Keep learning

Beyond Labels
beyond labels hero image


The learning and growing doesn’t stop here.

Check out these additional resources to expand your stigma knowledge and find more ways to create change.





The Health and Discrimination Framework

The health and discrimination framework figure below shows the stigmatization process as it unfolds across the socioecological health spectrum. To “underscore that all individuals can anticipate, perceive, internalize, experience, or perpetuate health-related stigma,” the framework does not distinguish between those who are “stigmatized” and the “stigmatizer” (Stangl et al., 2019, p. 4).

  • The framework begins with the drivers and facilitators of health-related stigma. Although the drivers are “inherently negative”—for example, stereotypes and prejudice—facilitators may be either positive or negative influences, such as cultural or social norms and health policy.
  • These drivers and facilitators determine whether stigma “marking” occurs. This is when stigma is “applied to people or groups according to a specific health condition or other perceived difference such as race, class, gender, sexual orientation or occupation” (Stangl et al., 2019, p. 2).
  • Stigma then manifests in a range of stigma experiences – or lived realities, which can include perceived stigma, self-stigma, and discrimination.
  • Stigma also manifests in practices, which can include beliefs (such as stereotypes), attitudes (such as prejudice), and actions (such as discrimination) toward people in a stigmatized group.
  • These types of stigma can influence outcomes for individuals within a stigmatized or affected population, including access to and acceptance of healthcare services. Stigma can also influence outcomes for organizations and institutions.
  • These population and organizational outcomes can then have health and social impacts, including affecting rates of illness and death, quality of life, and social inclusion and well-being.

This framework is useful in helping to identify when, where, and how to make changes to reduce stigma.

stangl 2019 health stigma and discrimination framework 2019

Open pdf of figure to zoom larger.

Figure Source: Stangl et al., 2019

Cooper, S., & Nielsen, S. (2017). Stigma and social support in pharmaceutical opioid treatment populations: A scoping review. International Journal of Mental Health and Addiction, 15(2), 452–469.

Corrigan, P.W., Druss, B.G., & Perlick, D.A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37–70.

Corrigan, P.W., & Nieweglowski, K. (2018). Stigma and the public health agenda for the opioid crisis in America. International Journal on Drug Policy, 59, 44–49.

Dawson, D.A., Grant, B.F., Stinson, F.S., Chou, P.S., Huang, B., & Ruan, W.J. (2005). Recovery from DSM-IV alcohol dependence: United States, 2001–2002. Addiction, 100(3), 281–292.

Hatzenbuehler, M.L., Phelan, J.C. & Link, B.G.(2013. Stigma as a fundamental cause of population health inequities. American Journal of Public Health. Am J Public Health.103:813–821. doi:10.2105/AJPH.2012.301069

Howard, H. (2015). Reducing stigma: Lessons from opioid-dependent women. Journal of Social Work Practice in the Addictions, 15(4), 418–438.

Johnson, L.A., Schrier, A.M., Swanson, M., Moye, J.P., & Ridner, S. (2019). Stigma and quality of life in patients with advance lung cancer. Oncology Nursing Forum, 46(3), 318–328. doi:10.1188/19.ONF.318-328

Kamaradova, D., Latalova, K., Prasko, J., Kubinek, R., Vrbova, K., Mainerova, B., … Tichackova, A. (2016). Connection between self-stigma, adherence to treatment, and discontinuation of medication. Patient preference and adherence, 10, 1289–1298. doi:10.2147/PPA.S99136

Latkin, C.A., Gicquelais, R.E., Clyde, C., Dayton, L., Davey-Rothwell, M., German, D., …Tobin, K. (2019). Stigma and drug use settings as correlates of self-reported, non-fatal overdose among people who use drugs in Baltimore, Maryland. International Journal of Drug Policy, 68, 86–92. doi:10.1016/j.drugpo.2019.03.012

Livingston, J.D., Milne, T., Fang, M.L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107(1), 39–50. doi: 10.1111/j.1360-0443.2011.03601.x

Mannheimer, S., Wang, L., Wilton, L., Tieu, H.V., del Rio, C. … Mayer, K.H. on behalf of the HPTN 061 Study Team. (2014). Infrequent HIV testing and late HIV diagnosis are common among a cohort of black men who have sex with men (BMSM) in six US cities. Journal of Acquired Immune Deficiency Syndrome, 67(4), 438–445. doi:10.1097/QAI.0000000000000334

National Academy of Sciences, Engineering and Medicine. (2016). Ending discrimination against people with mental and substance use disorders: The evidence for stigma change. Washington, DC: The National Academies Press.

Pescosolido, B.A. (2013). The public stigma of mental illness: What do we think; what do we know; what can we prove? Journal of Health and Social Behavior, 54(1), 1–21.

Stangl, A.L., Earnshaw, V.A., Logie, C.H., van Brakel, W., Simbayi, L.C., Barré, I., & Dovidio, J.F. (2019). The Health Stigma and Discrimination Framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine, 17, 31.

van Brakel, W.H., Cataldo, J., Grover, S., Kohrt, B.A., Nyblade, L., Stockton, M., Wouters, E., & Yang, L.H. (2019). Out of the silos: identifying cross-cutting features of health-related stigma to advance measurement and intervention. BMC Medicine, 17, 13.