TY - JOUR T1 - Why we should never do it: stigma as a behaviour change tool in global health JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2019-001911 VL - 4 IS - 5 SP - e001911 AU - Brewis, Alexandra AU - Wutich, Amber Y1 - 2019/10/01 UR - http://gh.bmj.com/content/4/5/e001911.abstract N2 - Summary boxStigma is used as a tool for motivating health behaviour change, often effective at budging otherwise hard-to-shift behaviour.Shame-induced stigma most damages those already vulnerable, reinforcing health disparities.Global health use of shaming tactics can inadvertently worsen health-damaging stigma, especially for those with the least power.These effects, that drive additional health disparities and suffering, are difficult to prevent.Ethically and practically, stigma should never be deployed as a global health tool because the effects are often both unavoidable and invisible to outsiders.One of the greatest public health successes of the last half of the 20th century was the rapid decline in smoking rates in higher income countries. Levels plummeted in the wake of vilifying campaigns that stigmatised not just tobacco but its users. As historian Allan Brandt described it, ‘What is fragrant became foul; what is attractive became repulsive; a public behavior became virtually private… American smokers became pariahs in a powerful moral tale of risk and responsibility—objects of scorn and hostility clustered around the doors of buildings’.1 Such stigma-based tactics can motivate people to profound and difficult behaviour change, leveraging the very human desire to feel valued by others. By stigma, we mean the process of attaching shame and disgust to traits that cause people to be pushed down and out from society.2 Stigma is also often a preferred public health tool, too, when it can substitute for other approaches that require long-term drug discovery efforts, costly hardware or specialised facilities to deliver. It relies, rather, mainly on health education with negative messaging.Yet, we must also look at the downsides of this use of what is a seemingly effective tool. Stigma is widely recognised in global health as a socially constructed barrier to effective healthcare. Those with lung cancer, for example, may avoid seeking … ER -