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Health Policy Brief: Structural Stigma In Law

A new health policy brief from Health Affairs, with support from the Robert Wood Johnson Foundation, is titled “Structural Stigma In Law: Implications And Opportunities For Health And Health Equity.” It was written by Sarah Hemeida, Lina Brou, and Daniel Goldberg, all of whom are affiliated with the University of Colorado Anschutz Medical Campus, and Hallie Conyers-Tucker, a JD candidate at Seattle University School of Law. The brief joins Health Affairs’ ongoing series of policy briefs on the social determinants of health.

As the brief states, stigma, defined as a stain on a person’s reputation, operates both as a process and an outcome. It is a pervasive experience for its targets and can go unnoticed by those who are unaffected. When stigma is promoted through the organizations and systems that govern daily life, it is called structural stigma. A powerful social determinant of health, the stigmatization process has been demonstrated to worsen physical health outcomes and social well-being.

The brief illustrates how laws and policies mediate structural stigma through the example of people with substance use disorder (SUD); explores potential mechanisms linking structural stigma in law to negative health outcomes, and therefore to health inequities for populations that are already marginalized; and recommends an approach for revision of laws and policies that can reduce structural stigma for targeted communities.

The authors completed a pilot study for the state of California to evaluate and map stigma in law against people with SUD and summarized their study findings in this brief. The legal domains in which such stigma is most prevalent include employment law, legal findings, and nuisance law. Looking beyond SUD, structural stigma related to different conditions and groups can be found across a variety of legal domains.

“Once structural stigma is mapped in law, remedies can be applied that broadly fall into three categories: stigma-promoting laws can be amended, stigma-promoting laws can be repealed, and additional antidiscrimination and stigma-reducing laws can be enacted and enforced,” the authors observe.

The workplace has proven to have a direct influence on exacerbating stigma’s health-harming effects, as the loss of employment as the result of stigma may also mean the loss of health insurance, and therefore access to care. Some models, such as California’s 2004 Mental Health Services Act, the authors note, are a step in the right direction: the act mandates the establishment of committees to evaluate existing laws “for any embedded discriminatory provisions [against people with mental health disorders] and gaps; and develop corrective strategies to address these problems.”

The authors recommend policy attention, at all levels of government, to evaluate legal language that intensifies stigma against already-vulnerable communities.

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