Stigma as a Public Health Tool: Implications for health promotion and citizen involvement

Stigma is a social mechanism by which individuals and groups are discredited; it reduces social status and creates ‘spoiled identities’ (Goffman, 1963). Stigma can operate at an individual and structural level; and be imposed externally or be self-perceived by individuals who apply negative stereotypes to themselves (Link & Phelan, 2001). In the field of substance use, debates around stigma tend to be divided between studies which assess the harms that stigma carries for health and identity, and an alternative body of work that ‘views stigma more benignly, as a form of social control’ (Room, 2005). We argue that if, as the second body of literature suggests, stigmatising measures are adopted widely in the substance use field their deleterious impact risks exacerbating substance use problems, particularly amongst the least well off. Furthermore, the strategy may impede the commitment to empowerment which has been fundamental to health promotion since the publication of the Ottawa Charter in 1986.