Addressing stigma: Towards a more inclusive health system
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In December 2019, Chief Public Health Officer (CPHO) Dr. Theresa Tam released a national report that shines a light on stigma as a key driver of health inequities in Canada. This report takes the position that “stigma affects us all. We are all vulnerable to the slow and insidious practice of dehumanizing others and we are all responsible for recognizing and stopping it” (p. 5).
The report was informed by meetings with key people across Canada that gathered input on two key questions:
- What holds stigma in place?
- How do we address stigma in the health system?
The report also highlights the health status of people in Canada and points to concerning public health trends as well as several growing health inequities (Chapter 1).
Stigma Pathways to Health Outcomes Model
The Stigma Pathways to Health Outcomes Model (Chapter 2) positions stigma as a public health issue, undermining health for individuals and contributing to population health inequities. The model provides a tool to consider the ways in which different stigmas intersect and lead to worse outcomes for some people. It supports efforts to address and resist the impact of stigma on health.
The model highlights the dimensions of stigma — drivers, types, practices, experiences and population outcomes. Using this model, the report describes the pathways of seven particular stigmas including:
- racism experienced by First Nations, Inuit and Métis peoples;
- racism experienced by African, Caribbean and Black Canadians;
- sexual and gender identity stigma as experienced by LGBTQ2+ people;
- mental illness stigma;
- HIV stigma;
- substance use stigma; and
- obesity stigma.
Action Framework for Building an Inclusive Health System
An Action Framework for Building an Inclusive Health System (p.41) (Chapter 3) (also available in an infographic) identifies how stigma operates and provides examples of interventions and promising initiatives to address stigma across individual, interpersonal, institutional and population levels.
Considering stigma at each of these levels adds to our understanding of the issue of stigma and its effects on health. It also provides guidance to develop and implement interventions at a variety of levels.
Use this resource to:
- facilitate a discussion about the dimensions of stigma and the experience of stigma at multiple levels;
- identify ways in which different stigmas intersect and lead to worse outcomes for groups who experience inequities;
- apply the action framework and guidance for practice to public health policy and program development that addresses the social determinants of health, and health equity; and
- design related continuing professional development opportunities for your team.
- Let’s Talk: Racism and health equity (2018)
- A review of frameworks on the determinants of health (2015)
- Pathways to health equity and differential outcomes: A summary of the WHO document Equity, social determinants and public health programmes (2015)
- Foundational documents in health equity: A curated list (2014)
- Closing the gap in a generation (2010)
- Webinar recording: Disruptive opportunities to enhance capacity for equity-oriented action in the health sector (2020)
- Webinar recording: Living health equity values within public health organizations (2019)
- A gaps analysis to improve health equity knowledge and practices (2018)
- Achieving health equity: A guide for health care organizations (2016)
- Oppression: A social determinant of health (2021)
Public Health Agency of Canada. (2019). The Chief Public Health Officer's Report on the State of Public Health in Canada 2019: Addressing Stigma Towards a More Inclusive Health System. Ottawa, ON: PHAC. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/addressing-stigma-what-we-heard/stigma-eng.pdf.