes to transformative research that will lead to improved health among the stigmatized.
SHARE
