The Return of Blaming and Shaming in Public Health

But if stigma individualizes responsibility, much of anti-stigma work to date has made a mirror-like mistake, addressing the problem at the individual level, Dr. Hatzenbuehler said. In general, this work has treated prejudice as something lodged inside a person’s mind, even though stigma is socially and culturally inculcated. “You’re pulled into a training and told that you personally are responsible, or this is a moral failing, when, in fact, this is water that you’ve been swimming in,” said Betsy Paluck, a psychologist at Princeton University.

In a 2021 review of more than 400 experiments to reduce prejudice, Dr. Paluck found that, on average, they had little effect. Most approaches were “light touch,” like brief trainings, videos and perspective-taking exercises, and the largest, most robust ones reduced prejudice by just four points on a 100-point scale. “It’s not going to result in a noticeable behavioral change,” Dr. Paluck said, adding, “our solution has not fit the problem.” In fact, when anti-stigma interventions treat prejudice as a personal defect rather than a social pattern, invoking guilt or shame, they can backfire, increasing bias compared with doing nothing at all.

The alternative is to move from instruction to infrastructure. With H.I.V., for example, advocates and public health officials changed the meaning of the disease, transforming it from a death sentence into a condition managed with medication, and pushing legal and policy changes that improved access to care and reduced discrimination, Dr. Yang said.

Obesity has not seen the same move from attitudes to rules. In almost every state, for example, you can be denied work or fired because of your weight, aside from Michigan, which has banned weight discrimination, and Washington, which protects obesity under disability law. Anti-stigma work shouldn’t just ask people to be kinder but change the laws and institutional practices that keep stigma in place, Dr. Puhl said.

Similarly, it should change where the blame lands. Researchers found that antismoking messages focused on industry deception — like how Big Tobacco targets teens or manipulates the public — were some of the most effective at reducing cigarette consumption.