Stigma as an Unrecognized Determinant of Population Health: Research and Policy Implications.

Stigma processes play an underrecognized role in the distribution of life chances, influencing health through the production of disadvantage and the induction of stress. Policies enact stigma processes, mitigate them, or ignore them. If each of these two statements is correct, the intersection of stigma and policy demands our attention. We propose a change of perspective from an approach that considers one stigmatized status and one outcome at a time to a perspective that considers the full range of stigmatized statuses and outcomes so as to reveal stigma's full impact. Concerning the second statement, literature addressing "structural stigma" provides compelling evidence that policy enacts stigma and harms health in some circumstances and mitigates stigma and improves health in others. In addition to the effects of active policies, we also bring attention to policy inattention-doing nothing. A core feature of stigma is a discounting-a mattering less-that allows and even fosters policy inattention toward the concerns of stigmatized groups. We end by engaging David Mechanic and Linda H. Aiken's ideas concerning how social science influences policy by changing how people think about problems and hope that our consideration of stigma and policy might ultimately have such a consequence.