Public Health Agency of Canada, Montréal, Quebec, Canada.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada.
Health Promot Chronic Dis Prev Can. 2021 Mar;41(3):85-115. doi: 10.24095/hpcdp.41.3.03.
Stigma has been identified as a key determinant of health and health inequities because of its effects on access to health-enabling resources and stress exposure. Though existing reports offer in-depth summaries of the mechanisms through which stigma influences health, a review of evidence on the upstream drivers of stigma across health and social conditions has been missing. The objective of this review is to summarize known structural determinants of stigma experienced across health and social conditions in developed country settings.
We conducted a rapid review of the literature. English- and French-language peer-reviewed and grey literature works published after 2008 were identified using MEDLINE, Embase, PsycINFO, Google and Google Scholar. Titles and abstracts were independently screened by two reviewers. Information from relevant publications was extracted, and a thematic analysis of identified determinants was conducted to identify broad domains of structural determinants. A narrative synthesis of study characteristics and identified determinants was conducted.
Of 657 publications identified, 53 were included. Ten domains of structural determinants of stigma were identified: legal frameworks, welfare policies, economic policies, social and built environments, media and marketing, pedagogical factors, health care policies and practices, biomedical technology, diagnostic frameworks and public health interventions. Each domain is defined and summarized, and a conceptual framework for how the identified domains relate to the stigma process is proposed.
At least 10 domains of structural factors influence the occurrence of stigma across health and social conditions. These domains can be used to structure policy discussions centred on ways to reduce stigma at the population level.
由于污名对获得促进健康资源和压力暴露的影响，它已被确定为健康和健康不平等的关键决定因素。尽管现有报告深入总结了污名影响健康的机制，但对健康和社会条件下污名的上游驱动因素的证据审查却一直缺失。本综述的目的是总结发达国家各种健康和社会条件下污名体验的已知结构决定因素。
我们进行了文献快速综述。使用 MEDLINE、Embase、PsycINFO、Google 和 Google Scholar 检索了 2008 年后发表的英文和法文同行评审和灰色文献。两名评审员独立筛选标题和摘要。从相关出版物中提取信息，并对确定的决定因素进行主题分析，以确定结构决定因素的广泛领域。对研究特征和确定的决定因素进行了叙述性综合。
在确定的 657 篇出版物中，有 53 篇被纳入。确定了污名的 10 个结构决定因素领域：法律框架、福利政策、经济政策、社会和建筑环境、媒体和营销、教学因素、医疗保健政策和实践、生物医学技术、诊断框架和公共卫生干预措施。每个领域都有定义和总结，并提出了一个概念框架，说明确定的领域与污名过程的关系。
至少有 10 个结构因素领域会影响健康和社会条件下污名的发生。这些领域可用于构建以减少人群层面污名为中心的政策讨论。
