New research highlights the impact of stigma on health equity

A new article published in Nature Reviews Disease Primers underscores the profound role that stigma can play in health care -- and how addressing stigma-related barriers can significantly improve health outcomes for individuals and communities around the world. 

Stigma has harmful effects on health, equity and justice. And while we need more rigorous evaluation of interventions to reduce health-care stigma, we certainly know enough to begin to confront it." 

Carmen Logie,  lead author, professor, University of Toronto's Factor-Inwentash Faculty of Social Work (FIFSW)

Logie and her co-author Laura Nyblade, a fellow at the Social, Statistical and Environmental Sciences, Research Triangle Institute in Washington DC, argue that health-care providers need to be able to identify what drives stigma in health-care settings, so they can take action to address stigmatizing practices as well as internalized, anticipated or perceived stigmatization on behalf of those in need of care. 

Stigma can play a huge role in health outcomes, say the researchers. For example, health-care providers who view weight as a moral issue or lack of personal willpower, may use stigmatizing language in conversation with patients, contributing to their disengagement from care. People who use drugs may be deemed "junkies", blamed for their substance use and denied services. In some regions, gender-based stigma has resulted in coerced sterilization and lack of informed choices around contraception and education for women living with HIV. 

The good news, say Logie and Nyblade, is that health-care settings are well positioned to identify what drives stigma and make changes to address it through evidence-based approaches. To start, health-care providers can examine misconceptions about disease transmission and infection control, and then make needed changes to institutional policies and practices. "Increasing health providers' awareness of how stigma is appearing in the ways they deliver services is key," says Logie, who is also Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations. 

In Ghana, for example, staff training and activities to reduce fear of HIV infection was shown to improve the caregivers' willingness to provide services to people with HIV. In Tanzania, stigmatizing beliefs held by HIV clinic staff around substance use was reduced through interventions that addressed commonly held misconceptions. The interventions also successfully conveyed the impact that stigmatizing language used by health-care providers can have on their patients. 

The researchers argue that relationship building and partnerships between health care providers and communities can enhance the ability of both professionals and their clients to strengthen social cohesion, collective resilience and coping strategies. Social movements and dates of significance, such as weight inclusivity movements and World AIDS Day, are examples of ways that people have come together to advocate for awareness and promote change. 

"These approaches move beyond the focus on stigma victimization to recognize and celebrate the strengths of communities who have been marginalized, as well as social histories of mutual support and stigma resistance," says Nyblade. 

Investing in stigma reduction in health care systems will yield results across the care continuum, and should be supported by governments, health-care institution polices, and licensing bodies, conclude the authors. 

"All types and levels of health-care providers need to be engaged in stigma reduction, through the training curriculums, continuing education programs, and more" says Logie. "The time to act is now." 

In addition to her role at FIFSW, Logie is affiliated with the United Nations University Institute for Water, Environment and Health, and the Women's College Research Insitute at Women's College Hospital in Toronto.