Rethinking Anti-Stigma Approaches

Stigma often personalizes responsibility, but much of the anti-stigma efforts have mirrored this mistake by focusing mainly on individuals, as noted by Dr. Hatzenbuehler. Typically, these efforts frame prejudice as an internal issue, disregarding the fact that stigma is deeply rooted in social and cultural contexts. Betsy Paluck, a psychologist at Princeton University, highlighted that people commonly undergo training that implies they are solely responsible for stigma, or that it reflects a moral weakness, while in reality, they are immersed in a societal issue.

In a 2021 review, Dr. Paluck analyzed over 400 studies aimed at reducing prejudice and found that, on average, these interventions had minimal impact. Many methods used were quite superficial—think brief training sessions, videos, and exercises designed for perspective-taking. The most effective methods only decreased prejudice by about four points on a 100-point scale. “It’s just not enough to create real change,” Dr. Paluck commented, adding that when interventions treat prejudice as a personal flaw rather than a societal issue, they might even exacerbate biases instead of alleviating them.

One potential solution is shifting focus from individual education to systemic change. For instance, in the case of H.I.V., advocates and public health leaders reframed the condition from a fatal diagnosis to a manageable illness through medication, coupled with legal shifts that improved access to healthcare and diminished discrimination, according to Dr. Yang.

On the other hand, the conversation around obesity hasn’t transitioned similarly. In almost every state, individuals can be discriminated against in hiring or fired due to their weight. Michigan is an exception, having banned weight discrimination, while Washington provides protections under disability law. Dr. Puhl argues that anti-stigma initiatives shouldn’t just encourage personal kindness but should also advocate for changing the laws and institutional practices that perpetuate stigma.

Moreover, blame needs to be reassigned in the conversation. Research suggests that antismoking campaigns focusing on the deceptive practices of the tobacco industry—like targeting young people or manipulating public perception—have proven to be among the most effective at reducing smoking rates.