Stigma as a fundamental cause of population health inequalities

Mark L Hatzenbuehler, Jo C Phelan, Bruce G Link, Mark L Hatzenbuehler, Jo C Phelan, Bruce G Link

Abstract

Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health.

Figures

FIGURE 1—
FIGURE 1—
Multiple mediating mechanisms reproduce disadvantage for stigmatized groups. Note. M = mediating mechanism; SES = socioeconomic status. The thick arrow indicates a strong effect whereas the thin arrow indicates a weak effect. The arrow interrupted with a dash indicates a blocked mechanism.

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