The impact of stigma and discrimination

Discrimination and stigma are unfortunately common experiences within healthcare settings.

In the United States, one in five adults over the age of 50 have experienced racial discrimination in healthcare settings (Rogers et al., 2015). Over half of U.S. health professionals also describe racial discrimination as a major problem or crisis facing the healthcare system – see Figure 3. Nursing care is most effective when providers embrace each person’s individuality, including their culture, race/ethnicity, gender and personal attributes (Méndez-Fernández et al., 2022; Rogers et al., 2015). Yet, discrimination and stigma may prevent the development of culturally-safe and patient-centred nursing care (Minton et al., 2022).

When asked the question: “In health care, how big of an issue do you think racism or discrimination based on race or ethnicity against patients is?”, over half of healthcare workers in the United States said racism facing patients was a major problem or crisis.

When working with vulnerable or marginalized populations, have you ever noticed barriers to building trust and rapport?
There are many sources of discrimination and stigma within care settings. For example, Puhl et al. (2008) found that weight discrimination was as prevalent as racial discrimination in the United States. Approximately 40% of adults with a Body Mass Index (BMI) of 35 kg/m² or above experienced weight discrimination across a variety of settings (Puhl et al., 2008). In turn, negative attitudes or stereotypes about people living with obesity shapes clinical interactions during care (Phelan et al., 2015).
Don’t patients just ‘move on’ from isolated incidents of discrimination in care?
Some patients are quite resilient and thrive despite experiencing discrimination within healthcare environments; however, we must consider how that experience will impact future emotions and behaviour. Let’s use the example of weight bias.
In this case, experiencing weight discrimination at a community clinic may motivate future avoidance of care and ongoing mistrust while interacting with health professionals (Phelan et al., 2015). Weight discrimination may continue to affect the patient throughout their care, meaning over providers may not know about their prior experiences.
Negative attitudes and social judgements tend negatively affect the quality of care that patients receive across a variety of settings (Cacciatore et al., 2015; DeVoe et al., 2009; Kaplan Serin & Tülüce, 2021; Mirete et al., 2022; Phelan et al., 2015). Independent of race and weight, younger and more socio-economically disadvantaged patients generally report lower levels of trust and rapport following communication with health professionals (Ahmadpour et al., 2020; DeVoe et al., 2009).
On the other hand, challenging provider biases improves both provider attitudes (Dincer & Inangil, 2022) and the quality of care (Cacciatore et al., 2015).