Health Related Stigmas
- Language MattersA guide to using respectful language in relation to sexual health, substance use, STBBIs and intersecting sources of stigma.
- Sexually Transmitted and Blood-borne Infections and Related StigmaResources and materials designed to help build capacity of health and social service organizations to implement stigma reduction training and interventions
- Resources to address stigma related to sexuality, substance use and sexually transmitted and blood-borne infectionsThese knowledge translation resources and training workshops represent a comprehensive set of tools developed in Canada that service providers can use to help reduce stigma when caring for clients/patients with STBBIs and related conditions.
- Infectious Disease Information for Health ProfessionalsThe control of communicable diseases in Toronto can only be achieved through a strong partnership between public health and community-based health care providers and institutions such as hospitals and long-term care homes.
- Social Stigma Surrounding Chronic IllnessHealth-related stigma has been a continually complex issue that forms the basis of adversities that many with chronic illness face. In particular, patients with chronic illnesses (e.g. diabetes, inflammatory bowel disease, asthma, etc.) are subjected to stigmas that consequently decrease their quality of life and prevent proper medical treatment. Marginalization of those with chronic illnesses often goes overlooked in society, furthering the misguided perceptions established in settings like workplaces and schools.
- Why Disease Names MatterA comment on the importance of language.
- From Leprosy to COVID-19, How Stigma Makes it Harder to Fight EpidemicsPast epidemics reveal how social stigma amplifies the dangers of infectious disease.
- Anti-Asian racism during coronavirus: How the language of disease produces hate and violenceSelf-isolation. Quaratine. Lockdown. The outbreak of COVID-19 and its subsequent dissemination across the globe has left a shock wave of disbelief and confusion in many countries. Accompanying this wave has been a spike in racist terms, memes and news articles targeting Asian communities in North America.
- As monkeypox spreads, know the difference between warning and stigmatizing peopleWhen the World Health Organization declared monkeypox a public health emergency over the weekend, it also warned of another threat to society: "Stigma and discrimination can be as dangerous as any virus," said WHO Director-general Tedros Adhanom Ghebreyesus.
Weight Bias in Health Care
- Weight Bias in Health CareThe focus of this guide is to educate healthcare providers on the impact of weight bias in a clinical setting. The guide also educates healthcare providers on the use of appropriate language when discussing weight with patients, and much more.
- Listen… and Speak: A Discussion of Weight Bias, its Intersections with Homophobia, Racism, and Misogyny, and Their Impacts on HealthThis article is a version of the Ryley–Jeffs Memorial Lecture, delivered on 8 June 2018. It discusses weight bias and the intersections with homophobia, racism, and misogyny, and how these impact health.
- Racial and weight discrimination associations with pain intensity and pain interference in an ethnically diverse sample of adults with obesityEveryday experiences with racial (RD) and weight discrimination (WD) are risk factors for chronic pain in ethnically diverse adults with obesity.
- Weight Stigma and Gender: Common Issues and DifferencesIs the experience of weight bias and stigma distinctly different depending on your gender?
- Obesity bias among preclinical and clinical chiropractic students and faculty at an integrative health care institution: A cross-sectional studyThe purpose of this study was to assess the prevalence of obesity bias among preclinical and clinical chiropractic students and faculty at an integrative health care academic institution.
- Reducing Stigma Toward Black Women Who Vary in Body SizeBlack women are at an increased risk for a variety of physical health outcomes. One out of four middle-aged Black women has diabetes and rates of death from heart disease and stroke are twice as high among Black people than White people. Obesity is a compounding problem to add to this list of health issues that disproportionately affect Black women. Eighty-two percent of Black women are classified as obese. And this disparity starts at an early age—21 percent of young girls are classified as obese compared to fifteen percent of White girls.
- Practical Approaches to Treating Obesity: Patient and Healthcare Professional PerspectivesIn this paper, guidance on how to raise and address the subject of weight with individuals is provided from an healthcare professionals and patient perspective using the 5As framework.
- Resources for Healthcare Providers to Combat Weight BiasThe Rudd Center has developed free, online educational resources for health care providers to help improve the quality of care for patients with obesity and reduce weight bias in clinical practice.
- Resources for Clinical CareResources for Clinical practice, education and training from Obesity Canada.
- Accommodating patients with obesity and mobility difficulties: Observations from physiciansGiven the growing population of U.S. adults with obesity and mobility disability, physicians will need to accommodate these patients. This study explores attitudes and practices of US physicians related to caring for patients with obesity and mobility disability.
People With Eating Disorders
- Tackling the stigma of eating disorders in men and boysDespite the scale of the problem, resources to treat eating disorders are scarce. There are very few specialised treatment centres. People affected are often young and vulnerable, and may avoid detection. However, the earlier a disorder can be diagnosed, the better the likely outcome for the patient.
- Barriers to CareVital access to treatment and recovery can be hampered by a limited availability of care or lack of care in remote areas, by stigma, poor professional skills and poor understanding of the pathways to care.
- Resources from the National Eating Disorder Information CenterFind online articles, brochures, links to websites, and videos or webinars.
Age and Ageism
- When It Comes to Older Adults, Language Matters: Journal of the American Geriatrics Society Adopts Modified American Medical Association StyleThe AMA style guide provides its own guidance on terms NOT to use when describing older people, reinforcing that words like (the) aged, elder(s), (the) elderly, and seniors should not be used. This is because such terms connote discrimination and certain negative stereotypes that may undercut research-based recommendations for better serving our needs as we age.
- Bias Free Language: AgeGuidelines for talking about age with inclusivity and respect.
- Research shows age missing from diversity & inclusion discussionResearch shows that age is often missing in the diversity and inclusion conversation. Yet our unconscious biases, thoughts, feelings and actions about aging have direct consequences for young and old alike.
- What is ageism, and how does it affect health?Ageism is prejudice or discrimination against people based on their age. It typically applies to people who are older but can also affect young people. Ageism has a negative impact on physical and mental health, and reports link it with earlier death.
- Experiences of Everyday Ageism and the Health of Older US AdultsMajor incidents of ageism have been shown to be associated with poorer health and well-being among older adults. Less is known about routine types of age-based discrimination, prejudice, and stereotyping that older adults encounter in their day-to-day lives, known as everyday ageism.
- “Kids these days”: Why youth-directed ageism is an issue for everyoneAs we become an increasingly aged society, it is important to understand how stereotypes and bias against both younger and older age groups functions and leads to fractures in intergenerational relationships. Ageism against older adults is often the focus of research on consequences of age-bias on the individual and structural level. As pointed out by researchers Francioli and North, a lesser studied component of ageism is age-bias against younger adults.
- Ageism: a social determinant of health that has come of ageA comment on the WHO Global Report on Ageism.
- Age-Friendly Health Care: A New ApproachCould health care focus on your personal preferences and health goals as you age, not just what your doctor thinks is best for you or your test results? AFHS recommends that doctors and nurses plan care for older adults based on what they or their caregivers value most. Every medical visit or decision should cover the 4Ms, four building blocks of high-quality care.
- Age-Friendly Health Care: A Systematic ReviewHealth care provided to older adults must take into account the characteristics of chronic diseases and the comorbidities resulting from ageing. However, health services are still too oriented towards acute situations. To overcome this problem, the World Health Organization (WHO) proposed a set of Age-Friendly Principles that seek to optimize the provision of health care for this population. This article aims to understand how such Principles are considered in the implementation of age-friendly health care worldwide.
Other Resources
- Laboratory for Culture and Mental Health DisparitiesThe mission of the Laboratory for Culture and Mental Health Disparities (CMHD) is to promote mental health and wellness in historically underserved groups through behavioral science, education, and service.
- Addressing Stigma: Towards a More inclusive Health Systemo A summary of the overall health of Canadians, including how stigma is one of the reasons for poor health in certain populations and guidelines to reduce bias and stigma in healthcare.
- Trauma- and Violence- Informed Care ToolkitTrauma- and violence-informed care (TVIC) is a framework that can reduce barriers to accessing health and social services and promote more caring, compassionate, person-centered and non-judgmental care. This Toolkit will help individuals and organizations apply the principles of TVIC and monitor and evaluate their progress.
- Helpful ResourcesSociety of Refugee Healthcare Providers.
Webinars
- The Impacts of Ageism on Canadian SocietyDr. Holroyd-Leduc discusses some of the issues that Canada will face as our population continues to age. She highlights how ageism in Canadian society is hindering our ability to prepare for these changes and impacts.
- Immigrant and Refugee HealthSession 5 of Epidemics of Injustice from the Collaboratory for Health Justice.
Articles
- Physician Use of Stigmatizing Language in Patient Medical RecordsNegative attitudes toward patients can adversely impact health care quality and contribute to health disparities. Stigmatizing language written in a patient’s medical record can perpetuate negative attitudes and influence decision-making of clinicians subsequently caring for that patient.
- Speaking on Stigma in Our Systems – How Can we Make Change?A comment on stigmatization in the healthcare system.
Communication and Interpersonal Skills
- Broaching Sensitive TopicsDiscussing sensitive topics is a difficult yet integral part of the clinician's role. Several basic principles can guide the approach to these discussions, the most important of which is to be nonjudgmental and practice acceptance.
- Motivational InterviewingClinicians often need to discuss behavior change with patients to optimize health or treat illness. Using three key aspects of the motivational interviewing technique--ask, listen, and inform--clinicians help patients discover their own reasons for wanting to make behavior changes and improve their health.
- Empathetic ResponseThe clinician's use of empathic responses is vital to establishing rapport with the patient and contributes to patient healing.
- Empowering the PatientIt is key for the clinician to establish a clinician–patient relationship that promotes partnership and builds trust, empowering the patient.
- Use of Non-Stigmatizing LanguageThe clinician's use of non-stigmatizing language reflects the patient's full identity, and acknowledges the patient's capacity to change and grow, by avoiding words or phrases that could be perceived by the patient as dehumanizing, that perpetuate stigma, and that marginalize rather than support.
- Rapport: Older AdultsWhether the clinician is interviewing the older adult patient in an office, hospital, or nursing home, adjusting the physical environment and the interviewing approach to put the patient at ease will result in better communication and more effective medical treatment.
- Working with Medical InterpretersThe key to the patient interview is getting as full a story from the patient as possible, even when the patient and clinician speak different languages. When working with a medical interpreter, the clinican should outline their specific goals for the interview. The ideal interpreter is a "cultural navigator" who is neutral but trained in both languages and cultures and can help the clinician obtain relevant patient information that might otherwise be missed.
- Responding to Emotional CuesExperiencing illness can cause emotional distress, and clinicians can learn more about a patient's health concern by picking up on and responding to emotional cues the patient might exhibit. Using the techniques summarized in the NURSE mnemonic, clinicians can convey their support for the patient in distress and explore their health problems more fully.
PEN: The Global Resource for Nutrition and Practice
- Food InsecurityFind practice questions, recommendations, evidence, tools and resources about food insecurity that will be useful to new practitioners or will serve as a refresher for more experienced health professionals.
- Weight and ObesityFind practice questions, recommendations, evidence, tools and resources about weight and obesity that will be useful to new practitioners or will serve as a refresher for more experienced health professionals.
People Experiencing Homelessness
- Language Matters: Let's Talk About HousingInfographic: Using person-first language when discussing housing.
- Myths and Questions About HomelessnessThere are many myths and stereotypes that people believe about homelessness. This misinformation is problematic, as it further contributes to the stigmatization of a population that is already marginalized. In order to appropriately tackle the issue of homelessness and create a society where individuals feel comfortable accessing supports, these myths must be deconstructed and understood to be false by the general public.
- Racialized Poverty in Housing and HomelessnessHow are racialized people disadvantaged in housing and homelessness?
- Transitioning from Child Welfare to Homelessness (Video)Adrianna discusses the “eternity of death” that is settler colonialism. From the child welfare system, homelessness to premature death, she is candid and poised in her description of state-sanctioned violence and the intergenerational trauma that has come to define her life as a Two-Spirit Indigenous person.
- Homelessness: cause and effectsIn today's world, wealth accumulates in ever fewer hands. People who live at the margin of the socioeconomic system and are infirm are most prone to become homeless. Many medical and psychiatric problems beset this population. Among them, rheumatic and musculoskeletal diseases are, at the same time, illnesses and barriers to care. Healthcare innovations may decrease the lot of these unfortunate. To correct the root of the problem, we should also set our moral compass to a more egalitarian society.
- Musculoskeletal Injuries and Conditions Among Homeless PatientsThis study analyzed existing literature on musculoskeletal diseases that homeless populations face and provides recommendations on improving musculoskeletal outcomes for homeless individuals.
- Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experienceProviders can improve the health of people who are homeless or vulnerably housed, most powerfully by following evidence-based initial steps, and working with communities and adopting anti-oppressive practices.
Refugees and Immigrants
- Talking About Refugees and Immigrants: Glossary of Refugee TermsMany different terms are used to describe refugees and immigrants, some with particular legal meanings, some with offensive associations. Using terms properly is an important way of treating people with respect and advancing an informed debate on the issues.
- Healthy Immigrant Effect: An OverviewStudies show that there is a healthy immigrant effect; persons who choose to migrate have better health than the native population, but there is a deterioration of health status the longer they reside in the host country.
- Improving the assessment and treatment of pain in torture survivorsAmong torture survivors who present to clinicians, the prevalence of chronic pain appears to be very high. However, the prevalence has not been estimated with any reliability in unselected groups of non-clinical refugees. The most common reported sites of pain are the head, back, musculoskeletal system and limbs; pelvic and urogenital pain are very probably underreported.
- Work-related musculoskeletal risk among refugees: recommendations for improvement to promote health and well-beingRefugees fall under the umbrella term of immigrants. Whereas immigrants chose to leave their host country for positive reasons, refugees are pushed out due to war and fear of persecution. The work they pursue does not align with their education and experience and oftentimes leaves them vulnerable to increased health and safety hazards causing musculoskeletal disorders (MSDs).
- Pain in persons who are marginalized by social conditionsThis study addresses the challenges of providing access to pain management for people who have been socially and economically marginalized and emphasizes the need for care at the intersection of 2 bodies of knowledge: the broad biopsychosocial model of health, given that social determinants of pain are of conspicuous importance in these populations, and the growing understanding of the intersections between trauma, violence, substance use, and pain.
- Managing chronic pain in survivors of tortureAll generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. They have many health, social and welfare problems; persistent pain in the musculoskeletal system is one of the most common.
- Levelling the playing field: How a trauma-informed approach can make physical activity more accessibleThe COVID-19 pandemic resulted in decreased levels of physical activity, which has implications for physical and mental health. Physical activity can also be an important tool for recovery from the collective trauma experienced and exacerbated throughout the pandemic, especially for equity-seeking communities.
Domestic and Intimate Partner Violence
- The Language We UseIn the domestic violence service field, there are many different ways to describe relationship violence. Throughout this site you will see an interchanging of “domestic violence” and “intimate partner violence.” What’s the difference and why do we use both phrases?
- Domestic ViolenceThis activity describes the evaluation, reporting, and management strategies for victims of domestic abuse and stresses the role of team-based interprofessional care for these victims.
- Health care practitioners’ responsibility to address intimate partner violence related to the COVID-19 pandemicRates of intimate partner violence (IPV) have increased and will remain an important health care concern as a result of the economic impact of the pandemic and the social distancing measures required to limit the health system burden of coronavirus disease 2019.
- Male Patients Report Greater Need in Screening for Intimate Partner ViolenceOne in 4 men are victims of intimate partner violence (IPV) and 1 in 5 report being perpetrators of violence, according to the results of an online survey published in Annals of Family Medicine. However, only 1 in 10 men said that their primary care provider asked about their history with IPV during well visits.
- Intimate Partner Violence, Sexual Violence, and Stalking Among MenUnderstanding Violence Against Men
- Elder Abuse and its PreventionUnderstanding elder abuse, the role of cultural factors and the evidence base for its detection and prevention.
- How to AskScreening for domestic abouse.
- What Are the Power and Control Wheels?A comprehensive guide to the many versions of this helpful illustration that outlines tactics abusers use.
- Tools, guidance, and promising practices to help you prevent and respond to family violenceOnline content is aimed at health care and social service providers, including students and those in practice.
Open Access eJournals
- The Lancet: HomelessnessThe Series highlights that being homeless is not only bad for physical and mental health, but also has dramatic effects on life expectancy.
- The Lancet: AgeingThis Series on Ageing highlights a neglected area in the health sector and in social and economic-policy development.
Podcasts
Have you ever wondered what mathematical modelling can teach us about how and why HIV and sexually transmitted infections spread in various geographical areas? Or why it's important to engage the public when discussing research priorities? What about the serious implications of stigma and the language associated with it? In this episode of Raw Talk, Alex sits down with infectious disease clinician and scientist, Dr. Sharmistha Mishra to discuss the magic of mathematics, vulnerability and stigma, and what it really means to do community-centered research.- Homelessness remains a persistent, societal and human rights issue that affects over 250,000 Canadians. The challenges go beyond just finding a place to live – those who are homeless or vulnerably housed have higher incidences of chronic mental and physical health problems and often face stigma while navigating the healthcare system. On this episode, we heard from different voices at the intersection of homelessness and health.
- Tuberculosis (TB) is a bacterial infectious disease that affects millions of people globally every year. Despite being one of the oldest infectious diseases in humans, control of the epidemic through treatment and vaccination has remained out of reach. Learn about what makes TB so difficult to control, from immunology to stigma.
- Weight Stigma 101 with Rebecca Pearl
People who experience weight discrimination are more likely to gain more weight over time than people with obesity who don’t describe these kinds of experiences. Weight bias, stigma and discrimination have received more and more attention among researchers, but also in the public. Think, for example, of the term “fat shaming.” Among the researchers doing path-breaking work in this area is Dr. Rebecca Pearl at the Perlman School of Medicine. Her research focuses on weight bias and its associated outcomes in patients with obesity. - Obesity: shifting to a patient-centred approach to management
Dr. Sean Wharton and Dr. David Lau discuss a newly published clinical practice guideline on obesity management. They are joined by Lisa Schaffer, who talks about her experience as a Canadian living with obesity. They discuss the complex interplay of factors that can lead to obesity, such as genetics, metabolic, behavioural, psychological and environmental factors. They also talk about stigma and its negative impact on health independent of other factors. 
This podcast aims to seek and share insight about Indigenous addictions and mental health issues. It takes a fearless approach to exploring the tough issues with some of the leading voices in Indigenous wellness.
