Stigma as a Fundamental Cause of Health Inequality

Abstract

Accumulating evidence shows that stigma has health-harming consequences that build health disparities between those who are stigmatized and those who are not. However, most research has considered one stigmatized status at a time as it affects (generally) one outcome at a time. Moving from this singular focus to consider all forms of stigma as they affect multiple outcomes suggests a large and pervasive effect of stigma on life chances. This chapter considers whether stigma should be classified as a “fundamental cause”—an especially pernicious social factor that remains persistently associated with health inequalities over time. The chapter concludes by observing that if the stigma-as-a-fundamental-cause idea is supported, it follows that reductive efforts to address disparities via biomedical interventions will fail. Stigma stands as a factor that needs to be addressed in its own right if health inequalities are to be addressed and population health improved.