Prompted by a discussion with Ron Cox, who asks whether we want to remove or reduce social stigma attached to drug use before we have definitive evidence on the degree to which stigma now deters and reduces the incidence of drug use. The result might be an increased incidence rate.
He notes that an analogy might be found in "loving and aiding the sinner" but "hating the sin."
Would anyone like to add comments in a respectful and dignified social policy discussion -- i.e., one that respects and treats comments as we would like our comments to be treated in a university-based discussion of alternative points of view and hypotheses? Let's welcome an exchange.
Socrates might ask whether we can use this line of reasoning for other purposes -- e.g., to reduce health care costs and the federal government expenditures on mental health and neurological care care via an initiative to increase the stigma attached to (1) being a recipient of mental health care or (2) receiving neurological services such as a brain scan after a consciousness-affecting blow to the head during a college football game?
Or, if we cannot ban sales and purchases of pain relievers, can we try to attach more stigma to taking these compounds in order to achieve pain relief?
You can think of other analogies that Socrates might work up with respect to obesity, failing to earn a 4.0 GPA, getting free breakfast or lunch at school,....
Are there pre-emptive values that should be called into play?
How would you describe those values?
Where in the university curriculum for epidemiology and public health do we introduce, explore, and debate these values and their policy implications?
As a clinical epidemiologist focused on HIV/AIDS, I would still come down on the side of stigma consistently having a net adverse effect on most health outcomes. For this reason, the society and most health outcomes will be best served by minimizing stigma.
ReplyDeleteThe evidence for majority of human-beings making rational decisions (especially in the direction favored by society) due to fear of stigma/adverse social judgment is very limited. More consistently, there is behavioral maladjustment to stigma that ultimately magnifies the prevalence/severity of bad outcomes - whether we think of this as the number of persons affected, the amount of money society spends to bring the problem under control and whether affected persons will start and continue on treatment for a stigmatized disease.
Now, I suspect that in most cases, as conditions are destigmatized, indeed the prevalence of some/all stigmatized conditions will rise. It is debatable whether this rise reflects willingness of people to admit they have a stigmatized condition OR whether this rise is because of some members of the society indulging in behaviors that they might have avoided due to stigma. The former is due to under-reporting (and hence not a bad outcome in reality) while the latter is a situation new want to avoid. Whatever the cause, perhaps most would agree that most newly diagnosed cases in a destigmatized context would be likely be detected earlier – given public health practitioners options in terms of treatment, remediation, etc. Further, one would expect that with destigmatization, resources education and prevention/support for general population will increase. This will allow sub-groups most affected to benefit from prevention efforts and in time translate to dramatic reduction in societal costs.
In the case of severely stigmatized conditions like HIV/AIDS, Stigma is now effectively the number one killer among sub-groups highly affected by HIV/AIDS. Stigma threatens all the benefits of biomedical advances to date and directly works against the realization of an AIDS free generation.
Amara Ezeamama:
ReplyDeleteAs a clinical epidemiologist focused on HIV/AIDS, I would still come down on the side of stigma consistently having a net adverse effect on most health outcomes. For this reason, the society and most health outcomes will be best served by minimizing stigma.
The evidence for majority of human-beings making rational decisions (especially in the direction favored by society) due to fear of stigma/adverse social judgment is very limited. More consistently, there is behavioral maladjustment to stigma that ultimately magnifies the prevalence/severity of bad outcomes - whether we think of this as the number of persons affected, the amount of money society spends to bring the problem under control and whether affected persons will start and continue on treatment for a stigmatized disease.
Now, I suspect that in most cases, as conditions are destigmatized, indeed the prevalence of some/all stigmatized conditions will rise. It is debatable whether this rise reflects willingness of people to admit they have a stigmatized condition OR whether this rise is because of some members of the society indulging in behaviors that they might have avoided due to stigma. The former is due to under-reporting (and hence not a bad outcome in reality) while the latter is a situation new want to avoid. Whatever the cause, perhaps most would agree that most newly diagnosed cases in a destigmatized context would be likely be detected earlier – given public health practitioners options in terms of treatment, remediation, etc. Further, one would expect that with destigmatization, resources education and prevention/support for general population will increase. This will allow sub-groups most affected to benefit from prevention efforts and in time translate to dramatic reduction in societal costs.
In the case of severely stigmatized conditions like HIV/AIDS, Stigma is now effectively the number one killer among sub-groups highly affected by HIV/AIDS. Stigma threatens all the benefits of biomedical advances to date and directly works against the realization of an AIDS free generation.
Is stigma a double-edged sword here? Sure, removing stigma can increase the incidence and persistence of drug use, but it also prevents treatment seeking. Maybe the question here is whether we should focus on incidence only? Maybe a better question is what we can do to reduce problematic drug use without any stigmatization of such behaviors? Access, prices, proper education are all viable ways. Do we have to tread the stigma water???
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