Stigma remains one of the most under-examined yet damaging forces shaping global health policy and practice, according to anthropologist Alex Brewis, who argues that shame-based approaches often undermine the very outcomes health interventions aim to achieve.

In a recent episode of Dialogues, a special program of the Global Health Matters Podcast hosted by Dr. Garry Aslanyan, Brewis said stigma should be removed entirely from the public health toolkit.

“The most effective way to undo the damage of stigma within public health is to prevent it from happening in the first place,” Brewis said. “Stigma should not be used in any way for any reason to promote public health.”

Brewis, Regents and Presidents Professor at Arizona State University, co-authored Lazy, Crazy, and Disgusting: Stigma and the Undoing of Global Health, which examines how moral judgments attached to traits such as body size, mental illness, or sanitation practices strip individuals and communities of power and opportunity.

“Stigma is really about applying moral meanings to an otherwise arbitrary trait and using that as a way to devalue some people relative to others,” she said, noting that stigma produces humiliation and shame and is “physiologically stressful,” with emerging evidence of intergenerational effects through epigenetics.

Drawing on fieldwork in Mozambique and Micronesia, Brewis highlighted how sanitation interventions can backfire when they ignore local realities. In Pemba, Mozambique, open defecation was viewed as “social and practical,” while latrines were seen as burdensome or unsafe. In Kiribati, imported toilet blocks were rejected as unhygienic, ultimately left unused.

Brewis also addressed global obesity campaigns, arguing that decades of individual-blame messaging in countries such as Samoa have plateaued health outcomes while intensifying stigma.

“It’s been a cacophony of anti-fat messages for decades,” she said.

The solution, Brewis emphasised, lies in structural awareness and empathy.

“The solution to stigma is empathy,” she said. “Just about sums the book up.”

Listen to the full episode:

Image Credits: Global Health Matters Podcast.