What is stigma?
Goffman, a sociologist, defined stigma as social devaluation and discrediting of people with certain marks, characteristics, or identities. Unfortunately, we have many examples of marks, characteristics, and identities that are socially devalued and discredited in society. These include physical illnesses such as HIV and mental illnesses such as schizophrenia, social norm violations such as substance misuse, and socio-demographic characteristics such as African American race or female gender.
When I use the term “stigma,” I’m usually talking less about one of these individual marks and more about a social phenomenon. Essentially, stigma results from a social process in which certain characteristics are constructed as indicators of tarnished character. These characteristics are then used to justify discrimination toward and power loss of people who have them.
Discrimination is one way in which this social process plays out between individual people. It involves mistreating people by giving them worse healthcare, not hiring them for jobs, or even not befriending them due to a socially devalued characteristic. There are other ways that this social process plays out between and among individual people, such as stereotyping, prejudice, and internalized stigma. I identify as a “stigma” researcher because I’m interested in both discrimination and other ways that stigma is constructed, maintained, and affects people.
What is health inequity?
Groups of people often have different health outcomes, with members of some groups being sicker than members of other groups. There are a lot of reasons why members of some groups would experience worse (or better) health than members of other groups. For example, some groups of people have genes that make them more likely to develop cancer.
Health inequities are differences in health that are unfair or unjust. Members of groups that experience social disadvantage, including stigma, tend to have worse health than members of groups that experience social advantage. As examples, poor people generally have worse health than wealthy people, and racial and ethnic minorities have worse health than white people in the U.S.
Why do you study stigma and health inequity?
I study stigma and health inequity because I’m mad. I’m mad that some people are treated worse than others for arbitrary reasons (or if we’re going to delve deeper, for reasons that justify power differences between groups or enforcement of socially constructed norms). I’m mad that people sometimes internalize this poor treatment, and come to feel badly about themselves. I’m mad that this mistreatment impacts people’s health, leading them to have worse quality of life or shorter lifespans.
I also study stigma and health inequity because I’m hopeful. I think that research can make a difference in these issues.
Can research really make a difference?
I sure hope so. Using research, we can prove that stigma actually makes people sicker. We can learn why stigma leads to poor health. We can even figure out why stigma harms some people more than others. This knowledge is power. Using research, we can even develop strategies to reduce and ultimately eliminate stigma to achieve health equity.
Why should I participate in your study?
Great question. Participating in studies about stigma often means thinking about tough, even painful experiences. People who participate in our studies sometimes report that they like the opportunity to report or talk about these things. More generally, participating in our studies can help lead to better understanding of stigma, including how people experience it and how it affects people, as well as and how to address stigma.
Knowledge about stigma can be empowering, helping people to articulate why discrimination, prejudice, and stereotypes are bad. After speaking to a community group on HIV stigma, one audience member told me: “You’ve got the data to prove what we’ve been talking about for decades!”
What happens after your research studies?
My colleagues and I tell people what we found. We tell other scientists about our results through presentations at conferences and articles in journals. There is a community of scientists working to understand and address stigma and health inequity. Our findings might help others succeed. We tell doctors about our results through presentations so that they can better understand their patients’ experiences. We tell community members about our results through presentations, field reports, and blog posts so that they can use the data for advocacy purposes.
We then work with other scientists, healthcare providers, community members, and others to do something about what we found. The ultimate goal is to find ways to eliminate prejudice, stereotypes, and discrimination among people who stigmatize others. Given that stigma has proven hard to change, we also look for ways to help people be resilient to stigma in the meantime.