Stigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the “stigma system” as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.

中文翻译：

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污名制度：社会政治统治、替罪羊和污名如何影响公共卫生


耻辱是不良健康结果的根本驱动因素。尽管耻辱通常在个人层面进行研究，重点关注耻辱如何影响被耻辱者的身心健康，但大量研究表明，耻辱是多层次和结构性的。本文提出了一种理论方法，综合了关于耻辱的文献和关于替罪羊和分而治之的文献，作​​为富人和强者用来维持其权力和财富的策略；关于种族、性别和其他从属地位的文献；有关社会政治体系中的意识形态和组织的文献；以及关于抵抗和反抗耻辱、压迫和其他形式的从属地位的文献。我们开发了一个“耻辱系统”模型，作为相互作用和冲突的结构和过程的辩证法。了解这一系统可以帮助公共卫生重新调整污名干预措施，以解决污名的根源以及污名造成的个人问题。在更广泛的层面上，该模型可以帮助那些反对耻辱及其影响的人建立联盟和战略，以反对耻辱及其产生的过程。