Disadvantaging the Disadvantaged: When Public Health Policies and Practices Negatively Effect Marginalized Populations

Public health has a tradition of advocacy and research directed toward improving the health of marginalized populations, i.e. populations with poor health due to systemic social, political, and economic injustices. Research into social determinants of health, as well as global health, are but two examples of public health's concern with marginalization.

However, sometimes public health practitioners unconsciously disadvantage marginalized populations because of preexisting inequalities. For example, public health advisories during influenza outbreaks may not apply to persons who are homeless. Tips such as ‘staying home' if feeling sick and avoiding crowed places are not feasible for persons who rely on shelters. In another example, persons with schizophrenia, who suffer from stigma and discrimination, also smoke at higher rates than the general population. Despite evidence that suggests neurological and social advantages to smoking for persons with schizophrenia, psychiatric facilities ban indoor smoking to reduce second-hand smoke, without considering the negative effects on inpatient smokers with schizophrenia.

This paper argues that public health's irreconcilable differences in attitude and practice toward marginalized populations is a product of multiple reinforcing and implicit beliefs. First, some believe that certain health practices are objectively and immutably ‘good' or ‘bad' (e.g. smoking can never have benefits). Second, an assumption exists that persons can relate across different life experiences (e.g. affluent persons ‘can relate' to the economically poor). Third, during public health emergencies people accept that differences in socioeconomic status cannot be accounted for when making decisions because of time constraints.