As a feature of many chronic health problems, stigma contributes to a hidden burden of illness. Health-related stigma is typically characterized by social disqualification of individuals and populations who are identified with particular health problems. Another aspect is characterized by social disqualification targeting other features of a person's identity-such as ethnicity, sexual preferences or socio-economic status-which through limited access to services and other social disadvantages result in adverse effects on health. Health professionals therefore have substantial interests in recognizing and mitigating the impact of stigma as both a feature and a cause of many health problems. Rendering historical concepts of stigma as a discrediting physical attribute obsolete, two generations of Goffman-inspired sociological studies have redefined stigma as a socially discrediting situation of individuals. Based on that formulation and to specify health research interests, a working definition of health-related stigma is proposed. It emphasizes the particular features of target health problems and the role of particular social, cultural and economic settings in developing countries. As a practical matter, it relates to various strategies for intervention, which may focus on controlling or treating target health problems with informed health and social policies, countering the disposition of perpetrators to stigmatize, and supporting those who are stigmatized to limit their vulnerability and strengthen their resilience. Our suggestions for health studies of stigma highlight needs for disease- and culture-specific research that serves the interests of international health.
EDITORS' I N T R O D U C T I O N IntroductionOver the past three decades the illness explanatory model framework has stimulated research in clinically applied medical anthropology, guided clinical training, sparked controversy in the health social sciences and guided developments in the field of cultural psychiatry. This formulation of explanatory models was conceived both to advance perspectivism in clinical medical practice and public health, and to show how ethnomedical study of sickness and medicine should contribute to cultural anthropology and social analysis. The appeal of the explanatory model framework for clinical training is based on the premise that it is important to examine relationships and consequences of interactions between patients' ideas about their health problems and those of clinicians and professionals who are responsible for their care. Although the clinical interests and applications of illness explanatory models extend to all aspects of medicine, it was mainly experience and interest in psychiatry andTextbook of Cultural Psychiatry, Dinesh Rhugra and Kamaldeep Bhui (eds.).
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