The public health consequences of stigma-based interventions

ASU anthropologists advise some global health strategies have invisible and serious costs

November 8, 2019

Judging others is a very human behavior. Stigma — treating people with specific traits as unwanted within society — is a particularly harmful manifestation of that. Feeling stigmatized is extremely painful, but it also creates barriers to health care.

Anthropologists and Arizona State University President’s Professors Alexandra Brewis Slade and Amber Wutich have spent decades studying stigma. They argue that current methods in public health policy can actually amplify or create troublesome offshoots of the problems they are meant to help solve, particularly for those in the most vulnerable groups. An image of a person sitting alone on a bench at sunset Download Full Image

These findings are distilled in a new book released this month: “Lazy, Crazy, and Disgusting: Stigma and the Undoing of Global Health.” Based on Brewis Slade and Wutich’s combined decades of fieldwork experience around the globe, it tackles what happens when interventions go sour because of stigma and addresses three of the most concerning and complicated areas of current public health focus — sanitation, mental illness and obesity.

This team long has worked together on research, and also as administrators. Brewis Slade founded the Center for Global Health in 2008 at ASU’s School of Human Evolution and Social Change, and Wutich is the center’s current director.

ASU President’s Professor Alexandra Brewis SladeAlexandra Brewis Slade  

Question: What got you interested in studying the science behind stigma and its direct impact on individuals?

Alexandra Brewis Slade: We have both long had a research focus on understanding how social norms and institutions act to push some people down and out of society. I started my career working on women’s struggles with infertility in Micronesia, and early in her career Amber was working in Bolivia on how people cope with water scarcity. More recently, we’ve been working together devising projects to understand what it means to live with high body weight. These strands are all ultimately about the causes and consequences of stigma for people in their everyday lives, a theme that ties our work together.

Q: How do you define stigma for the purposes of your studies, and has that understanding changed or evolved over time?

ASU President’s Professor Amber WutichAmber Wutich  

Amber Wutich: Much of what we know about the effects of stigma was gleaned using anthropological methods like ethnography — by listening to people in their own terms and trying to understand the world as they see it. Stigmas are always changing, since what is stigmatized is a reflection of what is treated as unwanted or disgusting in a particular social context.

ABS: Leprosy was once an incredibly stigmatized disease in medieval Europe because it was associated with sin against God. As ideas changed throughout the middle ages, and people saw those with leprosy as being closer to God, stigma toward the disease reduced. Similarly, we see a lot of rising stigma around obesity and large bodies, a relatively recent phenomenon that seems related to neoliberal ideas of individualism. These ideas are often reproduced in the media, including in public health messaging.

Q: What are some of the ways that stigma collectively shapes the ideas, beliefs, policies or institutional structures of communities or entire countries?

ABS: In our varied fieldwork, we’ve learned that people everywhere tend to connect specific reactions with not just behaviors but also with the people associated with those behaviors. This can happen even where health messages are trying to help.

For example, smoking rates have rapidly decreased in high-income countries as an effect of stigmatizing campaigns that made smoking — and smokers — socially unacceptable. The highest smoking rates are now seen in the most vulnerable groups — the young, the less educated, and those living with mental illness. This reinforces the stigma and means that people who do smoke and become ill are often treated with a lack of empathy both within and outside of health care systems.

AW: Another example is the community-led approaches to total sanitation first introduced in the 1990s in South Asia. The basic UNICEF manual for creating open-defecation-free (ODF) communities relies on using disgust to change hygiene behaviors and social shaming to maintain the new hygiene behaviors. This worked well at first. Lots of people built toilets. But once norms there shifted, families who could not afford household toilets became subjected to highly damaging forms of social rejection.

Q: Why did you focus on these three prominent issues in the book: bringing sanitation to all, treating mental illness and preventing obesity?

AW: We chose these particular issues exactly because they are the most complicated and intractable of them all. Sanitation remains at the center of the global health agenda because — despite decades of focused work — many people globally do not have basic sanitation. Public health workers know mental illness is greatly worsened by stigma and worked hard to remove it, yet it persists.

ABS: And anti-obesity efforts globally have yet to yield any real “success” stories. We suspect part of the reason is related to the latent stigma that the anti-obesity efforts carry with them.

Q: What do you hope readers take away from the book?

AW: The book isn’t just for those working in public health. Our hope is that readers from all backgrounds are better able to recognize stigma in their daily lives. We are all part of its production, and most of us are targeted by it. Awareness and empathy seems to be what best undermines the power of stigma to harm.

Q: What other innovations do you hope for regarding social stigma and health policy in the next 10 years?

ABS: One of our biggest concerns we address in the book is the ideas of a “sweet spot” where you can apply just the right amount of stigma to encourage desirable action, without doing damage. Our observations as anthropologists suggest that — in reality — this is incredibly hard to do, especially among groups that are more vulnerable. Almost all seem to miss the target. This is why we are suggesting that stigma should never be deployed as a tool in any behavior change interventions, most especially when the groups being targeted are not those with political or economic power.

Honoring STAR engineers and supporters

November 8, 2019

The 2019 Society of Hispanic Professional Engineers national convention gathered more than 9,000 STEM students, professionals and supporters together in Phoenix, Oct. 30–Nov. 3, to engage, educate and advance the careers of Hispanics in STEM.

Each year, the society gathers to honor the best and brightest among its members with the SHPE Technical Achievement Recognition, or STAR, Awards at its annual national convention. STAR Award recipients (from left to right) Carrie Robinson, Robert Anchondo and Erick Ponce were joined on stage by James Collofello (center), vice dean of academic and student affairs in the Ira A. Fulton Schools of Engineering and ASU student Miguel Cuen (right), a Society of Hispanic Professional Engineers National Undergraduate Representative, during the SHPE STAR Awards Gala. Photo by Erika Gronek/ASU Download Full Image

Three of this year’s STAR Award winners have special ties to the Ira A. Fulton Schools of Engineering at Arizona State University: Two are Fulton Schools alumni, Robert Anchondo and Eric Ponce, and another is longtime engineering adviser Carrie Robinson.

The STAR Awards recognize the contributions of the society's members to science, technology and engineering fields. The 28 recipients of the 2019 STAR awards were selected from a field of nominees that include professionals, educators, students, corporations and government agencies.

Robert Anchondo

The SHPE Corporate Achievement award recognizes professionals who have made significant contributions to corporate engineering projects, departments or budgets. Individuals who receive this honor are highly visible for technical success and have earned the respect of their peers for their work. This year, Robert Anchondo was awarded as a corporate leader.

Anchondo graduated from ASU in 1991 with a bachelor’s degree in engineering. Now he is the executive director of engineering for Honeywell Aerospace’s Integrated Avionics Systems division. He manages the overall accountability and ownership of multiple platforms and customers.

He says he is the most proud of the accomplishments he can attribute to his team.

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Robert Anchondo

“I have been fortunate to lead some very strong teams resulting in large spacecraft content and programs for our company that have excited and employed people for many years,” Anchondo said.

Designing a new organization in a different part of the company led Anchondo outside his defense and space background, but he found it “extremely challenging, exciting and rewarding.”

He used problem resolution, critical analytical thinking and collaborative project execution skills — skills learned at ASU —  to grow his career at Honeywell Aerospace.

Anchondo had been a student member of the Society of Hispanic Professional Engineers while at ASU and reconnected with the organization as a professional. He went on to become the Honeywell Aerospace executive sponsor for SHPE engagement for two years.

“Progressive companies tend to recognize the value that a workforce rich in diverse perspectives can offer to their environment and their financial bottom line,” Anchondo said. “SHPE helps train, progress and align a broad range of high-caliber candidates to fulfill these workforce needs.”

He enjoys engaging with current society students and other professionals who have participated in the organization at ASU forums, panel discussions, technology demonstrations and career presentations.

Earning a STAR Award from the society is “quite humbling,” Anchondo said.

“In addition to the personal efforts I have made in support of STEM and diversity, it is reflective of the support that we have as a team for each other here at Honeywell,” he said. “While I am fortunate and honored to be recognized, I am there representing the countless team members who day in and day out make our workplace better for one another.”

At the Excellence in STEM luncheon, Anchondo shared experiences with other SHPE members, recognized the progress they’ve made and outlined where they can take their work in the future.

Erick Ponce

The Society of Hispanic Professional Engineers also recognizes professionals who have provided selfless and outstanding contributions to their soceity professional chapter and the Hispanic community with the Professional Role Model award. The award is given to a member in each region who exemplifies honor, community service and leadership through his or her commitment to the society.

Ponce, who was awarded the Professional Role Model award for Region 5, graduated from ASU in 2013 with a bachelor’s degree in civil engineering and in 2014 with a master’s degree in the same field. He is currently a lead civil/structural/architectural field engineer for Bechtel Mining and Metals in their global business unit. He deals with all technical aspects related to the CSA scope of work and works in conjunction with superintendents to establish the means and methods needed to execute the work.

In just five and a half years, Ponce has been given the opportunity to perform seven different assignments in five locations spanning three countries while working for Bechtel. He most recently worked on a project in Chile.

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Erick Ponce

Ponce joined the society in fall 2009 during his first semester at ASU. He says it was one of the best decisions he’s made in his professional life. As a student, Ponce tried to be as active as possible.

“I am a strong believer that extracurricular activities are paramount to become a well-rounded individual,” said Ponce. “In the five years I attended ASU I was part of SHPE, MAES, ASCE, EPICS, and Bridges to Prosperity, among other organizations.”

As a member of those organizations, Ponce learned lessons that have stayed with him and helped advance his career.

“Being able to work as a team, understand how to allocate resources to meet deadlines, feel confident speaking to a crowd, etc. are characteristics that take time and effort to build up,” said Ponce. “If you are already performing them while you attend school, it will be an easy transition into the real world and will definitely give you a competitive advantage among your peers.”

While it’s been harder for Ponce to stay connected with the SHPE de ASU student chapter due to his international work assignments, he has been recently trying to connect with them for a pair of reasons.

“One is to see how Bechtel can collaborate with various student organizations such as SHPE, the Society of Women Engineers and the National Society of Black Engineers,” Ponce said. “While in Houston, we provided a combined event between those three student organizations at the University of Houston that was very successful. We want to mimic something similar at Arizona State.”

The second is provide brainstorming ideas to increase participation of ASU students at the national SHPE convention.

“As one of the largest universities in population in the United States, we should be bringing the biggest number of students every year,” Ponce said. “It is hard sometimes to show students the true value of such investment, especially when some of them are barely making ends meet.”

Being recognized by the society meant a lot to Ponce as he took the stage, following in the footsteps of those he admires.

“It is such a hard feeling to describe,” he said. “After being part of the organization for 10 years and always attending the gala, I remember seeing the people who walked that stage and thinking to myself: ‘I would love to be one of them someday’. Now here I am. After 10 years of being involved in SHPE, I will receive a national award and become a lifetime member in none other than my hometown, Phoenix, Arizona, surrounded by my family, coworkers and friends. SHPE is much more than a professional organization. It’s more like a family.” 

Carrie Robinson

The society also recognizes advisers for supporting its mission and vision along with giving diligent support toward the success and development of their chapter and its members with the Advisor of the Year award. The award is presented to an official chapter adviser who demonstrates advocacy for STEM programs and aids the improvement of the five pillars of SHPE.

This year, that award went to Carrie Robinson, who has been involved with the SHPE de ASU student chapter for several years.

Robinson grew up in rural Idaho working in her parent’s automotive electrical repair business and later in the practice of a local optometrist.

portrait of

Carrie Robinson

“Working through junior high and high school motivated me to seek career opportunities only available with an education beyond high school,” said Robinson. “Neither of my parents earned a college degree, but they helped me understand the value of education.”

Robinson began her college career majoring in math, and although she maintained a strong GPA, she became one of the millions of women who drop out of STEM majors. She accrued student loan debt and worked three jobs to sustain herself through school. After graduating with a Bachelor of Science in planning, public policy and management, she began a career path toward helping other underprepared students who often face similar personal, academic and financial struggles.

Early in her career, Robinson became intimately familiar with the challenges that underrepresented, ethnic minority, low income and first-generation students face. She worked to recruit diverse freshmen and transfer students, helped refine the résumés of Society of Hispanic Professional Engineers and Hispanic Business Students Association members and mentored Hispanic and undocumented students at a local high school.

Robinson joined the the Fulton Schools in 2010, where she developed and expanded undergraduate engineering success programs, including scholarships, undergraduate teaching assistants, the engineering tutoring centers, the engineering residential community, E2 (an innovative orientation for incoming first-year students) and academic success classes and workshops.

Over the last nine years, Robinson has become actively engaged with both the SHPE de ASU student chapter and the SHPE Greater Phoenix professional chapter. She regularly attends general body meetings, executive board meetings, social events and technical workshops. In that time, she’s seen firsthand how active involvement in the society has made an indelible impact on the careers of its members.

Robinson encourages her students to continue their involvement with the soceity after graduation. Alumni from SHPE de ASU have revived and joined professional chapters across the nation, joined committees on the society's national convention planning team and helped bring the national convention to Phoenix.

Along with alumni and staff who contribute to the Society of Hispanic Professional Engineers' mission, Fulton Schools faculty also play an important role in teaching and inspiring the next generation of Hispanic STEM professionals. Jean Andino, an associate professor of chemical engineering in the Fulton Schools, was named the recipient of the SHPE Educator of the Year Award in Higher Education for 2017.

Erik Wirtanen

Web content comm administrator, Ira A. Fulton Schools of Engineering