US to investigate impact
of stigma on health
2001;323:592 ( 15 September )
The US is planning an ambitious programme of research into the impact
of stigma on human health, led by part of the National Institutes of
Health in Bethesda, Maryland.
It faces a problem, however, in deciding which research methods to
use to determine the precise impact of stigma, a recent conference
The three day conference in Washington attended by investigators from
many parts of the world, looked at the relation between stigma and
public health, the social and cultural aspects of stigma, and the ways
it prevents people from seeking or receiving treatment for disease.
The fact that disease can be stigmatised is nothing new—from lepers
wearing a warning bell to segregating people with a mental illness from
the rest of society.
"For the first time we have taken a look at a whole set of conditions
that result in stigma —physical, behavioural, psychological—and have
gained a better understanding of the mechanisms behind stigma," said Dr
Gerald Keusch, director of the Fogarty International Center, a part of
the National Institutes of Health.
Dr Arthur Kleinman, a psychiatrist and medical anthropologist at
Harvard Medical School, acknowledged the work already done in the United
Kingdom: "Doctors, especially those in the UK, have been aware for a
long time of the social roots of disease, such as the association of
HIV/AIDS and tuberculosis with poverty."
"But," he said, "it’s not just that disease has social influences. It
also has social consequences, and now funding agencies such as the
National Institutes have recognised this."
The question now is how to develop research programmes that can
provide useful data. The basic behavioural scientists say that we need
to define stigmatisation more sharply, refining understanding of the
processes of stigmatisation and of its consequences.
But the most important contribution is going to come from the applied
sciences and will look at how interventions have affected health
outcomes, according to Dr Kleinman.
"This is critical," he said. "I thought we would hear a lot more here
about interventions, but we haven’t because they haven’t been done. So
there is a pressing need for demonstration projects—very careful
evaluations—that can tell us what works and what doesn’t regarding
interventions. In determining the research agenda it will be important
to develop programmes aimed at reducing or preventing stigma."
The next step was funding a research programme, Dr Keusch said.
Besides the Fogarty Centre, the meeting was sponsored by several of the
National Health Institutes, an indication of the widespread interest in