Essay FocusStigma and its public health implications
Section snippets
Major forms of discrimination
We characterise three major forms of discrimination, which can have varying degrees of severity. Direct discrimination occurs when A engages in overt rejection of B's job application, refuses to rent B an apartment, and so on. Structural discrimination is more subtle. An example would be white employers who rely on job recommendations from their white colleagues, who in turn are more likely to recommend white candidates. There is no direct denial of a job to a person of colour, yet
Stigma processes and life chances
Stigma processes have a dramatic and probably under-recognised effect on the distribution of life chances such as employment opportunities, housing, and access to medical care. We believe that under-recognition occurs because attempts to measure the impact of stigma have generally restricted analysis to one circumstance (eg, AIDS, obesity, race, or mental illness) and examined only one outcome (eg, earnings, self esteem, housing, or social interactions). If all stigmatised conditions were
Stigma and stress
The extent to which a stigmatised person is denied the good things in life and suffers more of the bad things has been posited as a source of chronic stress, with consequent negative effects on mental and physical health.9 Stress is also associated with the constant threat of being stigmatised. The social epidemiologist Sherman James suggests that such fear sometimes generates harmful health outcomes.10 An example would be the career woman who works extremely hard and under great pressure to
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