The paper describes a project in which the thesis of the social determinants of health is used in order to help identify groups that will be among the least advantaged members of society, when disadvantage is understood in terms of lack of genuine opportunity for secure functioning. The analysis is derived from the author's work with Avner de-Shalit in Disadvantage (Oxford University Press, 2007).

Stigma has become an important concept in public health law. It is widely accepted that certain diseases are disfavored in society, leading to discrimination against people identified with them, which in turn has the tendency to drive an epidemic underground—i.e., to make it more difficult for voluntary public health programs to reach and succeed among populations bent on concealing their disease or risk status. The need to reduce stigma and its effects has been used to justify the passage of privacy (...) and antidiscrimination law to protect people with HIV. More recently, stigma has been part of the arsenal of justification for special genetic antidiscrimination and privacy law. Despite its importance, however, there is no single widely accepted definition of stigma in social science, and its relationship to law has been generally under-theorized and unsupported by data, reducing our ability to effectively deploy law and other tools in the anti-stigma cause. (shrink)

Recent research in epidemiology has identified a number of factors beyond access to medical care that contribute to health disparities. Among the so-called socioeconomic determinants of health are income, education, and the distribution of social capital. One factor that has been overlooked in this discussion is the effect that stigmatization can have on health. In this paper, I identify two ways that social stigma can create health disparities: directly by impacting health-care seeking behaviour and indirectly through the internalization of negative (...) interpersonal judgments. I then argue that social arrangements that foster self-respect can reduce the impact of stigmatization on health disparities. I conclude by showing how John Rawls' conception of justice can be used to address the intersection of stigma, health, and self-respect, in contrast to critics of his position, who have seen him as excessively focused on the allocation of material goods. (shrink)

Stigma has become an important concept in public health law. It is widely accepted that certain diseases are disfavored in society, leading to discrimination against people identified with them, which in turn has the tendency to drive an epidemic underground—i.e., to make it more difficult for voluntary public health programs to reach and succeed among populations bent on concealing their disease or risk status. The need to reduce stigma and its effects has been used to justify the passage of privacy (...) and antidiscrimination law to protect people with HIV. More recently, stigma has been part of the arsenal of justification for special genetic antidiscrimination and privacy law. Despite its importance, however, there is no single widely accepted definition of stigma in social science, and its relationship to law has been generally under-theorized and unsupported by data, reducing our ability to effectively deploy law and other tools in the anti-stigma cause. (shrink)

The point of departure for this essay is the question of why pain is seriously undertreated in the United States. Some kinds of pain (for example, chronic nonmalignant pain) are treated worse than others (acute pain secondary to cancer), but there is excellent evidence that no matter what kind of pain, astonishingly large percentages of pain sufferers are undertreated (Furrow 2001; Hill 1995; Kirou-Mauro et al. 2009; Martino 1998; Morris 1991; NCHS 2006; Resnik, Rehm, and Minard 2001). Although some kinds (...) of pain are difficult to treat, we generally possess the technical armamentarium to significantly ameliorate the vast majority of pain experiences. Yet we do not. And, for as long as anyone in the United States .. (shrink)