Stigma and the ethics of public health: Not can we but should we

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Abstract

In the closing decades of the 20th century, a broadly shared view took hold that the stigmatization of those who were already vulnerable provided the context within which diseases spread, exacerbating morbidity and mortality by erecting barriers between caregivers and those who were sick and by imposing obstacles upon those who would intervene to contain the spread of illness. In this view, it was the responsibility of public health officials to counteract stigma if they were to fulfill their mission to protect the communal health. Furthermore, because stigma imposed unfair burdens on those who were already at social disadvantage, the process of stigmatization implicated the human right to dignity. Hence, to the instrumental reason for seeking to extirpate stigma, was added a moral concern. But is it true that stigmatization always represents a threat to public health? Are there occasions when the mobilization of stigma may effectively reduce the prevalence of behaviors linked to disease and death? And if so, how ought we to think about the human rights issues that are involved?

Section snippets

Judging stigma

The 1960s witnessed the rise of broad set of oppositional challenges to the established order. The African-American civil rights assault on racism; the new feminist attack on the interpersonal, social, and legal subordination of women; the effort on the part of gay men and lesbians to upend heterosexual domination and the classification of homosexuality as a psychiatric disorder – each represented a potent expression of a deep political and social disaffection. It is within this context that we

AIDS, public health and stigma

Much of the classic literature on stigma emerged from the experience of clinical encounters. As Jennifer Stuber and I have shown in an earlier paper which serves as the foundation for this analysis, it was the AIDS epidemic both domestically and globally that provided the context for the articulation of a strong thesis linking stigmatization and public health (Bayer & Stuber, 2006).

Within the United States, discussions centered on the fact that those who were initially most vulnerable to HIV —

Smoking and public health: an exception to the doctrine on stigma?

Against the backdrop of the discussion of stigma, AIDS, and human rights, the course of anti-tobacco advocacy and policy in the U. S. seems all the more striking. In contrast to the HIV epidemic, where those who were infected were seen as blameless, those who smoked would become the targets of public health policies that at first inadvertently but then explicitly sought to utilize the power of denormalization and marginalization to reduce tobacco consumption. Just as the tobacco industry would,

Toward an ethics of stigma

In liberal societies it is appropriate, sometimes obligatory, for government to use its coercive powers to affect behaviors of individuals that are injurious to the health and well-being of others. Laws that prohibit, punishment that seeks its impact by the force of specific or general deterrence, and fines that exact economic pain may be called on to limit threats to the commonweal, the choice of sanctions depending on considerations of proportionality and the costs of enforcement. More

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