Shaming drinkers and smokers can worsen health problems

02 June 2014

Dr Laura Williamson

Dr Laura Williamson

Public health campaigns that try to shame smokers, drinkers and other substance users into addressing their behaviour risk undermining efforts to create a healthier society, according to academic experts.

Glasgow Caledonian University’s (GCU) Dr Laura Williamson is the lead author of a new editorial in the prestigious International Journal of Drug Policy, which argues such strategies can force people – especially those living in low income communities – to unite against the shaming, undermining attempts to improve public health.

Dr Williamson, and colleagues, quote examples such as campaigns to reduce binge-drinking which feature images of young people covered in vomit, and the way users of e-cigarettes have rebranded themselves ‘vapers’ to avoid the stigma around smoking.

The editorial states: “Public health strategies that undermine individuals and communities, particularly those that urgently need to be engaged and brought within the reach of health services, risk having a negative impact on the fundamental aims of contemporary health promotion.

Dr Williamson held community cafes in Rutherglen and Govan as part of her work to develop a new “public ethic” able to connect communities with debates about the social challenges that undermine health.

The editorial argues “The role of stigma in undermining confidence, trust and capacities to form supportive relationships may prove more costly for community wellbeing than its exponents anticipate. Stigmatising and dehumanising entrenches or exacerbates inequalities, rather than helping to alleviate them.

“The use of stigma to control substance use urgently requires critical public debate to test its fit with the goals and ethical drivers of health promotion. This debate must include the voices of those who feel the burden of stigma most acutely.”

Dr Laura Williamson is a Senior Research Fellow (Health Ethics) within GCU’s Institute for Applied Health Research. She worked with colleagues Professor Betsy Thom, University of Middlesex, Professor Gerry Stimson, Imperial College and London School of Hygiene and Tropical Medicine and Dr Afred Uhl, Anton-Proksch Institute in Vienna.

Dr Williamson is writing a book on the ethical support that is needed to engage patients and citizens in health and healthcare more effectively. This includes the development of a new “public ethic” that is able to connect individuals and communities with the social challenges that undermine health.

This work also features in a recent paper published in The American Journal of Bioethics Patient and Citizen Participation in Health: The Need for Improved Ethical Support which argues that members of the public should be better supported to enable them to engage in the creation and delivery of health care.

She said: “Promoting health through participation requires an awareness among all partners that reliance on the principles with which they are most familiar, namely autonomy and choice, is inadequate.

“If the aim of sustainable health and healthcare is to be met, then all partners must look again at how they work with communities and how these communities are supported, and enabled, to take part in the process.”