Public Health and the Public Psyche: Taking Stigma of Disease into Account

In the 1950’s the cause of cancer was not yet well understood, and while statisticians had correlated cancer of the lung with smoking, a direct causative effect was not yet established. This week’s readings discuss the controversy surrounding smoking and a meta-issue that arises as a result of public health, stigmatization.

There has been a long history of stigmatization in public health. The poor, the foreign-born, and ethnic and racial minorities have all been the subject of scrutiny because of the negative connotations associated with them in terms of public health. In “Epidemiology in the United States after World War II: The Evolution of Technique”, Susser states that the obligation of epidemiologists is to “cultivate awareness and to see that what is learned is not misused”. While cancer of the lung was correlated with smoking, there was no concrete proof that tobacco smoke contributed to the development of carcinoma. Conflict and controversy erupted and in turn, public health interventions centered around denormalization and stigmatization instead to reduce smoking.

In “Smoking and Cancer of the Lung”, Berkson suggests that the controversy over linking smoking to cancer of the lung has the effect of an advertising campaign, and the tobacco companies benefited from the publicity. Here, Berkson argues that the publicity has not advanced public health and the larger danger lies in inciting “an epidemic of cancerphobia and causing neuroses in people who continue to smoke”.

In the Bayer paper “Tobacco Control, Stigma, and Public Health: Rethinking the Relations”, the author introduces the idea of stigmatization in the context of public health. With the AIDS epidemic, the stigma attached to AIDS worked to buttress the “social subordination of those who were already marginalized”. The stigma associated with AIDS also had a large effect on those with the disease, their loved ones, and affected their decisions about seeking assistance. Bayer compares this to the stigma attached to smoking and asks whether the stigmatization of smokers is justified despite the risk of “exacerbating already extant social disparities or having long-term counterproductive consequences. “

In “Nowhere Left to Hide? The Banishment of Smoking from Public Spaces”, Colgrove discusses the denormalization of smoking and its effect on the mental and physical health of smokers. Colgrove argues that measures to restrict smoking are paternalistic and overly restrictive and instead suggests that the central question in reducing rates of smoking should be “how far we want to go in reducing individual autonomy, including what can be perceived as self-destructive behavior.”

Denormalization of smoking has become the central prong of antitobacco efforts and while public health is largely concerned with minimizing actions that can have a detrimental effect, we must be aware that the same measures used to protect, can unintentionally cause harm as well.

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