A hospital room with three empty beds. Image by Pixabay under Pexels license.

People who cough or sneeze in public may receive disgusted glares. Addiction recovery programs are often anonymous. And many types of patients face isolation, negative stereotypes, and even verbal or physical abuse. All of these are examples of disease stigma, the negative meanings or stereotypes that we associate with a disease. Such stigmatization can lead to discrimination against people with health conditions. It can also cause people with health conditions to “self-stigmatize,” internalizing negative beliefs about themselves and their disease. Understanding how these processes work can help us create more effective ways to reduce stigma and its impact.

A recent study by Rachel Kahn Best and Alina Areseniev-Koehler aimed to understand why some diseases are more stigmatized by analyzing how different diseases were discussed in American media from 1980 to 2018. Media can reveal stereotypes that are widely recognized and publicly discussed. Even when individuals do not believe these stereotypes, they are likely aware of them and may be influenced by them. Best and Areseniev-Koehler used word embedding (a computational text analysis method) to examine 4.7 million newspaper articles and transcripts from TV and radio programs. The study considered 106 different diseases, including behavioral health conditions (addictions, eating disorders, and mental illnesses), infectious diseases (sexually transmitted infections, influenza, hepatitis, malaria, etc.), and chronic conditions (cancers, autoimmune diseases, genetic diseases, hypertension, etc.).

Previous research on disease stigma suggests that there are two main drivers of stigma: contagion avoidance and norm enforcement. Contagion avoidance happens when people, in an effort to stay healthy, avoid other people who look sick. Norm enforcement happens when a disease becomes associated with a personality trait or behavior that society views as deviant or as a violation of social norms. For example, some may view addictions as a sign of weakness and sexually transmitted infections as a sign of promiscuity. Over time, however, advocacy efforts can help to reduce both types of stigma. 

Testing out these theories, Best and Areseniev-Koehler find that behavioral health conditions generate the most judgmental language in the media, connected to discussions of immorality and negative personality traits. Among the infectious diseases, sexually transmitted infections generated the most judgment. Overall, infectious diseases were connected to meanings of disgust. These results support the idea that norm enforcement and contagion avoidance drive stigma. Best and Areseniev-Koehler also found that overall disease stigma has declined over time, but only for chronic physical illnesses. Stigma remains high for behavioral conditions and infectious diseases. 

Best and Areseniev-Koehler observed a somewhat lower stigma for diseases connected to stronger advocacy efforts. However, further research is needed to determine whether such advocacy causes a decrease in stigma.