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date: 15 November 2019

(p. xi) Preface

(p. xi) Preface

Everyone has the right to health; however, circumstances deny some groups of people this right. As a consequence, group differences in physical health—health disparities—are pervasive in the United States and globally. Health disparities are health differences that have their roots in inequitable economic, political, social, and psychological processes. Health disparities are multi-determined: They reflect the systematic effects of differences in the economic and educational resources available to members of various groups; historical and contemporary discrimination; bias within the health care system; and the interactions among genetic, physiological, social, and environmental influences on health. Because they are shaped and mutually reinforced by culture, politics, economics, and social and personal biases, health disparities are persistent and in some cases expanding despite significant technical and scientific advances in medical treatment. This book examines the role stigma plays in creating and sustaining these disparities.

Health disparities are not just a problem for stigmatized groups. Understanding and addressing health disparities are in the best interest of all, both morally and practically. Allowing health disparities to persist makes us all complicit in the unnecessary suffering and death of others. Economically, the healthy incur significant economic cost for the treatment of the unhealthy.

Understanding the causes and consequences of health disparities requires a multilevel analysis, involving recognition of structural forces, psychological processes, and biological mechanisms. This volume provides a multidisciplinary, multilevel analysis of health and health disparities through the integrative lens of stigma. Stigma is a social construction in which people who are distinguished by a “mark” are socially devalued. Stigma operates culturally and socially by marginalizing groups of people symbolically and practically. Stigma operates individually by permitting and encouraging active discrimination or exclusion. Stigma is also a stressor for members of stigmatized groups. Stigmatized individuals typically recognize their marked and devalued identities, expend time and energy coping psychologically and behaviorally, invest in anticipating when and how they might be treated unfairly, and sometimes internalize their social devaluation. All of these responses erode health.

A key contribution of this book is to show that these processes work across many different types of stigma to contribute to many types of health problems among stigmatized individuals. The chapters in this volume illustrate how stigma (p. xii) processes create health disparities between members of stigmatized and nonstigmatized groups and also why reducing or eliminating such disparities will need to attend to stigma.

The authors of the chapters in the volume are internationally recognized experts on stigma and health. The central goal of each chapter is to offer a broad overview of the topic, (1) highlighting the most important and foundational ideas and findings within the realm of the chapter topic, (2) identifying the most important findings and emerging themes relevant to this topic, and (3) proposing new and promising directions for future research. The authors explain what is known but also alert readers to what still needs to be known.

The chapters engage a wide range of disciplines, levels of analysis, methods, and processes. Collectively, they provide a comprehensive understanding of health and why some individuals and some groups may be healthier than others. This book is therefore intended for scholars and students in psychology, sociology, public health, medicine, law, political science, geography, and allied disciplines who are interested in understanding stigma and health. It is meant to be the definitive source of scholarship on the role that stigma plays in health disparities.

Moreover, we believe that this is a volume in which “the whole is more than the sum of its parts.” That is, the book is not only a source for the latest scholarship on a particular topic in a specific discipline but also offers readers the opportunity to expand their perspective on stigma and health. The interdisciplinary nature of the topic, the diverse academic background of the contributors to the volume, and the efforts of authors to speak across disciplinary lines direct readers to new literatures and enable them to adopt new ways of examining the bidirectional relationship between stigma and health. Indeed, a primary aim of this volume is to expand an understanding of stigma and health by increasing awareness of the ideas and insights of scholars outside one’s own discipline to generate new integrative lines of research on this topic.

This book has been a long time in the making. The three editors of this volume have, collectively, more than 100 years of scholarly investment in this area. We have devoted much of our professional lives to addressing issues related to stigma and health and deepening our understanding of the topic. However, we have adopted different scholarly perspectives, focusing on the experiences of members of stigmatized groups, interpersonal processes underlying the stigmatization of others, and the social and institutional context of stigma. On a rare occasion, our scholarly paths intersected. However, we independently recognized that our particular ways of understanding stigma and health were insufficient alone to address an issue of such scholarly and practical importance. Thus, at the initiative of the lead editor, the team was formed.

Our experiences with the expanded team, including the chapter authors and co-authors, reaffirmed our initial impression that there is still so much we do not know and that we need to know about stigma and health. We have learned so much from each other and from all of the authors. We believe that readers, from those entering the field to those who are already established experts in this area, will benefit from this book.

We gratefully acknowledge all the assistance that we have received in creating this book. Oxford University Press has provided invaluable guidance and support at every stage of the project. We especially express our appreciation to our spouses—Jim, Linda, and Jo—for their patience, encouragement, and support both during the tense deadline periods and across the years we have devoted to this project.

We also acknowledge the financial support we have received from several funding agencies during the time we have worked on this volume and for supporting the work that created the foundation for this project: for Brenda Major: NIH/NHLBI 5R01HL112818-02, NIH/NHLBI (p. xiii) 079383, and NSF BCS-9983888; for John Dovidio: NIH/NHLBI 2RO1HL085631-06, NIH/DHHS R01DA029888, and NSF 1310757.

We believe the integration of independent and interdisciplinary literatures on health-related outcomes of stigma and discrimination reflected in the chapters of this volume is critical for further understanding the diverse pathways by which stigma and discrimination affect health outcomes and health care. This volume should direct the attention of professionals and students in the social and health sciences to the important role that stigma plays in health and the mechanisms by which it does so. In so doing, it should set the research agenda for this relatively new line of research and guide the development of new interventions to enable all individuals to realize their right to healthy lives.

In conclusion, we believe that stigma and health is a topic of broad scholarly interest and of significant social importance. It is a topic that has personal relevance to large portions of the population. We hope that readers benefit from the comprehensive and cutting-edge reviews in this volume of the rapidly growing body of research examining the impact of social stigma and discrimination on physical health. (p. xiv)