Week 8 - Stigma, discrmination and SDH & Social justice and SDH

What is social exclusion?

A complex and multi-dimensional process, involving the denial of resources, rights, goods and services, and the inability to participate in normal relationships and activities available to the majority of people in a society, whether in economic, social, cultural or political arenas. It affects both the quality of life in individuals and the equity and cohesion of society as a whole.

Define health equity

A situation in which groups with different levels of underlying social advantage or disadvantage (wealth, power, or prestige) do not experience health inequlities associated soley with social positioning

What is social inclusion?

A socially inclusive society is defined as one where all people feel valued, their differences respected, and their basic needs are met so they can live in dignity

Goffman's theory of stigma

An attribute that is deeply discrediting and that reduces the bearer from a whole and usual person to a tainted, discounted one

How we professionally practice?

Be a responsible agent of society; treat but also refer and advocate; build partnerships that complement professional contribution

Why do we stigmatize?

Coping mechanism (deny our vulnerability), Ignorance (poor level of knowledge = poor attitude), Evolutionary psychology (natural selection, avoid those that lessen our chances of survival), Association to discredited groups (homos, sex workers etc.)

What are some health inequalities?

Differences in: mortality, morbidity, work-related injury rates, susceptibility to infectious diseases and access to health services

Which form (stigma or discrimination) can you take legal action against?

Discrimination

How do we fight stigma?

Educate yourself (having facts can help you challenge the misinformation that leads to stigma); Being aware of words (don't reduce people to a diagnosis or stereotype, correct those who use hurtful language); Challenge media stereotypes (write letters to newspapers, TV, radio stations etc.); Support those who may be stigmatised (treat them with respect); Share your story (if you or someone in your family has been stigmatised, speak up)

Who does a problem-focused system work best for?

For people who have a single presenting problem, who have self-care skills, have support at home and work. In essence, people who are already socially included and for whom their illness doesn't disrupt that inclusion.

What are some causes of health inequalities

Genetic factors, gender, health behaviours (smoking, physical inactivity, poor nutrition), exposure to toxins, access to health services, education disparities, ethnicity, nutrition, housing, location/environment, unfair trade, globalisation, lack of autonomy

What health conditions are likely to be stigmatised?

Health conditions connected with negative characteristics or with uncertain or unknown causes, and those that generate fear and disgust

What are some social policies that might improve health by reducing socioeconomic disparities?

Investment in early childhood development; nutrition programmes; improvements in the quality of the work environment; reductions in income inequality; greater political fairness

What is Amartya Sen's capability approach?

It describes the ability to effectively function in a modern society, that people need a range of capabilities and that they lack these key capabilities their life choices will be severely constriained and they will be disadvantaged.

What is capability?

It is a potential (what you could be or do if you so chose). (functioning is actuality).

What is social justice concerned about?

It is concerned with enhacing individual capacity (skills, health literacy) and ensuring access to services, with ensuring social participation and protecting citizenship rights, with structural changes that reduce social inequality and promote social inclusion.

What are the consequences of stigma in relation to infectious diseases?

It makes the control of the spread of infection more difficult; information from the infected person is often incomplete, inaccurate and not well-timed; facilitates the segregation of treatment; encourages avoidance of testing and treatment (underutilized services); promotes the segregation of knowledge (one set of know for non and another for stigma)

How does stigmatization occur? Step 4:

Labelled persons are experience status loss and discrimination that lead to unequal outcomes. A very degrading experience, may lose friends, people may look at you differently, may avoid talking to you, you might feel isolated

How does stigmatization occur? Step 2:

Labelled persons are linked to undersirable characteristics and/or to negative stereotypes

How does stigmatization occur? Step 3:

Labelled persons are placed in distinct categories as to accomplish some degree of separation of us from them

What are some capabilities?

Live a life of normal length, bodily health, bodily integrity, senses, imagination and thought, emotions, practical reason (a conception of the good), affiliation with others, respect for other species, play, control over one's environment (political and material)

How does stigmatization occur? Step 1:

Make a distinction and label human differences

Jones' theory of stigma

Stigma can be seen as a relationship between an attribute and a stereotype to produce a definition of stigma as a mark (attribute) that links a person to undesirable characteristics (stereotypes)

Stafford and Scott's theory of stigma

Stigma is a characteristic of persons that is contrary to a norm of a social unit where a norm is defined as a shared belief that a person ought to behave in a certain way at a certain time

What is the difference between stigma and discrimination?

Stigma refers to attitudes and beliefs that lead people to reject, avoid, or fear those they perceive as being different WHILST discrimination occurs when individuals or institutions unjustly deprive others of their rights and life opportunities due to stigma

How does stigmatization occur? Step 5

Stigmatization is entirely contingent on access to social, economic, and political power that allows the identification of differentness, the construction of stereotypes, the separation of labelled persons into distinct categories, and the full execution of disapproval, rejection, exclusion, and discrimination

Crocker et al's theory of stigma

Stigmatized individuals possess (or are believed to possess) some attribute, or characteristic, that conveys a social identity that is devalued in a particular social context

What is Sen's argument?

That it is the role of the government to set-up structures or spaces within which people can realise their capabilities.

What happens when a person is discriminated against?

The individual is treated differently

What is the arrangement-focused theory of justice (structures)?

There is a focus on structures. The focus is upon perfect or ideal justice rather than comparisons distinguishing 'more just' from 'less just' approaches. A top-down approach where if the rules are right then justice will follow is adapted.

What resources, opportunities and capabilities should socially included people have?

They should be able to learn (participate in education and training), work (participate in employment, unpaid or voluntary work incl. family or carer responsibilities), engage (connect with people, use local services and participate in local, cultural, civic and recreational activities) and have a voice (influence decisions that affect them)

What is the realisation-focused theory of justice (agency)?

This is the comparisons of societies that already exist, or could exist, in the interests of finding more just solutions. The primary interest is in removing injustice. A bottom-up approach is undertaken to teach people to behave justly to each other and with each other and a just society will emerge.

What is stigma?

a mark of disgrace; a stain, as on one's reputation. OR a characteristic mark or sign of defect, degeneration, disease etc.

What are the negative effects of stigma?

depressive symptoms, less integrated into the community, constricted social networks, avoidance of medical testing and/or non-compliance with treatment, lowered self-esteem (motivation to self-protect), self-stigmatization (a person believes they should expect stigma - withdraw and become secretive)

What must we do in promoting health?

enable, mediate, advocate for health; create supportive environments; strengthen community action; develop personal skills; reorient health services

Define equity

fairness

What is the relationship between social determinants of health and stigma?

influences several physical and mental health outcomes that affect millions of people in the US through multiple mechanisms; disrupts or inhibits access to multiple resources - structural, interpersonal, and psychological - that could otherwise be used to avoid or minimize poor health; and enables the creation of new, evolving mechanisms that ensure the reproduction of health inequalities among members of socially disadvantaged populations

What do just structures allow for?

local autonomy and initiative

What do just processes promote?

social inclusion

What happens when a person is stigmatized?

the individual is perceived as different from others

Define discrimination

the making of a difference in particular cases, as in favour of or against a person or thing, especially when arising from prejudice based on race, ethnicity, sex, religion, age etc.