Stigma, status, and population health

Abstract

Stigma and status are the major concepts in two important sociological traditions that describe related processes but that have developed in isolation. Although both approaches have great promise for understanding and improving population health, this promise has not been realized. In this paper, we consider the applicability of status characteristics theory (SCT) to the problem of stigma with the goal of better understanding social systemic aspects of stigma and their health consequences. To this end, we identify common and divergent features of status and stigma processes. In both, labels that are differentially valued produce unequal outcomes in resources via culturally shared expectations associated with the labels; macro-level inequalities are enacted in micro-level interactions, which in turn reinforce macro-level inequalities; and status is a key variable. Status and stigma processes also differ: Higher- and lower-status states (e.g., male and female) are both considered normal, whereas stigmatized characteristics (e.g., mental illness) are not; interactions between status groups are guided by “social ordering schemas” that provide mutually agreed-upon hierarchies and interaction patterns (e.g., men assert themselves while women defer), whereas interactions between “normals” and stigmatized individuals are not so guided and consequently involve uncertainty and strain; and social rejection is key to stigma but not status processes. Our juxtaposition of status and stigma processes reveals close parallels between stigmatization and status processes that contribute to systematic stratification by major social groupings, such as race, gender, and SES. These parallels make salient that stigma is not only an interpersonal or intrapersonal process but also a macro-level process and raise the possibility of considering stigma as a dimension of social stratification. As such, stigma’s impact on health should be scrutinized with the same intensity as that of other more status-based bases of stratification such as SES, race and gender, whose health impacts have been firmly established.

Self-regulatory processes underlying structural stigma and health

“…Members of stigmatized groups are unlikely to be viewed as contributors to these goals (Kurzban & Leary, 2001). Structural and interpersonal stigma, combining experiences of both a diminished control over resources and a devalued social identity, are defined by both low power and low status (also see Phelan, Lucas, Ridgeway, & Taylor, 2014).…”

Patient and Provider Perspectives on HIV and HIV-Related Stigma in Dutch Health Care Settings

“…2 It occurs in social interactions and is reproduced by existing social inequalities and the exercise of power. [2][3][4][5][6] Even today, HIV can yield anxiety about the potential for infection, generate fear given its previous association with death and wasting, and prompt moral judgments that assign responsibility for infection to those living with HIV. Additionally, people living with HIV (PLWH) are often associated with behaviors that are perceived by some to violate social norms, such as commercial sex work, homosexuality, and intravenous drug use.…”

Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

“…The ways in which stigma may impact on the policy and health systems intended to support HIV responses has also been raised by several reviewers. 16,25,26,[32][33][34][35] For example, does stigma within policy circuits influence the focus of funded research into GMSM communities, the availability and sustainability of such services to meet the needs of GMSM in the first place, or the trust that community and policy have in GMSM community-led responses? Does HIV stigma within health services, such as excessive infection control measures, accentuate already existing race-related discrimination?…”