University of Illinois, Chicago, IL, USA.
University of Alabama at Birmingham, Birmingham, AL, USA.
Health Educ Behav. 2021 Jun;48(3):342-351. doi: 10.1177/10901981211011927.
Understanding and addressing health inequities calls for enhanced theoretical and empirical attention to multiple forms of stigma and its influence on health behaviors and health outcomes within marginalized communities. While recent scholarship highlights the role of structural stigma on between-group health disparities, the extant literature has yet to elucidate the mechanisms through which structural stigma gives rise to within-group health disparities. In this article, we review and use relevant literature to inform the development of a conceptual model outlining how structural stigma contributes to within-group health disparities by creating division and tension within communities marginalized due to their social statuses and identities. We specifically focus on disparities among (1) communities of color due to White supremacy, (2) gender and sexual minority communities due to patriarchy and heterosexism, and (3) the disability community due to ableism. We argue that the nature and extent of the stigma members of stigmatized communities face are intricately tied to how visible the stigmatized characteristic is to others. By visibility, we refer to characteristics that are more easily perceived by others, and reveal a person's social identity (e.g., race/ethnicity, nativity, relationship status, gender expression, and disability status). This paper advances the literature by discussing the implications of the model for future research, practice, and policy, including the importance of acknowledging the ways in which structural stigma intentionally disrupts the collective identity and solidarity of communities and consequently threatens health equity.
理解和解决健康不平等问题需要加强对多种形式的污名及其对边缘化群体健康行为和健康结果的影响的理论和实证关注。虽然最近的学术研究强调了结构性污名对群体间健康差距的作用，但现有文献尚未阐明结构性污名如何导致群体内健康差距的机制。在本文中，我们回顾并利用相关文献为一个概念模型的发展提供信息，该模型概述了结构性污名如何通过在因社会地位和身份而边缘化的社区内制造分裂和紧张来导致群体内健康差距。我们特别关注（1）因白人至上而处于劣势的有色人种社区之间的差距，（2）因父权制和异性恋主义而处于劣势的性别和性少数群体社区之间的差距，以及（3）因能力主义而处于劣势的残疾社区之间的差距。我们认为，受污名化社区成员所面临的污名的性质和程度与污名化特征对他人的可见度密切相关。通过可见性，我们指的是更容易被他人感知的特征，并揭示了一个人的社会身份（例如，种族/族裔、原籍国、关系状况、性别表达和残疾状况）。本文通过讨论该模型对未来研究、实践和政策的意义，推进了文献的发展，包括承认结构性污名有意破坏社区的集体认同和团结，从而威胁健康公平的重要性。
