Understanding stigma drivers and practices that foster and sustain in the health system.

2. INTRODUCTION
OF STIGMATIZED
PATIENT
01
CHALLENGIES
AND OUTCOME
OF STIGMA ON
PATIENTS
02
INTERACTION
OF HEALTH
CARE WORKER
WITH
STIGMATISED
PATIENT
03

5. TYPES OF STIGMA
EXPERIENCED BY PEOPL
E
Racism as
experienced
Stigmas as
experienced by
LGBTQ2+ people
Mental illness
stigma
Substance use
stigma
HIV stigma Obesity stigma
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8. Understanding
stigma drivers
and practices
that foster and
sustain in the
health system
1. The language we use: Words communicate
assumptions, values, judgements, and stereotypes
that create and reinforce negative portrayals of
devalued groups. The way language is used in
media, popular culture, health promotion
initiatives, education, research, and policy shapes
how people understand the world.
2. Implicit and conscious biases: Conscious bias
occurs when an individual believes
and reproduces negative stereotypes and myths
about particular groups or individuals, resulting
in discriminatory language or practices.
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9. • 3. Lack of respect and understanding of
people's lives: Colonialism has driven unjust
attempts to erase cultural identity and
practices, and has contributed to loss of
language, exclusion from social and health
institutions, and continued spatial segregation​
• 4. Fear of danger and of contagion: Fear is a
significant driver of stigmas relating to
infectious disease. Quarantine-related policies,
mandatory immigration screening, and
notifiable disease frameworks can have
unintended stigmatizing effects.

10. How stigma
leads to
adverse
health
outcomes
• The following more fully unpacks how the
experience of stigma leads to poorer outcomes
and impacts overall health. Emerging research
indicates that stigma affects health in 3 key
ways:
1. It reduces access to and quality of protective
resources and health services
2. It increases the risk of chronic stress and poor
coping responses
3. It puts stigmatized people at higher risk of
assault and injury

13. Interaction of
doctor and
stigmatized patient
Doctor-patient relationship is part of a relational system
including the patient, his family, the physician and
society.
The four factors interact with each other, and the final
result, the result that has a therapeutic effect on the
patient, is a synthesis of all these interactions
In psychiatry these relations are more important than in
any other medical field
The brief analysis of these relations, in the therapeutic
context of a patient, is the subject of the following text.
Understanding all these aspects has a direct effect on the
quality and performance of the medical act.

15. • Clarke et al. compared “dialectical behavioral therapy,” which aims to
reduce prejudice and discrimination towards patients with
personality disorders by providing staff with knowledge and skills to
improve the effectiveness of their clinical practice, to “acceptance
and commitment training,” which aims to provide self-
management skills to reduce the impact of negative evaluations and
strengthen value-driven behavior. For both types of training, staff
attitudes improved and social distancing reduced, but they did not
significantly differ.

18. Why a new
stigma model
is needed
• It builds on recent efforts to understand the full
impact and significance of stigma on health,
including the experience of multiple and intersecting
stigmas that many people experience
• Stigma Model can be used to understand individual
stigmas to create worse outcomes for some people.
The Stigma Model also offers the opportunity
to understand the impact of stigma on different
health outcomes simultaneously
• The Stigma Model can be used by policy leaders,
researchers, practitioners, and service providers to
identify drivers of stigma and stigma practices in the
health system that cut across areas of stigma.

21. CONCLUSION
• Despite the ever-growing scientific evidence base on the prevalence of stigma in health facilities, and its negative impact on individuals’ health,
relatively few interventions exist to address this major impediment in healthcare.
• Particularly in resource-constrained health facilities, interventions that find synergies for stigma reduction across conditions could potentially create
economies of scale, offering cost and time savings.
• The current state of knowledge regarding stigma reduction interventions provides a solid foundation to further develop interventions that address
the gaps identified in this manuscript and address multiple health condition stigmas simultaneously.
• Future investment in stigma reduction should prioritize conditions that have been overlooked in the recent literature (for example, TB), rigorous
evaluation, underrepresented geographic locations, addressing stigma at multiple ecological levels within a health facility for a sustainable response,
and standardizing measures to facilitate comparisons between intervention approaches and methods.
• Stigma does not only affect those who are living with stigmatized health conditions.
• Its ramifications reverberate outward through communities and inwards through the health facility into the policies and procedures that guide care,
and on to the staff who are charged with providing care.
• It matters because reducing stigma has the potential to improve the health workplace environment, the quality of care provided by staff, the clinical
outcomes of individuals living with stigmatized health conditions, and the social risks taken when accessing healthcare for particular conditions.

22. Bibliography
• https://www.verywellmind.com/stigma-a-definition-of-stigma-425329
• https://www.avert.org/professionals/hiv-social-issues/stigma-discrimination
• http://dreamstime.com/
• Referred articles :
• Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Soc. 2001;27(1):363–
85
• United Nations Agency for International Development (UNAIDS). Protocol for
identification of discrimination against people living with HIV. Geneva:
UNAIDS; 2000.
• Ng C, Lai P, Lee Y, Azmi S, Teo C. Barriers and facilitators to starting insulin in
patients with type 2 diabetes: a systematic review. Int J Clin Pract.
2015;69(10):1050–70.
• https://www.canada.ca/en/public-health/corporate/publications/chief-
public-health-officer-reports-state-public-health-canada/addressing-stigma-
toward-more-inclusive-health-system.html#a4.4
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