Can a universal approach reduce healthcare stigma? Insights from Dr Elena Cama's research
What if healthcare stopped trying to identify who might experience stigma and instead assumed everyone could? That's the idea behind a study led by the Tackling Stigma in Healthcare team at the Centre for Social Research in Health at UNSW Sydney.
The research explored whether a universal approach to stigma reduction could help healthcare move beyond focusing on individual conditions, identities or behaviours, and instead create healthcare environments where everyone feels respected and welcome.
We spoke with researcher Dr Elena Cama about the findings.
Read the full paper “The power of universality is that everybody is treated the same’: Exploring the possibilities and limitations of a universal approach to stigma reduction among BBV/STI sector stakeholders in Australia”, here.
1. Stigma is everywhere
Stigma is often discussed in relation to specific groups or health conditions. HIV stigma. Weight stigma. Mental health stigma. Drug use stigma. The list goes on.
But Elena says the reality is often much more complex.
"We know that there are a number of different identities, conditions and practices that are stigmatised, and that many people in the Australian population - and globally - might be living with any number of those."
Rather than focusing on one form of stigma at a time, the study explored whether healthcare systems could adopt broader principles that help create safer experiences for everyone accessing care.
"The idea was that we needed to take a cross-cutting approach to stigma reduction in order to try to address stigma towards the full range of conditions, identities and practices that are stigmatised."
2. The goal isn't to change every belief. It's to change healthcare practices.
One of the strongest themes from the study was that people will always have personal beliefs, assumptions and biases. The question is whether those beliefs affect the care someone receives.
As one participant explained:
"Accepting that we all have judgements about others, we make them all the time. But as a health care professional, you need to suspend that and not allow it to affect the quality of care."
Participants repeatedly returned to the importance of non-judgemental care.
Rather than trying to eliminate every personal bias, stakeholders argued that healthcare workers should focus on ensuring all patients are treated with dignity, respect and professionalism regardless of their identities, health conditions or life circumstances.
As another participant put it:
"Leave your prejudices at the door and work with the person in front of you in a totally non-judgmental way and a respectful way."
3. Reflective practice may be one of the most powerful tools we already have
Many participants pointed to reflective practice as a practical way to reduce stigma. Reflective practice encourages health workers to examine their own beliefs, behaviours and decision-making, and consider how these may influence patient experiences.
Participants argued that this doesn't necessarily require an entirely new framework. Reflective practice is already embedded within many health professions.
Instead, the challenge is creating opportunities for health workers to think critically about how stigma may influence care and how they can respond differently.
Others also connected this idea to person-centred care, reinforcing that healthcare should focus on understanding the individual in front of you rather than making assumptions based on stereotypes, diagnoses or identities.
4. Treating everyone well doesn't mean treating everyone identically
One of the most interesting tensions in the study was the relationship between equality and equity.
Participants strongly supported the idea that everyone should receive respectful, high-quality care.
"The power of universality is that everybody is treated the same," one participant said.
At the same time, stakeholders were careful to point out that treating everyone the same does not necessarily address existing inequities.
Different communities face different barriers. Some people experience multiple forms of stigma. Others may require tailored support to access care safely and effectively.
As one participant explained: "Certain populations require a nuanced approach so, it's not a one-size-fits-all."
The study raises an important question: how can healthcare systems establish universal principles of respect, inclusion and non-judgement while still recognising that different people have different needs?
The findings suggest that a universal approach should not mean ignoring difference. Instead, it means creating consistent standards for welcoming, respectful care while remaining responsive to individual circumstances.
5. Stigma reduction needs to be embedded throughout the health system
Participants consistently pointed to the need for broader systems change.
Many argued that stigma reduction efforts need to be embedded throughout healthcare organisations, including policies, supervision, leadership and organisational culture.
Importantly, stakeholders emphasised that reducing stigma is not solely the responsibility of clinicians, explaining that… “systematic reform is an integral part of a universal approach to addressing stigma. In this sense, interventions mobilised within a universal agenda would include all staff from all levels of the organisation, from those working in executive and leadership positions to those delivering health care, working in reception, and so on.”
Receptionists, administrators, cleaners, managers, executives and other staff all contribute to how safe and welcome people feel when accessing care.
One participant recalled a cleaner describing their role as helping make the hospital safe and welcoming so people could receive good healthcare.
For many stakeholders, that captured an important principle of stigma reduction: everyone has a role to play.
At the same time, leadership remains critical. Executive support was seen as essential for creating the systems, expectations and accountability needed to drive meaningful change.
Together, these findings suggest that stigma reduction is not simply about individual behaviour. It also requires healthcare organisations to embed stigma-free care into the way they operate.
6. Lived experience cannot be an afterthought
While participants identified many different strategies for reducing stigma, they consistently returned to one principle: people with lived experience must be involved.
Stakeholders highlighted the value of involving people with lived experience in training, service design, governance and decision-making.
Many spoke about the power of hearing directly from people who have experienced stigma within healthcare settings.
"One of the key findings that came out of this project was that stakeholders really emphasised the need to centre the perspectives of people with lived experience of stigma," Elena said.
Participants also argued that lived experience should be included from the beginning of any initiative, not simply brought in to review a finished product.
At the same time, Elena raises an important question.
"If there are potentially a hundred different health conditions, identities and practices that are stigmatised, that raises a key issue about how to make sure that there's adequate representation of all of those voices," Elena explained.
The study highlights both the importance of lived experience involvement and the complexity of ensuring diverse experiences are genuinely represented.
As healthcare systems continue to grapple with that challenge, this research offers a vision of stigma reduction that moves beyond individual conditions and identities, and towards healthcare environments where everyone feels safe, respected and included.