Beyond HIV/AIDS: Ameliorating Chronic Disease Stigma in U.S. Public Health Law

The central claim of this paper is that understanding how U.S. public health law fuels chronic disease stigma is crucial to ameliorating its inequitable burden.  Stigma is a travesty both because it is independently correlated with adverse health and because it is intolerable in a just social order.  Fortunately, there is increasing recognition that disease stigma is an important determinant of population health and that law is a principal pathway through which such stigma flows.  However, the vast majority of legal and policy analyses of disease stigma have emphasized sexually-transmitted disease and HIV/AIDS in particular.  Yet, significant evidence suggests that chronic disease stigma is both widespread and is mediated by public health laws.  Drawing on Burris’s influential taxonomy of disease stigma and public health law (2002), the present paper – targeted at an expert audience – argues that chronic disease stigma in the U.S. is hegemonic, which means that it is more likely to be accepted as natural and even to be invisible since it so tightly reflects dominant social norms.  The paper evaluates how a variety of laws and policies reflect, sustain and fuel stigma in two specific disease paradigms – chronic pain and type II diabetes – and applies Powers and Faden’s health sufficiency model of social justice to show that such stigma and its inequitable distribution is ethically unacceptable.  The paper concludes by offering recommendations regarding evidence-based anti-stigma mechanisms in public health law and policy that could alleviate pain and type II diabetes stigma respectively.