What Is Structural Stigma in Health and Social Care?

Structural stigma happens when laws, policies, and institutions create or maintain unequal treatment for certain groups. It is not about individual actions or attitudes, but rather about how systems are set up and how they operate. In health and social care, structural stigma shapes who can access support, how they are treated, and what outcomes they experience.

How Structural Stigma Works

Structural stigma comes from rules, organisational processes, funding decisions, and the way services are designed or delivered. It is often invisible, built into the fabric of society through laws or standard practices. Unlike personal prejudice, individuals following these systems might not even be aware of the harm being caused.

Structural stigma is found in:

• National and local policies
• Legal frameworks
• Funding priorities
• Organisational procedures

When these systems disadvantage a group of people—on purpose or by neglect—that is structural stigma.

Examples in Health and Social Care

Structural stigma affects many people, especially those with:

• Mental health conditions
• Learning disabilities or neurodiversity
• Chronic physical health conditions or long-term illness
• Substance use issues
• HIV and other stigmatised conditions
• Older adults needing care

Some examples are:

• Education or employment policies that assume people with certain conditions cannot work, excluding them from opportunities
• Housing rules that make it hard for people leaving inpatient mental health care to find a home
• Healthcare rationing or longer waiting times for certain groups
• Limited funding for community or outreach services targeting marginalised populations
• Lack of physical access for those with mobility needs due to building design

Impact on Individuals and Communities

While it is easy to see that policies affect services, the impact on individuals can be life-changing:

• People may give up trying to access care
• Whole communities might be excluded from important health information and support
• Early intervention is missed, leading to poorer health in the long run
• Some may feel forced to hide their needs or conditions, out of fear or shame

Structural stigma makes it harder for individuals to challenge the status quo. Changing the system often requires group action, legal challenge, or strong advocacy.

Barriers Created by Structural Stigma

Structural stigma creates barriers that people cannot overcome through willpower or personal effort alone. Common barriers include:

• Eligibility rules that make support almost impossible to get
• Complex application forms with unfair requirements
• Refusal to adapt services to cultural or language needs
• Gaps in staff training about certain conditions
• Under-representation of stigmatised groups in decision-making

These barriers can affect every aspect of someone’s care experience, beginning with registration and lasting throughout their journey.

Equal Access and Fairness

Structural stigma threatens fairness by creating advantages for some and disadvantages for others. In a fair health and social care system, everyone is treated with respect and given access to the same quality of care.

Unequal access leads to:

• Widening health gaps between groups
• Higher rates of serious illness in vulnerable populations
• Poorer mental health outcomes linked to exclusion

Equality in policy and practice is needed to break the cycle of structural stigma.

The Role of Funding and Resources

How funding is allocated has a powerful effect. When services for certain conditions—such as addiction or complex disabilities—receive less funding, this can send a message that some groups are less worthy of support.

Funding decisions can:

• Limit the range of support available
• Delay development of new, more inclusive services
• Leave existing staff overstretched and unable to give person-centred care

Shortages can lead to longer waits and less dignity for those who already face disadvantage.

Examples of Positive Change

Some areas and organisations have taken steps to reduce structural stigma. Examples include:

• Changing admission policies so that people with lived experience of mental health problems can train and work in healthcare roles
• Adapting appointment processes for people with learning disabilities, such as allowing longer sessions
• Involving service users in policy-making and service design
• Funding outreach teams to connect with under-served communities

Small changes at policy level can make a real difference to people’s lives.

Legal Protections and Rights

In the UK, the Equality Act 2010 and the Human Rights Act 1998 both protect people from discrimination by organisations and public bodies. This means institutions must act fairly and remove barriers where possible. Failing to do so is not just poor practice—it can be unlawful.

Legal rights can be a tool for change. People can challenge policies or processes that treat them unfairly on the grounds of disability, race, age, gender, or other protected characteristics.

Intersectionality and Structural Stigma

Some people are affected by more than one type of structural stigma at the same time. For example, an older Black woman with a mental health condition may face overlapping disadvantages based on age, ethnicity, and diagnosis.

• Services may not be designed with her life experiences in mind
• She might face language or cultural barriers on top of policy-related ones
• Staff may not recognise how different forms of disadvantage interact

Understanding intersectionality leads to better, fairer support for all.

Addressing Structural Stigma in Health and Social Care

Tackling structural stigma requires action at many levels, including government, local authorities, organisations, and communities. Approaches include:

• Reviewing and removing unfair policies or practices
• Training staff in equality, diversity, and inclusion
• Including diverse voices in decision-making
• Collecting and analysing data to spot inequalities
• Making reasonable adjustments for those with different needs

Creating a fair system is a shared responsibility and requires ongoing commitment.

Supporting Individuals Affected by Structural Stigma

Health and social care staff can help by:

• Signposting people to advocacy services
• Sharing information about rights and entitlements
• Listening to concerns about unfair treatment
• Helping people challenge decisions or seek redress

Advocacy organisations, charities, and advice services are also sources of practical support.

The Power of Advocacy and Lived Experience

People who use health and social care services have unique knowledge of how systems work—and how they fail. Including people with lived experience in planning and policy discussions brings problems to light that professionals may miss.

• Advisory groups
• Co-production panels
• Public consultations

All of these help make systems fairer and reduce structural stigma.

Moving Towards a More Inclusive System

Creating fair, accessible services involves regular review and a willingness to accept feedback. Good practice includes:

• Involving people from varied backgrounds in staff teams
• Using plain language in leaflets and forms
• Routinely assessing whether policies create unwanted barriers
• Acting quickly to remove obstacles when identified

Inclusivity should be built into every process, not just added on at the end.

Everyday Actions That Make a Difference

Staff at all levels can help reduce structural stigma by:

• Treating each person as an individual
• Questioning rules or procedures that seem unfair
• Explaining options clearly and honestly
• Being flexible where possible

Even small changes in approach can open doors for people too often left out.

Final Thoughts

Structural stigma in health and social care is about policies, laws, and systems that make it harder for some groups to get the care and support they need. It can cut people off from opportunities, undermine wellbeing, and increase inequality. Change is possible—through policy review, service redesign, legal protections, and putting lived experience at the heart of decision-making. Everyone deserves health and care that is fair, accessible, and respectful.