Understanding stigma and food inequity: a conceptual framework to inform research, intervention, and policy

There is increasing understanding that stigma associated with poverty, race, nationality, gender, obesity, and other intersecting, socially devalued characteristics is a key social determinant of health that plays a role in food inequities; yet, the processes linking stigma with food inequities are poorly defined. Building on prior conceptual and empirical stigma research in public health, this paper introduces The Stigma and Food Inequity Framework. Supporting empirical evidence for the associations proposed by the framework is reviewed. The framework proposes that stigma is manifested at the structural (e.g., neighborhood infrastructure and targeted marketing) and individual (e.g., internalized stigma and stereotypes) levels. These stigma manifestations are associated with food inequities via a series of mediating mechanisms, including access to resources, the home food environment, and psychosocial and behavioral processes, which ultimately undermine healthy food consumption, contribute to food insecurity, and impact diet quality. The framework further proposes that processes linking stigma with food inequities are situated within contexts of history, culture, and human development. Future directions to address stigma and enhance food equity include the value of addressing the broad range of underlying structural stigma manifestations when creating policy to promote food equity.