Stigma as a Fundamental Cause of Population Health Inequalities

Exploring the psychological and structural pathways through which stigma influences health.

Stigma, as defined by these investigators, is the “co-occurrence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised.” It encompasses multiple statuses and characteristics—mental illness, minority sexual orientation, obesity, HIV/AIDS, disability, and minority race/ethnicity—and is broader in scope than race/ethnicity and discrimination.

These investigators posit that stigma is a fundamental cause of population health inequities. They maintain that choosing one stigmatizing characteristic and examining its effect on one or even multiple outcomes does not fully measure the impact of all stigmatizing circumstances that may be operating.

In this study, they examine six stigmatizing characteristics common in the general population mentioned above. They find that stigma thwarts or exacerbates processes (i.e., the availability of resources, social relationships, psychological and behavioral responses, and stress) and ultimately leads to adverse health outcomes. For example, being a minority, having mental illness, or being incarcerated reduces resources such as employment, loans, housing options, quality education, and health care. Some stigmatized individuals have low self-esteem which affects their health negatively, which also can lead to social isolation and stress and behaviors detrimental to health such as smoking, drinking, and overeating. Stigma adds to the burden an individual has above or beyond that of the impairment or deficit itself.

They call for more research “that spans the multiple levels of analysis to fully appreciate the ways stigma operates to shape population heath.”

Learn more about why RWJF Health & Society Scholar Mark Hatzenbuehler and colleagues say it's time to examine stigma through a wider lens. Read the story