Legal Remedies to Address Stigma‐Based Health Inequalities in the United States: Challenges and Opportunities

Abstract

Stigma is an established driver of population‐level health outcomes. Antidiscrimination laws can generate or alleviate stigma and, thus, are a critical component in the study of improving population health. Currently, antidiscrimination laws are often underenforced and are sometimes conceptualized by courts and lawmakers in ways that are too narrow to fully reach all forms of stigma and all individuals who are stigmatized. To remedy these limitations, we propose the creation of a new population‐level surveillance system of antidiscrimination law and its enforcement, a central body to enforce antidiscrimination laws, as well as a collaborative research initiative to enhance the study of the linkages between health and antidiscrimination law in the future. Context Stigma is conceptualized as a fundamental cause of population health inequalities. Antidiscrimination law is one important lever that can influence stigma‐based health inequities, and yet several challenges currently limit the law's potential to address them. Methods To determine whether antidiscrimination law adequately addresses stigma, we compared antidiscrimination law for its applicability to the domains and statuses where stigma is experienced according to the social science literature. To further examine whether law is a sufficient remedy for stigma, we reviewed law literature and government sources for the adequacy of antidiscrimination law enforcement. We also reviewed the law literature for critiques of antidiscrimination law, which revealed conceptual limits of antidiscrimination law that we applied to the context of stigma. Findings In this article, we explored the importance of antidiscrimination law in addressing the population‐level health consequences of stigma and found two key challenges—conceptualization and enforcement—that currently limit its potential. We identified several practical solutions to make antidiscrimination law a more available tool to tackle the health inequities caused by stigma, including (1) the development of a new surveillance system for antidiscrimination laws and their enforcement, (2) an interdisciplinary working group to study the impact of antidiscrimination laws on health, and (3) a central agency tasked with monitoring enforcement of antidiscrimination laws. Conclusions Antidiscrimination law requires better tailoring based on the evidence of who is affected by stigma, as well as where and how stigma occurs, or it will be a poor tool for remedying stigma, regardless of its level of enforcement. Further interdisciplinary research is needed to identify the ways in which law can be crafted into a better tool for redressing the health harms of stigma and to delimit clearer boundaries for when law is and is not the appropriate remedy for these stigma‐induced inequities.

Differential Effects of State Policy Environments on Substance Use by Sexual Identity: Findings From the 2000–2015 National Alcohol Surveys

“…There also is a need for ongoing surveillance of laws prohibiting discrimination, as well as how these laws and their enforcement impact health outcomes. 58 Our findings underscore the value of reducing structural stigma as a strategy for addressing disparities in health by sexual identity. Findings from the current study are also compatible with calls to further investigate coping and resilience among sexual minorities in individual, interpersonal, and social realms.…”

Fighting for a (wide enough) seat at the table: weight stigma in law and policy

“…Such protections are intended to provide full access to participation in society that has always been afforded to thin people. The emphasis is not simply on "treating people equally," but on leveraging antidiscrimination and civil rights law to remedy structural disadvantage fat people so commonly experience in the West (Blake & Hatzenbuehler, 2019). For the sake of simplicity, we may return to the reliably contentious chair issue: equity, or true equality, does not dictate that everybody should be made to sit in the same chairs, but that everybody should be able to sit down at work.…”

“…Legal protections are not intended to provide special treatment for a particular group; rather, they are intended to eliminate existing disadvantage. In this context, a strong case can be made for the addition of weight as a protected category under equality and anti-discrimination laws (Blake & Hatzenbuehler, 2019). Systemic anti-fat biases have resulted in barriers to equal opportunity for higher-weight individuals that start in early childhood and are compounded throughout the life course (Daníelsdóttir, 2020;Puhl & King, 2013).…”

Toward Fair and Humane Pain Policy

“…A public health response to the ubiquity and inequity of undertreated pain ought to target stigma at the macro‐ or structural level, which would require policy development to identify the laws and policies that intensify preexisting stigmas against people in pain and then to eliminate or amend them. Communities could also enact stigma‐inhibiting policies, such as antidiscrimination provisions that have increasingly been identified as important strategies for lessening the stigma marginalized groups commonly endure 24 . Finally, it is important to understand the significance of local policy in perpetuating stigma and inequalities against people in pain.…”