Structural stigma and health management strategies.

The concept of structural stigma (or institutional stigma) expands the focus of stigma from individual measures of this construct (e.g., perceived discrimination) to considering the ways in which the structural conditions in which stigmatized individuals are embedded undermine their health and wellbeing. Stigma exert powerful, direct influences on the health of stigmatized individuals, nevertheless, it would be misleading to suggest that structures are unidirectional and static. Social structures actively shape individual and group-level processes; at the same time, however, structures are themselves molded and altered by individual and interpersonal factors.

Structures have been defined by Bonilla-Silva in 1997 as “organizing principles on which sets of social relations are systematically patterned”. Structural stigma is defined as the societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and wellbeing of the stigmatized.

Recent research has begun to generate a set of findings concerning the role of structural stigma in the production of negative outcomes for members of stigmatized groups, including individuals with mental illness, sexual minorities, Blacks and individuals infected with HIV/ AIDS.

Hatzenbuehl offered potential operationalizations of structural stigma, including “the policies of private and governmental institutions that restrict the opportunities of stigmatized groups” Some of their results raise the provocative possibility that structural racism/stigma may not only harm the targets of structural stigma but also benefit those who wield the power to enact stigma and discrimination, consistent with theories put forward and/or elaborated on in this issue, including stigma power and systemic racism.

Health programs worldwide have been one potential way to struggle with racism, discrimination or stigma, but at the same time, these have been a good strategy to enforce and prevail the power over the population affected by poverty and social exclusion. One example are the health plans carries out by many countries in South, Central and North America with the goals of reduce the birth rate. While these plans used management strategies to introduce birth control methods to medium and high social class, an important group of people living in poverty or being stigmatized by gender, race, maternal language were totally excluded from these birth control plans.

After some years, these societies now have a wider gap between those who have been empowered to self-manage their reproduction and those who have not. It is to say that, women who face huge barrier to access a good birth control empowerment are now stigmatized as “ignorant women” or “unconscious women”. Thus, some health interventions to deal with this gap are to perform permanent birth control methods such as surgery which at some point where performed without the authorization of women when being under the anesthesia effect. Obstetricians were asked to reach a certain number of surgeries per month.

Nowadays, we risk of being irresponsible at the time of managing health policies or even giving medical advice in the primary healthcare center on behalf efficiency and improving outcomes. Sometimes, the main focus of health management professionals are the strategies intended to improve the value of each dollar/euro invested in health, to manage health insurances, to expand the health coverage, etcetera. If professionals remain blind, when designing the new management of chronic conditions or health promotion, to the ethical commitment of fighting back discrimination and stigma we are condemned to widen the inequality gap.

Eduardo Vaquero