ASU anthropologists design new ways to reduce stigma in global health care

June 13, 2022

People who are large-bodied have no self-control. People with mental health conditions can’t be productive members of society. People who don’t use toilets are disgusting. 

These are all stigmas Arizona State University anthropologists and President’s Professors Alexandra Brewis and Amber Wutich have observed over and over from different health professionals over many years.  ASU Presidents' Professors Alexandra Brewis and Amber Wutich ASU President's Professors Alexandra Brewis (left) and Amber Wutich. Photo courtesy Tim Trumble Photography

Brewis and Wutich have spent many years identifying stigmas within health care practices across the world. Through global health classes, online trainings and an award-winning book, the professors are bringing attention to an often overlooked but solvable problem. 

Their recent book “Lazy, Crazy, and Disgusting: Stigma and the Undoing of Global Health,” is based on their 50 years of combined fieldwork as medical anthropologists. Over the last decade, Brewis studied weight and issues around weight stigma in clinical settings, while Wutich has focused on people’s experiences of living with inadequate sanitation in places like South America and the U.S.-Mexico border. 

“After doing fieldwork on an array of stigmatized issues over many years — like water insecurity, high body weight and ADHD — I came to understand that self-stigma, when we judge ourselves harshly and believe and agree with the negative values, is one of the more emotionally painful things that people endure,” Brewis said, a biocultural anthropologist with ASU’s School of Human Evolution and Social Change.

“This is why we think it is so important to address any aspect of health care that might — even inadvertently — be contributing to that profound human pain,” she said.

Brewis said what is most concerning is when doctors contribute to the pain patients are already enduring from self-stigma. For example, she said people with large bodies sometimes avoid going to the doctor’s office because they anticipate poor treatment. 

“Stigmas also tend to beget other stigmas,” Brewis said. “We sometimes refer to this as intersecting or layered stigmas — it is easier to pile stigma onto people already classified as less human than others, whether on the basis of racialized categories, gender identity, poverty, migrant status and so on.”

Lazy, Crazy, and Disgusting: Stigma and the Undoing of Global Health

Cover courtesy Johns Hopkins University Press, Baltimore. Cover design by Kelley Galbreath

The book is a continuation of the work the professors do at the Center for Global Health and the Culture, Health, and Environment Laboratory in the School of Human Evolution and Social Change. In the lab, undergraduate and graduate students are involved in their data collection and analysis, with collaborators at many different sites all around the world. 

Other related team projects with a similar purpose of improving health globally are looking at the emotional and health consequences of lack of access to clean and adequate water, and working with engineers to design better solutions for low-resource communities,” Brewis said. 

Along with the book and lab experiences, Brewis and Wutich both teach courses like Poverty and Global Health (ASB 305). Students learn how poverty shapes health risks and how stigma ultimately promotes illness and poverty as part of the school's global health degree programs. The global health program has options for bachelor's, master's and accelerated 4+1 degree programs.

“This is one of the things that makes the way we study global health of great value: the ability to turn tables and consider — and rectify — and identify how global health efforts in themselves might inadvertently be part of the problem, even while people practicing it believe they are ‘doing good,’” Brewis said. “This ability to be more reflective to improve how we work is one of the core benefits that anthropology brings to the table. Global health as a field has a particular responsibility to be ethical and impactful in the broad sense, as well as a narrow one. Anthropology is central to gaining that wider lens.”

Brewis and Wutich have gone beyond the book and classroom to find practical ways to reduce stigma in global health care, including last year's training around stigma reduction for Centers for Disease Control management. The one-hour “Recognizing and Challenging Stigma” self-paced online course they developed for health professionals is, says Brewis, a great tool for those who want an accessible overview of the book’s recommendations about how health professionals can recognize and avoid promoting stigma through their work. 

“Lazy, Crazy, and Disgusting: Stigma and the Undoing of Global Health” has won numerous awards, including the 2022 Human Biology Association Book Award; the 2020 Carol R. Ember Book Prize from the Society for Anthropological Sciences; and was a finalist for the 2020 Book of the Year Award from the British Sociology Association/Foundation for the Sociology of Health and Illness.

Nicole Pomerantz

Communications specialist, School of Human Evolution and Social Change


ASU developing sustainable tourism training curriculum for tribal lands

Promoting travel poses challenges not often experienced in non-Native tourism, professor says

June 13, 2022

Unlike those who work in retail or restaurants, tourism professionals not only need to interest people in their product; sometimes they have to convince them to travel a long distance for it.

And if they happen to be Indigenous peoples eager to welcome visitors to tribal lands, they may be further challenged to successfully attract audiences to places that are often more difficult to reach than those near major infrastructure and transportation corridors. A desert sunset with flowers in the foreground. Photo by iStock Download Full Image

Even travelers to relatively remote, yet well-attended sites, such as the Grand Canyon and Monument Valley, may not learn about how Native culture and tradition are infused in stories whispered for centuries among the ancient rock formations.

To help promoters on tribal lands gain greater insights into sustainable tourism options, the American Indian Alaska Native Tourism Association (AIANTA) asked faculty from the Arizona State University School of Community Resources and Development to develop a curriculum in sustainable tourism specifically for those working to promote visits to tribal lands.

Sherry Rupert (Paiute/Washoe), AIANTA’s chief executive officer, said visitors to many major attractions often miss the richness that Indigenous culture adds to that experience.

“Even if you have gone to iconic places like Grand Canyon, for example, you haven’t really experienced it until you’ve spoken with Native people from the 11 tribes of the Grand Canyon to tell you about their connection to that place, how they survived there, stories passed down from generation to generation,” she said.

Professor Kathleen Andereck said her team is developing a sustainable tourism curriculum that will debut in spring 2023. Its seven modules are each specifically tailored to tribal communities and nations, using case studies and examples of sustainable tourism already found in these locations.

The program awards a non-credit certificate. It also may be taken for one credit in tourism and recreation management from ASU.

Fewer staff members hamper tribes’ tourism push

Tribal communities and nations can have more challenges finding business than others in tourism do, Andereck said. Sometimes infrastructure and access issues, as well as the fact that tribes often have fewer staff members involved in promoting tourism, present obstacles beyond what many others in tourism experience.

“Everyone knows Monument Valley, but there are other opportunities on tribal land for tourist experiences,” Andereck said. “Not all tribes have the same level of development as others, and roads and infrastructure differ, and it can be a bit limiting for tourism. Sometimes there are different levels of expertise in tourism in different tribes.”

Andereck said the curriculum is designed to help those working in tribal tourism promote the fascinating Indigenous cultural aspects of many tourist destinations, especially ones on tribal lands often not generally known to the traveling public.

“Frequently, the first time that people go somewhere, they visit the more iconic attractions,” Andereck said. “The next time they will often try the off-the-beaten track destinations. Tribal attractions tend to be of this kind.”

AIANTA Program Development Director Hannah Peterson said it was critical for ASU to tailor a curriculum specifically to their needs.

“The conversation we had with ASU is that it’s not sustainable tourism, period, but sustainable tourism for cultural tourism development for Native communities in the U.S.,” Peterson said. “That’s different than teaching a general audience.”

AIANTA members already had access to a certificate program in cultural tourism with an international focus, but they needed more information on sustainable tourism, a subject ASU has thoroughly researched, Rupert said.

Organization sought ASU to develop program

“We wanted to really grow our certificate programs and knew ASU has a sustainable tourism program, where my husband is in the master’s program. We know that ASU is a great school,” Rupert said. “We are providing opportunities for learning in the tourism industry and across Indian Country. We provide resources to tribes across the nation to help them be successful in the tourism industry.”

A significant number of non-Native people participate in the certificate programs as well, she said.

AIANTA members who connect with the curriculum include both tribal employees and Native small business owners, Rupert said. Tourism practitioners and state and federal staff working in tourism also seek training to better learn how to engage with tribal communities.

Unlike tourism industry promoters in non-Native communities, those in tourism on tribal lands do not always have access to promotional revenue from state taxes on hotel room rentals, Rupert said. Tribes that levy room taxes often spend the revenue on vital services such as public safety, health care and education, leaving little — sometimes nothing — to fund tourism.

One of AIANTA’s main missions is to advocate on behalf of tribes and Native-owned businesses to experience more inclusion and equity in the tourism industry, Rupert said.

Rupert said it is important for her organization to have partners like ASU to help them grow the number of tourism professionals on tribal lands.

A spring 2019 AIANTA report, "State of Indian Country Tourism," surveyed more than 3,000 tribal tourism enterprises and Native-owned businesses in AIANTA’s proprietary database. The report stated that 28% of respondents said they had more than 10 full-time employees, while 37% said they employed one to three full-time workers.

Mark J. Scarp

Media Relations Officer, Watts College of Public Service and Community Solutions